PHA 521 > EAR 1 > Flashcards

EAR 1 Flashcards

(69 cards)

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1
Q

Conductive Loss (weber and rinne)

A

Weber: lateralizes to bad ear

Rinne: BC>AC

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2
Q

Sensorineuronal Loss (weber and rinne)

A

Weber: lateralizes to good ear

Rinne: AC>BC (normal)

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3
Q

Cone of Light always points

A

anteriorly

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4
Q

Disorders of External Ear

A

Cerumen impaction
Foreign body
Otitis externa
Hematoma of external ear

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5
Q

Cerumen Impaction: clinical presentation

A

often asymptomatic

hearing loss
earache or fullness

itchiness
reflex cough
dizziness
tinnitus

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6
Q

Cerumen Impaction: treatment

A

Most common: irrigation

  • detergent ear drops (debrox/carbamide peroxide)
  • mechanical removal
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7
Q

Irrigation

A

body temperature water
only when TM is intact
dry canal after

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8
Q

Foreign Body: clinical presentation

A

often asymptomatic

decreased hearing
pain
drainage
chronic cough/hiccups

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9
Q

Foreign Body: treatment (urgent)

A

button batteries
live insects
penetrating fb

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10
Q

Foreign Body: treatment (firm object)

A

Remove with loop/hook or irrigation

Avoid pushing closer to TM

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11
Q

Foreign Body: treatment (organic object)

A

ex: beans, insects

DO NOT IRRIGATE

immobilize living insects w/ lidocaine

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12
Q

Hematoma of External Ear

A

traumatic auricular hematoma

recognize promptly

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13
Q

Hematoma of External Ear: treatment and complications

A

Treatment: drainage

Complications: cauliflower ear

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14
Q

Otitis Externa

A

aka swimmers ear

inflammation of external auditory canal

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15
Q

Otitis Externa: etiology

A

most common: infection

  • gram negative rods (pseudomonas)
  • fungi

allergic
dermatologic

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16
Q

Otitis Externa: risk factors

A
  • warmer climates with high humidity
  • inc water exposure
  • debris from dermatologic conditions
  • trauma
  • occlusive devices
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17
Q

Otitis Externa: clinical presentation

A
  • otalgia
  • pruritus
  • purulent discharge (black in fungal)
  • hearing loss
  • fullness
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18
Q

Otitis Externa: physical exam

A
  • erythema and edema of ear canal
  • purulent exudate
  • tenderness with palpation
  • erythematous TM
  • normal movement with pneumatic otoscopy
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19
Q

Otitis Externa: differential diagnosis

A
  • middle ear disease
  • contact dermatitis
  • psoriasis
  • chronic suppurative otitis media
  • squamous cell carcinoma of external ear
  • herpes simplex virus
  • radiation therapy
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20
Q

Ramsay Hunt Syndrome

A

aka herpes zoster oticus

herpes simplex virus

ipsilateral facial paralysis + pain + vesicles in ear canal

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21
Q

Otitis Externa: treatment

A

7-10 d of topical aminoglycoside or fluoroquinolone antibiotic w/ or w/out corticosteroids
(TM perforation = no aminoglycosides)

keep canal dry

avoid additional moisture, scratching

remove debris

place a wick

severe = oral antibiotics

refer to ENT if immunocompromised or DM

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22
Q

Otitis Externa: complications

A

periauricular cellulitis
contact dermatitis
malignant otitis externa

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23
Q

Malignant Otitis Externa

A

osteomyelitis of temporal bone/skull base

DM + immunocompromised at highest risk

  • foul smelling discharge
  • granulations in ear canal
  • deep otalgia
  • cranial nerve palsies
  • HA

Dx: CT (osseous erosion)

