quiz 3 part 1 (ear) Flashcards
S+S of a nontraumatic TM rupture?
preceded by a stabbing ear pain, pain is releived after the rupture, post rupture otorrhea
what can cause a nontraumatic rupture?
severe acute otitis media
what suggests an inner ear injury in a TM rupture?
tinnitis, hearing loss, vertigo
how can you diagnose a TM ruputre?
otoscope where it will be visible and audiometry to document conductive hearing loss
treatment of TM rupture?
-surgery if it stays open >3months
-no earplugs or water
-test otorrea to make sure it is not CSF leak from a basilar fracture
-suction blood obscuring the ear canal
-DO NOT irrigate keep it dry
-broad spectrum antibiotic if the ear was contaminated
complications of TM rupture from trauma
-basilar fracture can allow the infection to go into the brain
-fluid can cause infection
what is often the result of a basilar skull fracture?
hemotypanum: blood in the middle ear cavity
-blue black discoloration of the TM
what is ramsey hunt syndrome?
acute facial paralysis in assocation with herpetic blisters/ herpes zoster
-blisters in the ear canal, auricle or bother
-manifestation of shingles
other names for ramsey hunt?
intermedius neuralgia and genticulate neuralgia
pathophysiology of ramsey hunt?
in the ganglion of the seventh cranial nerve
-nervous intermedius is in sensory portion of CN7
ramsey hunt s+s?
deep ear pain, pain radiating toward the pinna, constant dull background pain
-vertigo, tinnitus, ipsilateral hearing loss, facial paresis from inflammation of the facial nerve
-rash and blisters on the anterior 2/3 of tongue, soft palate, external auditory canal and pinna
complication of ramsey?
blisters becoming infected causing cellulitis
ramsey hunt workup:
WBC count, ESR, VZV serology
how are you going to treat ramsey hunt?
-**oral acycolvir **
-corticosteorids
-vestibular suppresants bc of the vertigo
-local anesthetic for otalgia relief
-carbamazepine *especially in the case of nerve pain to the facial nerve (idiopathic genticulate neuralgia
what is someone also has bels palsy with ramsey?
make sure to protect corneal irritation
and injury
-make sure there are no contraindication from the drug
-droppy eye
what is otitis media with effusion?
fluid in the middle ear without S+S of infection
S+S of OM with effusion?
-seorus or mucoid
-opaque or yello
-decrease mobility or air fluid level
-hearing loss, speech effects, language and learning impact
why might otitis media with effusion occur
-allergic rhinitis
-as an inflammatory response to AOM or poor euschian tube hygiene
-nasopharygeal carcinoma
-unresolved AOM
-there is no infection in the fluid
signs of otitis media with effusion?
TM is dull and impaired mobility sometimes cloudy
-air bubbles in the middle ear
-acoustic reflectometry and tympanometry detect fluid
what if the effusion is not resolving?
think malignancy
how to treat OM with effusion?
-cotricosteroids, decongesstants, abx, antihistamine
-tympanostomy (tube insertion) and a myringotomy (if persistant??)
age range for typical OM w effosion?
6 months to 4 years
-in an adult think barotrauma, urti, OR chronic allergic rhinitis
what is a euschian tube dysfunction?
a closed tube the would normally provide ventilation and drainage for the middle ear cleft
what typically precedes a euschian tube dysfunction?
viral uri or allergy
euschian tube S+S
popping and cracking sound (from a partial blockage), aural fullness, fluctuating hearing, dyscomfort (barometric pressure changes)
what will the TM look like in a case of euschian tube dysfunction?
hypomobile due to the build up of fluid
how can we treat euschian tube dysfunction?
pop ears against closed nostrils *DO NOT due this if there is an active intranasal infection
-decongestant
-no barometric pressure changes
-balloon dilation of the tube
complications of euschian tube dysfunction
developing serous otitis media
what predisposes you for a euschian tube dysfunction?
having a patulous tube (wider) bc it is easier to get infected
there is a high chance chronic otitis media is caused by what?
food or inhalant allergy that can help an urti spread to the ear
S+S of chronic OM
-otorrhea, conductive hearing loss, perforated TM that is draining, macerated auditory canal with granulation tissue, might have cholesteatoma
what does it mean if you have pain on top of a chronic otitis media and why?
you probably have an AOM as well because pain is NOT associated with chronic otitis media
how are we diagnosing chronic OM (tests?)
