tennitis etc. x 2 Flashcards
Barotrauma
discomfort or dmage due to pressure dufferrnces
- flying or diving common causes
Barotrauma exam
middle ear effusion, hemotympanum, possible TM rupture
Barotrauma tx
avoidance oral or nasal decongest swallowing, nchewing gum tx of injury if vertigo refer to ENT
Acoustic Neruoma
Schwann cell tumor
arise from vestibylar portion of CN vII
very slow growing tumor
- usually in older adult s
Acoustic neuroma risks/ present
radiation exposure as a kid
- present: unilaterl sensorineual hearing loss and tinnitus
+/- gait disturbance
Neurofibromotatosis type 2 also risk factor- bilateral often
Acoustic Neuroma
Audiometry best initial test
MRI
- alt CT w/w/o contrast
Aucoustic neuroma tx
surgery, radiation, observation
Tinnitus presentation
Perception of sound in one or both ears M>F - buzzing or ringing - can be continuous or come and go Often indicator of cochlear hair cell disfunction or loss
Tinnitus Etiology
Autitory - ototoxic medication -presbycusis (aging hearing loss) - otosclerosis - vestibular schwannoma - chiari malformation - barrow trauma Pulsatile tinnitus: commonly a vascular etiology
Tinnitus diagnosis
based on history
- physical - HEENT exam
- if pulsitile refer to ENT and check for bruist
Tinnitus tx
main goal is to lessen awareness and impact on qulity of life - behvioral therapy - biofeedback or CBT Bensodiazepines masking devices- "white nose"
Allergic Rhinitis types
Alergic: - seasonal- hay fever, ususlly only certain times of the year - perennial- occurs year round Vasomotor Rhinitis - perennial non-allergic
Allergic Rhinitis present
sneezing , rhinorrhea, nasal obstruction
- often accompanied by itchy eyes nose and palate
- cough and fatigue
- response of IgE antibodies which sensitizes mast cells and basophills
Allergic rhinitis physical exam eyes
Periorbital area
- “sllergy shiners” bluish rings arounf the eyes
- Dennie- morgan lines: skin folds associated with conjunctivitis
Eyes:
- diffuse redness, tearing, chemosis, eyelid edema
Rhinitis exam nose, ears, throat
Nose: boggy, pales, bluish mucosa
Throat: post nasal drainage, “cobblestoning”
Ears: retracted TM
Allergic rhinits dx
clinical diagnosis
- can do allery testing not always necessay
Skin testing: scratch or prick skin test
- “wheel and flare” reactions normally occur within 15 -20 min
serum testing: immunoCAP
- detects IGE antibodies, less risk but less sensitive
ALlergic Rhinitis Tx
- Avoidance
- Pharm
- oral/intanasal antihistamines
- Intranasal glucocorticosteroids**
- sympathomimeticss/decongestants
- leukotriene receptor antagonists - Immunotherapy
1st generation of antihistamines of allergic rhinitis
- will not releive the nasal congestion
1. Chlorpheniramine
2. Diphenhydramine
side effects- dry mouth, constipation, sedation
2nd gen antihistamines
less sedating
- loratadine (clartin)
- Fexofedadine
- Cetirizine (zyrtec)
Antihistamine Nasal Sprays - allergic rhinitis
Rapid onset
bitter taste
can be used in combination
Cromolyn Nasal spray
mast cell stabilzer
- lower efficay but no serious side effects
Nsal Steroid Sprays
More effective than oral antihistamines
- lower bioavailability in the 2nd generation
side effect- epistaxis
Leukortriene receptor antagonist
Montelukast (singular)
- LTRA +2nd gen antihistamine it provides real good releif
Sympathomimetics (decongestants)
if have congestant despite antihistamine use
- will has vasocontrictions will release edma
- caution in patients with hypertension
Immunotherapy
allergy dose
tx: allergic asthma, conjunctiitis, rhinitis
- gradual administation of increasing the amount of the allergen
- typically subcutanious and sublingual
Tx time 3-5 years
Allergic rhinitis pharmacotherpay children
Cromolyn nasal spray
2nd gen antihistamines
ex: cetirizine (zyrtec approved for chilfren >6mo
Rhinitis tx kids and adults mild
Mild:
2nd gen oral antihistamines: loratadine(claratin), Cetriizine(zyrtec), Fexofenadine (allegra)
Nasal spray: azelastine, olopatadine
Glucocorticoid nasal spray ( strat 2-3 days before exposure)
Mod/sever allergic rhinits Tx
Glucocoticoid nasal spray! - 2nd generation are the safest best single drug Can add in another drug if needed ex: antihistamine or cromoly nasal spray
Allergic rhinitis and asthma or conjunctivitis
Asthma: Montelikast(singulair)
Conjuct:
- steroid nasal spray and opthalmic antihisamine drip
Allergc rhinitis pregnancy
- 2nd gen antihistamines
- glucocorticoid therapy
Lactating women:
Budesonide or cromolyn
Perennial non-allergic rhinitis
“vasomotor rhinitis”
autonomic response
- triggered by stress, sexual arousal, purfumes, cigarette smoke, temp change
Non allergic rhinitis presenation
nasal congestion, rhinorrhea, postnasal drainage
- usually no ocular/ nasal itching
nasal mucosal may appear normal, erythematous, or boddy edmea
Non allergic rhinits tx
avpidance of triggeres
- nasal steroid spray
- antihistamine nasal spray
- ***ipratropium nasal spray ( anticholinergic ) if rhinorrhea is primary sx
Adjunctive therapy: oral decongestants nd 1st gen antihistamines
Nasal polyps
non tender, pedunculates, grey soft tissue growths
Sx: nasa; congestion/ onstruction
Seen with allergic rhinitis, vasomotor rhinitis, and asthma
Tx: Nasal steroid spray and refer to ENt
Rhinitis Medicamentosa
Result of regular use of decongestant nasa spray
>3days of use leads to reboud congestion
- become dependen
Tx: discontinue use and start of nasal steroid spray
Urticaria presentation
Hives, welts, wheals - well circumscribed prurutic riased wheels - pale to bright red - +/- central pallor acute- < 6wks chronic> 6wks occuring most days they are transient lesions
Uticaria pathophysip
caused by histamine relase from mast cells
- can be accompanies by angioedema
Uticaria Dx/Tx
based on hisotry and physical
Tx: H1 histamine blocker
- cetirizine(zyrtec) and levocetirizine (Xyzal)
H2 blocker Ranitidine, Famotidine, cimetidine
Oral glucocorticoids- if angioedema or sx are persisant
