SM_29b: Ear Infection and Pathology Flashcards
Microtia and aural atresia results in ____ conductive hearing loss but ____ bone conduction
Microtia and aural atresia results in maximal conductive hearing loss but normal bone conduction (normal sensorineural hearing)
- Type 1 to 4 microtia: with Type 1 having most landmarks and Type 4 having no ear (anotia)
- Aural atresia: missing ear canal
- Treated by rebuilding the external ear: osseointegrated implant for hearing uses bone conduction to restore hearing, or can drill out a new ear canal
Describe cerumen
Cerumen
- Produced in outer third of external auditory canal
- Contains lysosomes, immunoglobulins, and polyunsaturated fatty acids
- Is slightly acidic (pH 6.1): controls growth of some bacteria especially Pseudomonas aeruginosa
- Has a waterproofing effect: reduces maceration of external auditory canal
Cerumen impaction is treated with ____, ____, and ____
Cerumen impaction is treated with cerumen loop, irrigation, and peroxide
Bacterial otitis externa is known as ____ and is usually caused by ____
Bacterial otitis externa is known as swimmer’s ear and is usually caused by Pseudomonas aeruginosa
Bacterial acute otitis externa treatment includes ____, ____, and ____
Bacterial acute otitis externa treatment includes cleaning the canal, topical therapy with antibiotic and steroid ear drops, and suitable pain management
(systemic antibiotics generally not required for uncomplicated cases)
Foreign body in the ear canal removal may require ____ and ____
Foreign body in the ear canal removal may require special equipment and general anesthesia
Ear canal osteomas are ____, while exostosis are ____
Ear canal osteomas are pedunculated and single, while exostosis are broad-based and multiple (associated with cold water exposure)
- May require surgery if obstructive
Acquired external auditory canal stenosis is usually acquired after ____ and may require ____
Acquired external auditory canal stenosis is usually acquired after infection and may require surgery
Middle ear pathologies lead to ____
Middle ear pathologies lead to conductive hearing loss
Tympanic membrane perforation may be caused by ____, ____, or ____ and results in ____
Tympanic membrane perforation may be caused by extruded ear tube, traumatic perforation, and underlying Eustachian tube dysfunction and may result in conductive hearing loss
Tympanic membrane perforation is treated with ____
Tympanic membrane perforation is treated with tympanoplasty (repair)
- To protect middle ear and improve hearing
- Use graft
Eustachian tube dysfunction causes ____ on ____ tympanogram
Eustachian tube dysfunction causes negative pressure (C) or no pressure (B) on tympanogram
Eustachian tube dysfunction causes ____, causing ____ and interfering with ____
Eustachian tube dysfunction causes tympanic membrane retraction, causing conductive hearing loss and interfering with tympanic membrane vibration
Middle ear pathology includes ____, ____, ____, and ____
Middle ear pathology includes otitis media, cholesteatoma, middle ear masses, and otosclerosis
Describe acute otitis media
Acute otitis media
- Purulence behind tympanic membrane
- Pathogens enter middle ear from nasopharynx via Eustachian tube: S. pneumonia. H. influenzae, M. catarrhalis
- Symptoms: fever, otalgia, irritability, hearing loss
- Treatment: oral antibiotics (penicillin based)
Serous otitis media (chronic otitis media with effusion) is ____ causing ____
Serous otitis media (chronic otitis media with effusion) is resolved purulent otitis media but persistence of middle ear fluid causing conductive hearing loss
Tympanostomy tubes ____, ____, ____, ____, and ____
Tympanostomy tubes drain middle ear fluid, equalize pressure on either side of tympanic membrane, restore hearing, decrease ear infections, and make ear infections easier to treat (topical drops)
Indications for tympanostomy tubes are ____ an d____
Indications for tympanostomy tubes are
- Recurrent otitis media: 3 in 6 months or 5 in 1 year
- Persistent effusions: longer than 3 months, speech delay
Describe complications of acute otitis media
Complications of acute otitis media
- Facial palsy
- CN VI palsy (Gradenigo syndrome)
- Coalescent mastoiditis with subperiosteal abscess
- Intracranial complication: epidural abscess, subdural abscess, brain abscess
- Meningitis
- Sinus thrombosis
Ossicular discontinuation / fixation results from ____, ____, ____, and ____ and is treated by ____
Ossicular discontinuation / fixation results from congenital fixation / malformation, erosion from retracted tympanic membrane, traumatic disarticulation, and otosclerosis and is treated by lifting up the eardrum and placing a spacer
Otosclerosis causes ____ and results from ____
Otosclerosis causes progressive low frequency conductive hearing loss and results from absent stapedial reflexes