-draining and culturing if there is a cholesteatoma
-CT or MRI if it has spread (intratemporal and intracranial processes, labyrinthitis, ossicular or temporal erosion and abscess)
how can we treat chronic otitis media
-ear canal irrigation
-granulation tissue removal
-systemic antibiotic therapy -tympanoplaty (if the pt is not at risk for learning problems you can monitor for three months and wait to fix it)
-topical antibiotic drops (ofloxacin, ciproflaxacin with dexamethasone)
-oral cipro for pseudomonas
-antihistamine, decongestant, corticosteroid,
-surgery (myringotomy, mastoidectomy or TM) if the hearing is impaired
-elimination diet to find allergy
if they have cholesteatoma and chronic OM what might they have?
acute OM on top of the chronic
recurrent acute OM criteria
-3 or more OM in a 6mnth period or during respiratory season
-more than 4 in one year
how to treat recurrent AOM
-prophylactic antibiotics
-amoxicillin 20mg once a day 1-3 months
-reduces recurrent 40-50 percent
reccurrent AOM risk factors
-cleft palate, craniofacial deformities, down syndrome, day care, smoker, first episode was under 6 mnths of age, not breast fed, native american or inuit
what can cause acute OM?
urti
non severe illness AOM
-mild otalgia and fever <39 celsius
severe illness
moderate to severe otalgia
fever >39 celsius
when to treat AOm vs when to observe
child under 6 mnth treat STAT
-6mnth to 2 years you can observe
S+S of AOM
irritability, difficulty sleeping, fever, nausea, vom, diahrrea, perforation, purulent and serosanguineous otorrhea, headache, confusion, neurological signs, facial paralysis, vertigo
what suggests a spread of AOM?
-neurological signs indicate a potential abscess or mastoiditis
-facial paralysis or vertigo suggests extension of the fallopian canal or labyrinth, swelling, tinnitus (less common), effusion
t or f aom can also cause nystagmus
t just less common
-horizontal or jerk type
facial paralysis with AOM means?
disease in the temporal bone
swelling of posterior auricle area means?
mastoiditis
purulent conjunctivities with AOM means?
haemophilus influenza
signs of AOM
-erythmatous TM and otoscope light displacement
-hypomobilization with insufflation
-acoustic reflectometry detects middle ear fluid
-fluid bulging
-decrease hearing and otalgia (symp)
how can breast feed cause AOM
-if reclining the milk can go into the tubes
-it can also decrease the risk tho due to IgA and IgG
how to treat AOM
-analgesiac, decongestant, antihistamine, myrigotomy, tympanocentesis, self resolving, nsaids, topical agents, otikon otic, narcotic algesia (codeine or analogs), tympanostomy, azithromycin/clindamycin, PNC, cefdinir, cefpodoxime
-10 day regimen
topical agents for aom
benzocaine, american otic, auralgan
why no aspirin to small kids?
avoid reye syndrome that would harm the liver
repetitive AOM can lead to?
hearing loss
unresolved AOM can lead to?
euschian tube dysfunction
most common age for AOM
3mnth to 3 yrs, peak at 6-18 mnths
what i the next step if the pain worsens/ failure to respond 3-5 days
axoxicillin 80-100 mg 10 days in a low risk child
-still nothing aaugmentin, ceftin or azithromycin
cause of menier disease
-fluid in the semicircular canal
meniere symptoms:
-vertigo, hearing loss, tinninut (main three)
-aural fullness
-episodic
-vertigo is the symp that comes after the first few
t or f menier hearing loss is perm
T, it starts as temporary then becomes permanent
menier attacks usually get better in?
5 years
menier treatment goal
reduce serverity of the attacks
meniere treatment
-antiemetic, antinausea, anti vertigo med therapy
-furosemide (wont make it worse)/ diuretic to decrease water
-no caffeine/ alc
-vestibular suppresant and antianxiety drug
-surgery
vertigo treatments
antihistamine, prochlorperazine and scopolamine
what is peripheral vertigo
secondary disorder of the inner ear/ 8th cranial nerve
what is central vertigo
2ndary disorder of the vestibular nuclei and their brainstem/ cerebellum pathway
what can some drugs cause?
benign positional vertigo
-aminoglycosides, chloroquine, furosemide
what infections can cause BPV?
shingles, labyrinthitis, neurosyphilis, ototis media, vestibular neuronitis, menier, tumor, trauma, ms,
pathology of bpv is?
displacement of the otoconial crystals which should be in the saccule and utricle
vertigo symp
-balance/ gait bad
-false sense of movement
-whirling/ spinning
-nausea/ vom
-NOT dizzy or light headed
-deafness and tinnitis
bpv episode length:
under 60 sec, peak in the morning, certain head positions
horizontal nystagmus
-peripheral vertigo which is acute or central vertigo which is longer lasting (weeks to months)
vertical nystagmus
central lession
-alarming
pendular nystagmus
to and from
true nystagmus
sustained and demonstratable
how to diagnose pbv
hallpike maneuver and watch for nystagmus
pbv fix
canalith repositioning maneuver to try and get the otoconia crystals back in
-meclizine benzos
-epley maneuver
