Week 1 ENT 1 of 4 Flashcards
Using an otoscope to examine the adult ear, what do you do?
pull the auricle UP and BACK
Using an otoscope to examine an infant/child’s ear, what do you do?
pull the auricle DOWN and OUT
What is important to ensure regarding the otoscope when using?
- brightly lit
- proper tip
This d/o occurs when there is an excessive amount of cerumen that occludes the external canal:
Impacted Cerumen
Subjective findings for impacted cerumen:
- fullness of the canal
- itching
- pain
- cough
- vertigo
- hearing loss
Objective findings of Impacted cerumen:
Hard/soft cerumen occluding external canal
-unable to visualize TM
Mgmt and Health Promotion for Impacted cerumen:
Mgmt:
- Removal of cerumen by warm water irrigation for symptomatic pts.
-Be mindful of foreign objects
HP:
- no using cotton swabs
-OTC products work well for cerumen removal
Inner Ear Disturbances include:
- Labyrinthitis
- Meniere’s Disease
- Tinnitus
Inflammation of what CN can cause vertigo sensations?
CN 8 - Vestibulocochlear nerve
Subjective findings of inner ear disturbances:
severe vertigo
N/V
disequilibrium
Objective findings of inner ear disturbances:
there may be no objective findings
Mgmt of Labyrinthits:
prednisone tapered dose
Meclizine 25mg prn (for vertigo)
Mgmt of Meniere’s Dx:
otolaryngologist referral
Mgmt of Tinnitus:
otolaryngologist referral to R/O neuroma
Additional causes of tinnitus:
- large/fast doses of IV Lasix
- lidocaine toxicity (? 5mcg plasma concentration)
- EPIDURAL turned venous
Explain how tinnitus can be associated with an epidural:
Epidural test dose is an epi and lidocaine mixture. when administered, if venous the pt will c/o of:
- numbness
- tingling
- and/or TINNITUS
Functions of the Eustachian Tube:
- allows air into the middle ear
- Equalizes Pressure in the middle ear (d/t altitude)
- Drain normal secretions of the middle ear.
- Drains secretions into the nasopharynx
how do the eustachian tubes allow for middle ear secretions to drain?
- by a mucociliary transport system
2. repeated active tubal opening and closing
cellulitis of the external auditory canal that may extend to the auricle is:
otitis externa
Causes of Otitis externa:
- excessive moisture
- any condition that compromises the integrity of the external ear
Subjective findings with otitis externa:
- Pain and tenderness of external ear and/or canal
- itching
Objective findings with otitis externa:
- redness and irritation of the canal
- slough or exudate
- edema of the canal
Mgmt and HP for otitis externa:
Mgmt:
- topical abx (corisporine otic suspension)
- pain control w/NSAIDS
- Wick
HP - decrease moisture in canal
- gentle use of blow dryer
- 1:2 mix of vinegar/rubbing alcohol
an inflammatory or infectious process that occurs in the middle ear from an accumulation of fluid is likely:
Otitis media
Otitis media may result in what forms:
- bacterial
- fungal
- viral
Subjective findings for otitis media:
pain
hearing loss
stuffiness of ear
congestion
Chronic congestion /chronic otitis media may potentially cause what in young children
speech delays
Objective findings for otitis media:
-decreased /absent mobility of TM is Diagnostic
-erythema or bulging of the TM
(with obscure landmarks)
-Mgmt and HP for otitis media:
Mgmt:
- analgesics and auralgen (unless bacterial)
- Amoxicillin if 1st line for bacterial
HP:
-assess each case carefully before RX meds/abx
auralgen is
an ear gtt with:
- benzocaine (pain)
- Antipyrine (an anti-inflammatory)
- glycerin (to soften ear wax; protect the ear)
what % of otitis media cases are bacterial?
< 25%
First line abx therapy for otitis media:
amoxicillin
any tear in the integrity of the TM is known as:
TM rupture
TM rupture can be caused by
- Trauma
- Infection
- Neoplasm
“TIN for TiM”
Subjective findings for TM rupture
pain
hearing loss
objective findings for TM rupture
actual tear in the TM
Mgmt and HP for TM rupture
Mgmt:
- most heal spontaneously unless infx was the cause.
- referral for surgical intervention
HP:
- R/O cholesteatoma formation
- monitor hearing function
A cholesteatoma is an
abnormal, noncancerous skin growth that can develop in the middle section of your ear, behind the eardrum. It may be a birth defect, but it’s most commonly caused by repeated middle ear infections. A cholesteatoma often develops as a cyst, or sac, that sheds layers of old skin
$$ Examples of Conductive Hearing Loss:
Foreign body Impacted cerumen Infection Cholesteatoma Otitis media Otosclerosis Trauma Tumor
$$ examples of sensorineural Hearing loss:
Acoustic tumor Trauma Congenital or hereditary Infection Meniere’s Ototoxic medications Neurological disorders Presbycusis
Otosclerosis
is the abnormal growth of bone of the MIDDLE ear.
This bone prevents structures within the ear from working properly and causes hearing loss. For some people with otosclerosis, the hearing loss may become severe.
Presbycusis
is the most common type of Sensorineural Hearing Loss caused by the natural aging of the auditory system. It occurs gradually and initially affects the ability to hear higher pitched (higher frequency) sounds.
For patients with PE tubes, ruptured TM or recent ear surgeries, what otic drops would be a better option for them?
Ciprodex
Otofloxin
Pearls for ear examination:
- look carefully - repeatedly looking improves skills
- watch for foreign bodies (kids like ears)
- secure the head of kids during exam to reduce R/O trauma during exam
Types of Ear Pain (broadly broken down)
- Primary - originating within ear STRUCTURES
2. Secondary - referred to the ear from OTHER REGIONS
ear pain referred to the ear from another area is known as
secondary ear pain
infections and inflammations of middle and external ear structures and mastoid tissues are considered what type of ear pain?
primary
Examples of secondary ear pain
- TMJ (dental and periodontal problems)
- sinus/ nasopharyngeal infections
- lesions of the tongue
- cervical musculoskeletal problems
- Neuralgias
Name the components of physical ear exam:
- inspection - general appearance, external ear, inspection of ear w/an otoscope
- Palpation - each ear separately by pulling the pinna OUT and BACK, and either Up/Down.
- apply pressure to the tragus
functions of the ear include:
- interpreting and identifying sound
- detecting the direction of sound
- maintaining equilibrium
Major parts of the ear include
- external ear (pinna or auricle & the ear canal
- middle ear (tympanic cavity)
- inner ear
the hearing process begins here by collecting sound waves and channeling them through the ear canal
external ear
This part of the ear contains the structures for balance and hearing through a series of connecting chambers and tubes
the inner ear
functions as a conduit for hear and as a regulator of the ventilation pressure
the inner ear
undiagnosed ear disorders may contribute to
- poor language development
- delayed learning
- social isolation
- hearing loss
- risk for falls
- missed dx of respiratory and oral infx’s