- Genetic disorder: autosomal dominant with variable pentrance
- Normal tympanogram
Otosclerosis is managed with ____, ____, or ____
Otosclerosis is managed with observation, hearing aid, or stapedectomy with prosthesis
Cholesteatoma is ____
Cholesteatoma is epithelial (skin) cyst in the middle ear that may extend into the mastoid
- Difficult dissection: inflamed and infiltrative
- Unpredictable, often long surgeries
- Relentless
- Often multiple surgeries
- Cannot leave a single cell behind
Congenital cholesteatoma is most likely due to ____ and must be treated with ____
Congenital cholesteatoma is most likely due to epithelial cells trapped behind tympanic membrane during embryogenesis and must be treated with surgical excision
- Prognosis for recurrence and hearing is good
Describe formation of acquired cholesteatoma
Acquired cholesteatoma formation
- Chronic Eustachian tube dysfunction leads to chronic negative middle ear pressure
- Atmospheric pressure pushes in the weakened tympanic membrane
- Retraction pocket forms
- Retraction pocket becomes so deep that desquamating epithelium cannot exist -> forms cholesteatoma
- Inflammatory reaction and enzymes from cyst cause bony erosion: ossicles (conductive hearing loss), otic capsule, tegmen, and facial nerve
- Eventually extends from middle ear into mastoid cavity and / or down Eustachian tube
Acquired cholesteatoma must be treated with ____
Acquired cholesteatoma must be treated with surgical resection with removal of entire cyst and rebuilding of ossicles and tympanic membrane
Describe the history and physical exam findings for acquired cholesteatoma
History and physical exam findings for acquired cholesteatoma
- Eustachian tube dysfunction (previous ear tubes), sniffing, chronic intermittent foul smelling ear drainage, conductive hearing loss
- Retracted tympanic membrane with white / yellow mass in middle ear, often associated with granulation / inflammatory tissue
Surgical procedure for acquired cholesteatoma is ____
Surgical procedure for acquired cholesteatoma is mastoidectomy
Inner ear pathologies cause ____
Inner ear pathologies cause sensorineural hearing loss
- Congenital sensorineural hearing loss: infectious (CMV, TORCH), genetic, cochlear malformations
- Acquired sensorineural hearing loss: sudden
- Meniere’s disease
- Tumors: vestibular schwannoma (acoustic neuroma), glomus jugulare
Describe risk factors and workup for congenital sensorineural hearing loss
Congenital sensorineural hearing loss
- Risk factors: ICU stay at birth / intubation, blood transfusion / hyperbilirubinemia, family history, perinatal infections
- Current workup: CMV testing, genetic testing (GJB2 most common), imaging
- Many etiologies
Describe the critical speech and language learning window
Critical speech and language learning window
- Central neuroplasticity plays a strong role in the development of language
- Significant drop-off in ability to obtain oral speech if hearing loss persists after age 3
- Hearing loss should be diagnosed and treatment started before 6 months of age
(screen at 1 month, diagnose at 3 months, treat before 6 months)
Cochlear implantation involves an electrode typically placed through the ____ into the ____ of the cochlea
Cochlear implantation involves an electrode typically placed through the round window into the sinus tympani of the cochlea
Sudden hearing loss is ____, presents with ____, results from ____, and is treated with ____
Sudden hearing loss is an acute change in hearing, presents with clogged ear, results from inflammation, and is treated with steroids (prednisone)
- Recovery 50/50: should be treated in first week
- Poor prognosis with severe hearing loss or vertigo
- Most patients will have tinnitus
Acoustic neuroma (vestibular schwannoma) presents with ____ and ____ and is treated with ____, ____, or ____
Acoustic neuroma (vestibular schwannoma) presents with sudden asymmetric hearing loss and tinnitus and is treated with observation, microsurgery, or Gamma knife
Describe Meniere’s Disease
Meniere’s Disease
- Characterized by episodic vertigo, fluctuating hearing less, aural pressure, and tinnitus - endolymphatic hydrops
- Requires ≥ 2 episodes of vertigo lasting ≥ 20 minutes, audiometrically documented hearing loss on at least one occasion, and tinnitus or aural fullness in affected ear
- Negative MRI
- Endolymphatic hydrops
- Cause unknown and course varies
Meniere’s Disease is treated medically with ____, ____, and ____ or surgically with ____, ____, ____, or ____
Meniere’s Disease is treated medically with low salt diet, diuretics, and expectant treatment or surgically with nerve section, labyrinthectomy (drillout of entire inner ear), gentamicin injection, or endolymphatic sac drillout (decompression)
