Ear, Nose, Sinus Flashcards by Elizabeth Sager

Describe the etiology/risk factors for otitis media

Acute: middle ear effusion leading to infection of middle ear space
Chronic: untreated 6+ weeks leading to TM retraction, perforation, cholesteatoma, mastoiditis
- common in kids <5, M>F
- mostly viral, also bacterial (strep pneumo, M. cat, H. flu)
- RF: smoke, allergies, craniofacial abnormalities

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Describe the clinical presentation of otitis media

pain, hearing loss, crackling, popping, fever, URI, drainage
bulging, red TM with pus in middle ear, fluid, perforation and drainage

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Describe the diagnostic testing for otitis media

pneumatic otoscopy: limited mobility of TM
criteria: bulging of TM, new onset otorrhea

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Describe the treatment for otitis media

refer to ent for PE tubes if 3+ mos hearing loss
1st line: amoxicillin 90mg/kg/day divided in 2 doses x10 days

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Describe the etiology/risk factors for mastoiditis

suppurative infection & inflammation of mastoid air cells that **starts in the ear
untreated acute otitis media, s pneumo, h flu**

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Describe the clinical presentation of mastoiditis

**- pain in & behind the ear
- hearing loss
- fever
- bulging, red TM
- purulent middle ear
- post-auricular warmth, erythema, edema, fluctuance
- +/- protrusion of auricle
- +/- cranial nerve palsy

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Describe the diagnostic testing for mastoiditis

CT temporal bone w/o contrast shows mastoid effusion, loss of trabecular bone
elevated CBC, ESR, CRP
do lactate, blood cultures, LP if toxic

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Describe the treatment of mastoiditis

IV abx +/- myringotomy
IV abx + mastoidectomy if abscess develops/does not improve

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Describe the etiology/risk factors of otitis externa

aka swimmer’s ear
- infection of external auditory canal d/t excess moisture, trauma, bacterial/fungal infection
- Bacteria: pseudomonas aeruginosa, s. epi, s. aureus
- Fungal: candida, aspergillus

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Describe the clinical presentation of otitis externa

**plugging/fullness
hearing loss**
drainage
pain
itching (fingal)
wet, edematous canal with debris, redness, flaking

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Describe the diagnostic criteria of otitis externa

rapid onset (<48 hr) canal inflammation w/wo otorrhea, regional adenopathy, erythematous TM, cellulitis

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Describe the 3 components of otitis externa treatment

strict dry ear
abx/antifungal drops +/- wick (fluoroquinolones with steroid, neomycin, hydrocortisone, polymixin b, clotrimazole, acetic acid)
removal of debris

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Describe the etiology/risk factors of necrotizing otitis externa

secondary to untreated otitis externa (usually pseudomonas) leading to osteomyelitis of temporal bone
- RF: elderly, diabetic, immunocompromised

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Describe the clinical presentation of necrotizing OE

+/- exposed bone
tissue granulation
CN7 palsy
sepsis with altered mental status

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Describe the treatment for necrotizing OE

hospital admit with IV abx, +/- glucose control or surgery

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Describe the etiology/risk factors for tympanic membrane perforation

hole in eardrum
M>F
RF: recurrent AOM, flying/diving with ETD, multiple ear surgeries, barotrauma, q-tip use, water irrigation, myringotomies, non-healing PE tube sites

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Describe the clinical presentation of tympanic membrane perforations

asymptomatic if small/chronic
sudden pop +/- drainage/blood
hearing loss
tinnitus
vertigo

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Describe the diagnostic testing for tympanic membrane perforation

insufflation: no movement
otoscopy: describe size, shape, quadrant
tympanometry: flat with large vol
audiogram: +/- conductive hearing loss

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Describe the treatment for tympanic membrane perforation

spontaneously healing in 2 mos
avoid irrigation
abx drops if concerned for infection
refer to ENT if not healed in 2 mos, suspect ossicle injury, >40 dB hearing loss, vestibular sx
paper patching, tympanoplasty, ossicular chain reconstruction

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Describe the etiology/risk factors for vertigo

80% peripheral, 20% central
MC benign paroxysmal positional vertigo (BPPV): **calcium carbonate crystals (otoliths) become loose/misplaced in semicircular canal

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Describe the clinical presentation of BPPV

room spinning
triggered by positional movement
+/- n/v
residual imbalance after
periodic recurrence for weeks/mos
otoliths can displace posteriorly, unilateral/bilateral

