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NRS 250: Exam 2 ENT and ID > Pathology of the Ears > Flashcards

Pathology of the Ears Flashcards

1
Q

Cerumen Impaction: S/Sxs and Tx

A
  • S/Sxs:
    • hearing loss
    • ear ache
    • fullness
    • pruritus
    • reflex cough
    • dizziness
    • tinnitus
  • Tx:
    • symptomatic individuals and those unable to express themselves (children or disabled)
    • Cerumenolytics (carbamide peroxide)
    • irrigation with bacteriostatic agent
    • manual removal
      *
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2
Q

Cauliflower Ear aka Auricular Hematome Permanent causes

A
  • repeated damage to the ear and resulting hematomas that are not drained
    • leads to increased production of fibrocartilage and permament cauliflower ear
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3
Q

Piercing Related Infections S/sxs, the bug, and tx

A
  • S/sxs: cardinal signs of infection
  • The bug: assume pseudomonas aeruginosa
  • Tx: Ciprofloxacin or levofloxacin (Keflex will not work)
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4
Q

Mastoiditis: s/xs, complications, diagnosis, treatments, the bugs

A
  • s/sxs: fever, drainage, tenderness, otalgia, lethargy, OM signs
  • Complications: facial nerve paralysis, hearing loss, labrynthitis, osteomylitis, Bezold abscess (deep neck abscess)
  • Diagnosis:
    • CBC: elevated WBC with left shift
    • CRP: elevated CRP or ESR
  • Tx: admission and IV abx for 7-10 days followed by oral abx for a total of 4 weeks
  • the bugs: S. pneumoniae, S. aureaus, S. pyogenes (GAS)
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5
Q

Otitis Externa

A
  • s/sxs: ear pain, hearing loss, discharge, pruritus
    • tender with manipulation to ear
    • edema and erya of the ear canal
    • debris or cerumen brown, yellow or grey
      • (white = candida, fine-dark: aspergillus)
    • TM may have erya but no fluid behind
  • NEED TO R/o Malignant External Otitis ***
  • Treatment:
    • topical acid-based, steroid and abx combo
    • clean ear
    • mild: topical acetic acid with hydrocortisone
    • moderate: topical acetic acid with cipro or polymixen-neomycin
    • severe: topical plus floroquinolones, and possibly oral abx
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6
Q

Malignant Otitis Externa: s/sxs, diagnosis, tx, the bugs

A
  • pts with diabetes at high risk!!!
  • s/sxs: pain out of proportion, ear pain with jaw pain, white-pink granulation tissue where bone meets cartilage, typically facial nerve involvement
  • diagnosis: bone scan → will see osteoclast and osteoblast involvement
  • tx: oral ciprofloxacin for 6-8 weeks, sometimes surgery
  • the bugs: pseudomonas aeruginosis, candida, aspergillus
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7
Q

Aural foreign bodies: urgent removal and what requires a consult

A
  • urgent removal: button batteries, penetrating objects, insects
  • consults: pain, vertigo, nystagmus, otorrhea, facial nerve paralysis, and/or hearing loss
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8
Q

Obstructive Dysfunction of the Eustachian Tube

A
  • failure to open to provide adequate ventilation to middle ear
  • often caused by: rhinosinusitis, or allergic/nonallergic rhinitis
  • s/sxs: ear pain, sensation of fullness, tinnitus, hearing loss, ears feel “plugged”, ear popping, vertigo and dysequilibrium
  • tx: systemic decongestants (topical will not work)
    • topical nasal steroids: if sinonasal inflammation is present
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9
Q

Patulous Dysfunction of the Eustachian Tube

A
  • failure of the tube to close → hallmark sxs is breathsounds and hearing is greatly amplified for the patient
  • s/sxs: ear pain, sensation of fullness, tinnitus, hearing loss, ears feel “plugged”, ear popping, vertigo and dysequilibrium

tx: systemic decongestants (topical will not work)
* topical nasal steroids: if sinonasal inflammation is present

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10
Q

stapedius muscle

A

attaches to the stapes, prevent super loud noises from entering the oval window → innervated by CN 7

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11
Q

Acute Otitis Media

A
  • common causes: S. pneuomoniae, H. influenzae, Moraxella catarrhalis
  • previous viral URI → predisposing factor **
  • high fever <40F, irritability, not wanting to feed
  • tx: Amoxicillin or Augmentin
    • ​if pcn allergy non anaphylactic: Cephalosporins
    • if pcn allergy anaphylactic: Macrolides
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12
Q

Otitis Media With Effusion

A
  • fluctuating hearing loss, NO FEVER or signs of infection
  • dizziness, tinnitus
  • usually spontaneously resolves within 3 months
  • may need to refer to ENT for tympanostomy
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13
Q