Tx: IV antibiotics, surgery

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24
Q

Disorders of the Middle Ear

A 
Acute otitis media
Chronic otitis media
Otitis media with effusion
Cholesteatoma
TM perforation
Otic barotrauma
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25
Acute Otitis Media
bacterial infx of middle ear usually precipitated by URI
26
Acute Otitis Media: etiology
Most common bacterial causes: 1. streptococcus pneumoniae 2. haemophilus influenza 3. moraxella pyogenes Recurrent cases associated with allergies or 2ndhand smoke
27
Acute Otitis Media: epidemiology
most common in children 4-24 months inc in call and winter
28
Acute Otitis Media: risk factors
``` family hx day care lack of breastfeeding tobacco smoke/air pollution pacifier use ```
29
Acute Otitis Media: clinical presentation
otalgia, pressure hearing loss fever (more common in children) URI symptoms
30
Acute Otitis Media: physical examination
TM - immobile - erythematous - bulging - may rupture bullae associated with mycoplasma infx retraction can occur
31
Acute Otitis Media: differential diagnosis
- otitis media w/ effusion - otitis externa - eustachian tube dysfunction - herpes zoster - head/neck infx
32
Acute Otitis Media: treatment
1st line: high dose AMOX (80-90mg/kg/day divided twice daily) 2nd line: high dose AMOX-clavulanate or 2nd/3rd cephalosporin improves in 48-72 hours analgesics
33
Acute Otitis Media: treatment w/ perforated TM
include topical antibiotic with low ototoxicity (ofloxacin)
34
Acute Otitis Media: prevention
pneumovax
35
Acute Otitis Media: observation
6 mo-2 yr: unilateral, mild >2yr: unilateral or bilateral, not severe antibiotics if - worsening - no improvement in 48-72 hrs
36
Acute Otitis Media: immediate antibiotics
< 6 months <24 months if severe - mod-severe pain - pain > 48 hrs - T > 102.2 F - bilateral
37
Acute Otitis Media: complications
- labyrinthitis - hearing loss - mastoiditis - non response to meds - recurrent infection
38
Mastoiditis
spiking fevers postauricular pain erythema Tx: antibiotics or mastoidectomy
39
Chronic Otitis Media: etiology
recurrent AOM
40
Chronic Otitis Media: presentation
chronic otorrhea
41
Chronic Otitis Media: physical exam
perforated TM | conductive hearing loss
42
Chronic Otitis Media: treatment
- removal of infected debris - earplug use - antibiotics (topical, oral) - surgery (TM repair)
43
Serous Otitis Media
otitis media with effusion
44
Serous Otitis Media: pathophysiology
eustachian tube stays blocked for a prolonged time neg pressure --> transudation of fluid into middle ear
45
Serous Otitis Media: epidemiology
More common in children (eustachian tubes are narrower, more horizontal) Less common in adults (after URI, barotrauma, chronic allergies)
46
Serous Otitis Media: clinical presentation
no acute signs conductive hearing loss fullness
47
Serous Otitis Media: physical exam
TM - dull - hypermobile bubbles conductive hearing loss
48
Serous Otitis Media: treatment
? decongestants, antihistamines if underlying allergies: nasal steroids if resistant: ventilating tubes
49
Cholesteatoma
specific type of chronic otitis media
50
Cholesteatoma: etiology
most common: prolonged eustachian tube dysfunction chronic negative middle ear pressure draws in part of TM creates sac lined with squamous epithelium can get secondarily infected (pseudomonas, proteus)
51
Cholesteatoma: presentation
asymptomatic or hearing loss chronic: ear drainage
52
Cholesteatoma: physical exam
TM pocket | TM perforation exuding debris
53
Cholesteatoma: treatment
``` antibiotic drops surgical removal (mostly this) ```
54
Cholesteatoma: complications
erosion into inner ear, facial nerve, brain | abscess
55
Eustachian Tube
connects middle ear and nasopharynx provides ventilation and drainage to middle ear normally closed -open during yawning, swallowing
56
Eustachian Tube Dysfunction: etiology
edema of tubal lining air trapped in middle ear causing negative pressure - viral URI - allergies
57
Eustachian Tube Dysfunction: presentation
fullness fluctuating hearing pain with pressure change popping/crackling sensation
58
Eustachian Tube Dysfunction: physical exam
TM - retraction - dec mobility
59
Eustachian Tube Dysfunction: management
AVOID air travel altitude change underwater diving
60
Eustachian Tube Dysfunction: treatment
``` decongestants autoinflation desensitization therapy (allergies) intranasal corticosteroids surgical ```
61
Eustachian Tube Dysfunction: complications
inc risk for - serous otitis media - cholesteatoma
62
Otic Barotrauma
inability to equalize pressure exerted on middle ear during - air travel - rapid altitude change - underwater diving precursor: poor eustachian tube dysfunction (mucosal edema, congenital narrowing)
63
Otic Barotrauma: presentation
otalgia | DESCENT > ascent
64
Otic Barotrauma: treatment
enhance eustachian tube function - systemic decongestants before travel - topical nasal decongestant 1 hr before descent
65
Otic Barotrauma: patient education
swallow, yawn, autoinflate during descent
66
Otic Barotrauma: diving without equilibrating
can experience - hemotympanum - perilymphatic fistula
67
Perilymphatic Fistula
rupture of oval window sensory hearing loss acute vertigo vomiting
68
Otic Barotrauma: complications
TM rupture | persistant pressure
69
Tympanic Membrane Perforation
small ruptures (<25%) will close on their own larger require tympanoplasty
PHA 521
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