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Clinical medicine HEENT > quiz 3 part 1 (ear) > Flashcards

quiz 3 part 1 (ear) Flashcards

1
Q

S+S of a nontraumatic TM rupture?

A

preceded by a stabbing ear pain, pain is releived after the rupture, post rupture otorrhea

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2
Q

what can cause a nontraumatic rupture?

A

severe acute otitis media

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3
Q

what suggests an inner ear injury in a TM rupture?

A

tinnitis, hearing loss, vertigo

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4
Q

how can you diagnose a TM ruputre?

A

otoscope where it will be visible and audiometry to document conductive hearing loss

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5
Q

treatment of TM rupture?

A

-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

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6
Q

complications of TM rupture from trauma

A

-basilar fracture can allow the infection to go into the brain
-fluid can cause infection

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7
Q

what is often the result of a basilar skull fracture?

A

hemotypanum: blood in the middle ear cavity
-blue black discoloration of the TM

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8
Q

what is ramsey hunt syndrome?

A

acute facial paralysis in assocation with herpetic blisters/ herpes zoster
-blisters in the ear canal, auricle or bother
-manifestation of shingles

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9
Q

other names for ramsey hunt?

A

intermedius neuralgia and genticulate neuralgia

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10
Q

pathophysiology of ramsey hunt?

A

in the ganglion of the seventh cranial nerve
-nervous intermedius is in sensory portion of CN7

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11
Q

ramsey hunt s+s?

A

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

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12
Q

complication of ramsey?

A

blisters becoming infected causing cellulitis

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13
Q

ramsey hunt workup:

A

WBC count, ESR, VZV serology

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14
Q

how are you going to treat ramsey hunt?

A

-**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

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15
Q

what is someone also has bels palsy with ramsey?

A

make sure to protect corneal irritation
and injury
-make sure there are no contraindication from the drug
-droppy eye

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16
Q

what is otitis media with effusion?

A

fluid in the middle ear without S+S of infection

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17
Q

S+S of OM with effusion?

A

-seorus or mucoid
-opaque or yello
-decrease mobility or air fluid level
-hearing loss, speech effects, language and learning impact

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18
Q

why might otitis media with effusion occur

A

-allergic rhinitis
-as an inflammatory response to AOM or poor euschian tube hygiene
-nasopharygeal carcinoma
-unresolved AOM
-there is no infection in the fluid

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19
Q

signs of otitis media with effusion?

A

TM is dull and impaired mobility sometimes cloudy
-air bubbles in the middle ear
-acoustic reflectometry and tympanometry detect fluid

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20
Q

what if the effusion is not resolving?

A

think malignancy

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21
Q

how to treat OM with effusion?

A

-cotricosteroids, decongesstants, abx, antihistamine
-tympanostomy (tube insertion) and a myringotomy (if persistant??)

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22
Q

age range for typical OM w effosion?

A

6 months to 4 years
-in an adult think barotrauma, urti, OR chronic allergic rhinitis

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23
Q

what is a euschian tube dysfunction?

A

a closed tube the would normally provide ventilation and drainage for the middle ear cleft

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24
Q

what typically precedes a euschian tube dysfunction?

A

viral uri or allergy

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25
Q

euschian tube S+S

A

popping and cracking sound (from a partial blockage), aural fullness, fluctuating hearing, dyscomfort (barometric pressure changes)

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26
Q

what will the TM look like in a case of euschian tube dysfunction?

A

hypomobile due to the build up of fluid

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27
Q

how can we treat euschian tube dysfunction?

A

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

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28
Q

complications of euschian tube dysfunction

A

developing serous otitis media

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29
Q

what predisposes you for a euschian tube dysfunction?

A

having a patulous tube (wider) bc it is easier to get infected

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30
Q

there is a high chance chronic otitis media is caused by what?

A

food or inhalant allergy that can help an urti spread to the ear

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31
Q

S+S of chronic OM

A

-otorrhea, conductive hearing loss, perforated TM that is draining, macerated auditory canal with granulation tissue, might have cholesteatoma

32
Q

what does it mean if you have pain on top of a chronic otitis media and why?

A

you probably have an AOM as well because pain is NOT associated with chronic otitis media

33
Q

how are we diagnosing chronic OM (tests?)

A

-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)

34
Q

how can we treat chronic otitis media

A

-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

35
Q

if they have cholesteatoma and chronic OM what might they have?

