quiz 3 part 2 (ear) Flashcards
what is an auricle hematoma?
collection of blood in the cartilaginous auricle/ outer ear
complications of auricle hematoma
cauliflower ear and conductive hearing loss, otitis and periosteum damage, must fully drain
what is mastoiditis
bacterial infection of the mastoid air cells
-this is an AOM complication
what bacteria is linked to mastoiditis
pneumococcus
S+S of mastoiditis
fever, postauricle pain, otorrhea, swelling, tenderness, pinna displacement, edema of the external canal, destruction of bony septa, lump pushing the ear forward (pinna displacement0
mastoiditis x ray
air cells will coalesce and destory the bony septa
mastoiditis treat
iv ceftriaxone
-myringotomy to remove the TM fluid to releive the pressure
-mastoidectomy
*emergency
complications of mastoiditis
infection can decompress through the TM and go to lateral mastoid cortex forming a superiosteal abscess
-rare: extends centrally causing Temporal lobe abscess or spetic thrombosis of the lateral sinus
what is a possible complication of AOM
cholesteatoma
-only if it was there for a long time
trauma or euschian tube dysfunction can also cause?
cholesteatoma
why is cholesteatoma bad
it erodes the ear and needs to be cleared out
-can also cause vertigo
-extends from the TM and possible to the bone
how can we treat cholesteatoma
-get a ct to see the extent of the spread,
-audiogram to asses conductive and possible sensorineural hearing loss
-surgery to remove the membrane so it does not come back
-ear drop
-antibiotics (questionable)
complications of cholesteatoma untreated
bone destruction, deafness, facial nerve paralysis, dizziness, abscess, systemic infection, death
neuralgia can affect what?
trigeminal, glossopharyngeal, genticulate or sphenopalatine
-causes ear ache
cerumen impaction
-common cause of conductive hearing loss
cerumen impaction S+S
-vague pain with hearing loss
-NO OTHER symptoms
treatment for cerumen impaction
-clean it out with cerumol or hydrogen peroxide (sometimes dissolves it)
-dont flush TM could be perforated and water would damage
what is bullous myringitis
blood filled ball
-caused by herpes or mycoplasma pneumoniae
bullous myringitis S+S
balls on TM< sudden pain, fluidy bulging TM, herpetic lessions near the tragus
malignant external otitis
persistant otitis externa
what bacteria causes malignant external otitis
pseudomonas auregenosa
S+S of malignant otitis externa
fouls smelling discharge, granulations in ear canal, deep otalgia, palsies of nerves 6,7,10,11,12
what scan should we do for malignant OE
ct scan to look for osseous erosion
how are we treating malignant OE
antipseudomonal antibiotics long term (cipro)
-start with an IV bc this is a severe infection then go to oral
complications of malignant otitis externa
spread to bone: osteomyelitis
-risky especially in immunocomp
-can hit the base of the skull
otitis externa
-swimmers ear, can be from a lack of hygiene, kocalized to the canal not the TM, not properly drying ears
likley bacterial causes of otitis externa
pseudomonas, proteus, aspergillus
what are risk factors of otitis externa
seborrhatic dermatitis and mechanical trauma
otitis externa S+S
swelling that can cause ear occlusion and hearing loss, pain, no relief from pulling on the ear, erythematous and edematous ear canal, tenderness with tragus movement, thick white purulent otorrhea, insufflation of TM (-): there should BE movement unless there is also an otitis media at the same time
what does not causes relief of otitis externa
pulling on the ear
how to diagnose OE
-culture if there is no improvement and otorrhea
-clinical diagnosis
how to treat OE
-keep the ear dry, cipro drops if pseudomonas, insert a wick if there is severe edema (not possible if too painful), oral fluroquinolones
why can you not give oral fluroquinoloes to under 18yrs
it can cause their tendons to rupture
who is at risk to get OE
swimmers and diabetics
when does otalgia become chronic
2-3 weeks
what else can cause otalgia
refered pain: nasopharynx, tonsils and upt
otalgia presents in older pt
suspect tumor
differential dx for otalgia
-serous otitis media, otitis media w effusion, otitis externa, barotrauma, fb, dental infection, mastoiditis, TMJ, herpes, chickenpox
chronic om vs externa
-externa causes pain
-chronic can decrease hearing
central hearing loss
-issue is at the cortex/brainstem, ascending auditory pathway (CNS
common cause of central hearing loss
vestibular schwanoma/ acoustic neuroma
-8th cranial nerve schwanoma are the most common intracranial tumors
-the tumor grows from the myelin
MRI for vestibular schwanoma
to look for how far the tumor spread
malingering hearing loss
faking it for attention
psycogenic hearing loss
you are unaware that it is fake
nonorganic hearing loss
equal hearing loss at all frequencies and no reponse to pure tones in one or both ears
conductive hearing loss results
rinnie: (-) bc they will not be able to hear once it has been moved off the mastoif
websters: sound goes to the bad ear because the bone conduction is better
causes of congenital:
cholesteatoma, secretory otitis media, euschian tube dysfunction, congenital atresia (narrowing), external otits, TM perforation, ossicular fixation, ossicular disarticulation
what can people not hear with congenital
low or flat frequencies
-deficit of loudness
ossicular disarticulation
ossicles/ middle ear bones are not alignes
-from trauma
ossicular fixation
-otosclerosis/ age and joint changes
-bones can not move properly
where does the webster sound go on conductive loss
to the bad ear
how do ppl with conductive speak
maintain their soft voice, can hear speech when it is loud, equal loss for all frequencies, can not hear consonants, background noise helps
sensorineural loss is
progressive, preventable, permanent and painless
how does a sensorineural person speak
shouting
sensorineural test results
rinni(+): AC louder than BC
webster: sound goes to the good ear
what does a sensorineural person hear
sounds are jumbled, background noise makes it worse, high frequency loss
what are potential causes of sensorineural
-measles, mumps, meningitis, cmv
-menier disease, acoustic neroma, hair cell destruction
how does sensorineural speak
yelling, they might have tinnitus