Rosas--Ear Diseases Flashcards
Tuning Fork Tests-512 Hz
Rinne
AC >BC (Normal)
BC>AC (CHL–conductive hearing loss)
Weber
Midline (Normal)
Lateralizes to CHL or to better ear
Otoacoustic Emission Testing
- Outer Hair Cells emit low intensity sound following acoustic stimulation
Newborn Screening Test
Testing for kids < 2 yrs
Presbycusis
Etiology of Sensorineural Hearing Loss
- most common (50% of >75 yo) loss of hair cells, progressive
Etiology of Sensorineural Hearing Loss
Infectious
OM, viral, syphilis
Etiology of Sensorineural Hearing Loss
Neoplastic
Vestibular schwannoma
Otosclerosis
- Autosomal Dominant incomplete penetrance
- 60 % have family Hx
- Fluoride prevents
- Rx: hearing aids or Stapedectomy
Temporal Bone Fracture
Head Trauma
- Sympt: Headache, vertigo, SNHL (sensorineuroal = inner ear), CHL (conductive = outer ear), facial nerve paralysis, CSF leak via ear canal or nose
- Rx: Neurosurgical unit observation, sx relief, lumbar drain, audio, possible ossicular reconstruction
Acoustic Neuroma
- Asymmetric SNHL (sensorineural)
- Vertigo
- Facial nerve paralysis
- Aural Fullness
- Trigeminal numbness (impingment)
- Diplopia
- Dx: MRI of IACs with contrast
- Rx: OBS vs SURG vs XRT
- LOOK AT FIRST AID
Subjective Tinnitus
Perception of sound in the absence of acoustic, electrical or external stimulus (Assoc w High Freq SNHL 3-5 kHz)
SNHL: presbycusis, menieres, neuromas
Rx: ASA/NSAIDS, aminoglycosides, anti HTN, antidepressants, anticancer agents many more
Trauma: Noise, Whiplash, Concussion, Baro
Systemic Diseases: HTN, depression, anxiety, multiple sclerosis, stroke, meningitis
Metabolic: Hyper-Hypothyroidism, hyperlipidemia, Vit A, Vit B, zinc deficiency
Objective Tinnitus
Perception of sound caused by internal body sound or vibration, May be exacerbated by Conductive Hearing Loss
- Vascular Causes: Benign intracranial HTN, AVM, arterial bruits, venous hums, HTN, vascular tumors
- Patulous eustachian tube
- Palatal myoclonus
- Tensor tympani/stapedius syndrome
- Spontaneous otoacoustic emissions
Vestibular Disorders
- Vertigo: illusion of movement (ie rocking, rotary, ground rolling, since of falling forward/backward), commonly episodic
- Dysequilibrium: sense of poor coordination with erect posture or movement, usually continuous
- Imbalance: implies orthopedic or neuro problem
- Dizziness: all-encompassing term (ie light-headed, orthostatic, hypoglycemic, inability to concentrate)
Most common cause of Peripheral Vertigo
Benign paroxysmal positional vertigo (BPPV)
Differential Diagnosis of Central Vertigo
- Multiple sclerosis
- Stroke
- Cerebellar lesions
- Diabetes
- Vertebrobasilar insufficiency
- Migraines
- Vascular loop compression syndrome
Benign Paroxysmal Positional Vertigo
(EXAM)
- Most common peripheral vertigo
- Cause: post trauma, post viral infection
- SSx: recurrent brief positional vertigo, latency, fatigability
- Dx: Hx, Dix-Hallpike
- Ppys: canalithiasis
- Normal Hearing
INFLAMMATORY LESIONS OF THE PINNA
- RELAPSING POLYCHONDRITIS
- NODULARIS CHRONICUS HELICUS
- KELOIDS
- CELLULITIS
OTITIS EXTERNA
- VERY PAINFUL RED SWOLLEN CANAL WITH PURULENCE
- SEEN IN SWIMMERS, Q TIP USERS, DIABETICS, IMMUNOSUPRESSION
- RX ANTIBIOTIC DROPS AND SYSTEMIC ANTIBX
- TOPICAL SUCTIONING AND DEBRIDEMENT
- PSEUDOMONAS, E COLI, STAPH CORYNEBACTER
- HEARING MAY BE AFFECTED
HERPES ZOSTER OTICUS
- PURULENT ULCERS IN AND AROUND EAR
- DECREASED HEARING
- SEVERE PAIN
- FACIAL NERVE PARALYSIS
- ANTIVIRAL RX AND PAIN RELIEF
- IMMUNOCOMPROMISE MAJOR RISK FACTOR
Cerumenectomy
Procedure to remove ear wax
- May be performed with half strength H2O2 irrigation with syringe or water Pick
- Otologists prefer instrument techniques such as suctioning, curetting, or grasping with alligators
- Complications include pain, laceration of canal skin, TM perforation, perilymph fistula, vertigo and deafness
Tympanosclerosis
White plaques on TM
- Hyalin or Calcium deposition
- PPx prior Otitis Media or Trauma (PE Tubes)
- Normal hearing if limited to the TM
- If middle ear involved there may be conductive hearing loss
Cholesteratoma
- Squamous epithelium in middle ear
- Causes bone and soft tissue destruction of ear structures pressure necrosis, secondary infection and proteolytic enzyme release by cholesteatoma.
- SOFT BALL OF KERATIN
- CAUSES BONE EROSION
- SURGERY IS ALMOST ALWAYS INDICATED TO EXCISE TO PREVENT DESTRUCTION OF EAR = tympanomastoidectomy
acute otitis media
- Acute middle ear space infection (< 3 wk)
- 2nd most common disease in children (URI #1)
- PPx Eustachian tube dysfunction causes negative middle ear pressure
- middle ear pressure resulting in transudative fluid collection in middle ear space and subsequent infection (EXAM)
- S. pnemoniae, H. influenza, Mor. Catarrhalis most common pathogens (EXAM)