Cholesteatoma

A
  • **ear drainage for more than 2 weeks with appropriate treatment = most common presentation**
  • new onset hearing loss after a recent ear surgery
    • conductive hearing loss
  • keratinized, desquamitized cells ususally in the pars flaccida, or behind the TM → can erode the surrounding bone/tissue
  • REFERAL TO ENT
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14
Q

Barotrauma and perforation

A
  • diagnosed with clinical presentation and history
  • tx: usually resolve within 3 months
    • slow healing? refer to ENT
    • blood clots? DO NOT REMOVE
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15
Q

BPPV

A
  • benign paroxsysmal positional vertigo
  • NO HEARING LOSS
  • spinning sensation that lasts for a few seconds, positional dependent
  • diagnosis: Dix-Hallpike Maneuver
  • treatment: Epley maneuver, Semont Maneuver
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16
Q

Meniere Disease

A
  • Cause:
    • abnormal ion and fluid balance in the inner ear
  • Triad:
    • 1.episodic vertigo: rocking or spinning sensation that lasts for hours or up to one day
    • 2.tinnitus
    • 3.sensorineural hearing loss
  • tx: reduce sodium intake and caffeine
  • vestibular surpressant = benzodiazepine
    • antihistamines = meclizine
    • anticholinergic = scopolamine
    • antiemetic = promethazine and zofran
    • diuretic = thiazides
17
Q

Vestibular neuritis

A
  • viral infection of the vestibular nerve
  • sudden onset of vertigo, emesis, nausea, and gait impairement (loss of balance but still able to walk) NO HEARING LOSS
  • positive headthrust test
  • tx: antihistamines: meclizine and dymenhydrinate
    • vestibular suppressants: benzodiazepine
    • antiemetic: zofran and promethazine
    • anticholinergic: scopolamine
    • Can give acyclovir for herpes simplex virus
    • or abx if concern for AOM
18
Q

Labrinthitis

A
  • viral or bacterial infection of the whole labrinth
  • acute onset vertigo, balance deficits but still able to walk , nausea, vomiting and sensorineural HEARING LOSS
  • positive head thrust test
  • need to rule out cerebellar hemorrhage or brainstem infarction →MRI/CT scan
  • tx: vestibular suppressant: benzodiazepine
    • antihistamines: meclizine and dimenhydrinate
    • antiemetics: promethazine and zofran
    • anticholinergics: scopolamine
    • acyclovir or abx
19
Q

Acoustic neuroma

A
  • schwann cell based tumor that usually begins on the CN VIII
  • neurofibramatosis II → often bilateral acoustic neuromas
  • **unilateral sensorineural hearing loss is this until otherwise ruled out **
  • ataxia, dizziness, hearing loss, tinnitus, headache, facial numbness (CN V) or facial paralysis (CNVII)
  • diagnosis: need to assess cranial nerves, MRI > CT
  • tx: observation, radiation (gamma-knife radiation), surgery
20
Q

Nasal Polyp

A
  • s/sxs: clear rhinorrhea, nasal obstruction, cobblestoning (post-nasal drip), anosmia or hyposmia
  • diagnosis: rhinoscopy or CT scan if considering surgery
  • tx: intranasal or systemic glucocorticoids, want to reduce IL-5 and eosinophils, or treat the underlying condition
  • referal to ENT if chronic
  • **often indicative of asthma**
21
Q

Allergic Rhinitis

A
  • Triad:
    1. sneezing attacks (paroxysms)
    2. runny nose
    3. nasal obstruction
  • PE: transverse nasal crease, allergic shiners (infraorbital edema), clear rhinorrhea, TMs may have serous fluid behind
  • tx: Chronic Rx: allergy testing and immunological therapy
    • children: Cromolyn (mast cell stabilizer)
    • oral: 2nd gen antihistamines: loratidine
      • phenylepherine (afrin) or pseudoephedrine
      • fluticasone (flonase) → intranasal steroid
22
Q

Acute Viral Rhinosinusitis

A
  • viral common cold
  • lasts less than 10 days
  • **commonly caused by rhinovirus, adenovirus, coronavirus**
  • may have colorful nasal discharge, sometimes fever (more common in children)
  • tx: SHOULD IMPROVE WITHIN 10 days (may not fully resolve) OTC analgesics, saline nasal irrigation, intranasal glucocorticoids (flonase)
23
Q

Acute Bacterial Rhinosinusitis

A
  • **most common bacteria S.pneumoniae, HIB, Moraxella catarrhalis **
  • pts tend to feel better then worse → lasts more than 10 days
  • Facial pain and or purulent drainage down back of throat
  • tx: pts without risk factors for pneumoniae resistance: Amoxicillin 500 mg PO TID, or amoxicillin 875 PO BID
    • Augmentin 500mg/ 125mg PO TID, or Augmentin 875mg/125mg PO BID
  • with risk factors for pneumoniae:
    • high does Augmentin: 2g/125mg ER PO BID

NRS 250: Exam 2 ENT and ID (9 decks)

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