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
*
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
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)
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)
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
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
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
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
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
10
Q
stapedius muscle
A
attaches to the stapes, prevent super loud noises from entering the oval window → innervated by CN 7
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
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
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
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
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
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:
- sneezing attacks (paroxysms)
- runny nose
- 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