A

acute OM on top of the chronic

36
Q

recurrent acute OM criteria

A

-3 or more OM in a 6mnth period or during respiratory season
-more than 4 in one year

37
Q

how to treat recurrent AOM

A

-prophylactic antibiotics
-amoxicillin 20mg once a day 1-3 months
-reduces recurrent 40-50 percent

38
Q

reccurrent AOM risk factors

A

-cleft palate, craniofacial deformities, down syndrome, day care, smoker, first episode was under 6 mnths of age, not breast fed, native american or inuit

39
Q

what can cause acute OM?

A

urti

40
Q

non severe illness AOM

A

-mild otalgia and fever <39 celsius

41
Q

severe illness

A

moderate to severe otalgia
fever >39 celsius

42
Q

when to treat AOm vs when to observe

A

child under 6 mnth treat STAT
-6mnth to 2 years you can observe

43
Q

S+S of AOM

A

irritability, difficulty sleeping, fever, nausea, vom, diahrrea, perforation, purulent and serosanguineous otorrhea, headache, confusion, neurological signs, facial paralysis, vertigo

44
Q

what suggests a spread of AOM?

A

-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

45
Q

t or f aom can also cause nystagmus

A

t just less common
-horizontal or jerk type

46
Q

facial paralysis with AOM means?

A

disease in the temporal bone

47
Q

swelling of posterior auricle area means?

A

mastoiditis

48
Q

purulent conjunctivities with AOM means?

A

haemophilus influenza

49
Q

signs of AOM

A

-erythmatous TM and otoscope light displacement
-hypomobilization with insufflation
-acoustic reflectometry detects middle ear fluid
-fluid bulging
-decrease hearing and otalgia (symp)

50
Q

how can breast feed cause AOM

A

-if reclining the milk can go into the tubes
-it can also decrease the risk tho due to IgA and IgG

51
Q

how to treat AOM

A

-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

52
Q

topical agents for aom

A

benzocaine, american otic, auralgan

53
Q

why no aspirin to small kids?

A

avoid reye syndrome that would harm the liver

54
Q

repetitive AOM can lead to?

A

hearing loss

55
Q

unresolved AOM can lead to?

A

euschian tube dysfunction

56
Q

most common age for AOM

A

3mnth to 3 yrs, peak at 6-18 mnths

57
Q

what i the next step if the pain worsens/ failure to respond 3-5 days

A

axoxicillin 80-100 mg 10 days in a low risk child
-still nothing aaugmentin, ceftin or azithromycin

58
Q

cause of menier disease

A

-fluid in the semicircular canal

59
Q

meniere symptoms:

A

-vertigo, hearing loss, tinninut (main three)
-aural fullness
-episodic
-vertigo is the symp that comes after the first few

60
Q

t or f menier hearing loss is perm

A

T, it starts as temporary then becomes permanent

61
Q

menier attacks usually get better in?

A

5 years

62
Q

menier treatment goal

A

reduce serverity of the attacks

63
Q

meniere treatment

A

-antiemetic, antinausea, anti vertigo med therapy
-furosemide (wont make it worse)/ diuretic to decrease water
-no caffeine/ alc
-vestibular suppresant and antianxiety drug
-surgery

64
Q

vertigo treatments

A

antihistamine, prochlorperazine and scopolamine

65
Q

what is peripheral vertigo

A

secondary disorder of the inner ear/ 8th cranial nerve

66
Q

what is central vertigo

A

2ndary disorder of the vestibular nuclei and their brainstem/ cerebellum pathway

67
Q

what can some drugs cause?

A

benign positional vertigo
-aminoglycosides, chloroquine, furosemide

68
Q

what infections can cause BPV?

A

shingles, labyrinthitis, neurosyphilis, ototis media, vestibular neuronitis, menier, tumor, trauma, ms,

69
Q

pathology of bpv is?

A

displacement of the otoconial crystals which should be in the saccule and utricle

70
Q

vertigo symp

A

-balance/ gait bad
-false sense of movement
-whirling/ spinning
-nausea/ vom
-NOT dizzy or light headed
-deafness and tinnitis

71
Q

bpv episode length:

A

under 60 sec, peak in the morning, certain head positions

72
Q

horizontal nystagmus

A

-peripheral vertigo which is acute or central vertigo which is longer lasting (weeks to months)

73
Q

vertical nystagmus

A

central lession
-alarming

74
Q

pendular nystagmus

A

to and from

75
Q

true nystagmus

A

sustained and demonstratable

76
Q

how to diagnose pbv

A

hallpike maneuver and watch for nystagmus

77
Q

pbv fix

A

canalith repositioning maneuver to try and get the otoconia crystals back in
-meclizine benzos
-epley maneuver

Clinical medicine HEENT (10 decks)

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