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Describe the diagnostic testing for BPPV

-Normal audiogram, MRI, videonystagmography

Criteria: dix-hallpike maneuver
- nystagmus/vertigo appear within seconds and last 30 sec
- Nystagmus has predictable trajectory
- Nystagmus recurs in opposite direction after sitting up
- Intensity and duration diminishes with repeat

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Describe the treatment for BPPV

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Epley maneuver
Semont maneuver
antihistamines, antiemetics, benzos

Describe the etiology/risk factors for labyrinthitis & vestibular neuritis

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Labyrinthitis: with SNHL
Vestibular neuritis: w/o SNHL

viral/postviral (HSV) inflammatory disorder affecting a portion of CN8

Describe the clinical presentation of labyrinthitis & vestibular neuritis

- intense spinning vertigo for a few days followed by imbalance for a few months - room spinning, n/v, gait instability toward affected side - spontaneous nystagmus suppressed with visual fixation

Describe the diagnostic testing and PE for labyrinthitis & vestibular neuritis

- MRI shows findings 29% of the time: inflammation - positive head thrust test - audiogram: asymmetric SNHL in labyrinthitis

Describe the treatment for labyrinthitis & vestibular neuritis

- **high dose steroids - TTI** - +/- antivirals - antihistamines - antiemetics - vestibular rehab - 2% recurrence but 15% develop BPPV/panic disorder

Describe the etiology/risk factors for hematoma of the ear

auricular perichondrium separates from underlying cartilage and space fills with blood causing swelling/cauliflower ear - RF: wrestlers, M>F, limited mobility

Describe the clinical presentation of cauliflower ear

- tense, fluctuant pinnae - +/- pain - +/- erythema/ecchymosis

Describe the treatment for hematoma of the ear

- drainage & reapposition of periochondrial layer asap before clotting - I&D + bolster placement - cephalexin x1 week, no trauma x2 weeks

Describe the etiology/risk factors for foreign bodies in the ear/nose

object lodged in small cavity of ear/nose - mostly pediatric (nose MC)

Describe the clinical presentation of ear vs nose foreign bodies

**Ear:** commonly asymptomatic, +/- HL, pain, drainage/bleeding **Nose:** unilateral foul nasal drainage/bleeding, congestion, +/- pain

Describe the treatment for foreign body of the nose & ear

- "mother kiss" - forcep, suction, swab + adhesive, flushing, lidocaine/oil - **RED FLAGS for ENT: button battery, magnets, sharp objects**

Describe the complications of a button battery foreign body

can erode/ulcerate in 2 hrs, perforate in 8hrs

Describe the etiology/risk factors of epistaxis

- dry weather, anticoags, clotting disorders, HTN, trauma, intranasal drug use, etoh, neoplasm - **anterior (90%): Kesselbach's plexus (minor) - posterior: Woodruff's plexus (more concerning)**

Describe the clinical presentation of epistaxis

- recurrent blood from nostrils/oropharynx - active bleeding/stigmata of recent bleeding, obvious vessel on septum, blood in oropharynx

Describe the diagnostic testing for epistaxis

may consider CBC, INR, coag studies

Describe the treatment of epistaxis

- cotton ball soaked in Afrin + pressure for 15 mins - pack & observe 30 mins, cephalexin, refer to ENT for rhino balloon pack or spongy foam pack - emergent ENT page for OR intervention if persistent (cautery, silver nitrate)

Describe the etiology/risk factors of nasal septal hematoma

blood pooling in nasal septum, can lead to infection, necrosis, deformity - RF: recent surgery, nasal trauma

Describe the clinical presentation of nasal septal hematoma

sudden onset of nasal congestion, change in nose shape, painful swelling of septum - red fluctuant mass

Describe the treatment of nasal septal hematoma

emergent ENT referral: drainage, sterile packing, prophylactic abx

Describe the etiology/risk factors for sinusitis

acute v chronic inflammation of paranasal sinuses and nasal cavity - RF: allergy, polyps, age, smoking, air travel, dental disease, immunodeficiency - viral: rhino, flu, adeno, parainfluenza - bacterial: s. pneumo, m. cat, h. flu)

Describe the stages/types of sinusitis

- acute: <4 weeks - subacute: 4-12 weeks - chronic: >12 weeks - recurrent: 4+ occurrences per year with complete resolution between episodes

Describe the clinical presentation of sinusitis

**- nasal congestion - pressure/pain - purulence - hyposmia** - foul smell - fever - fatigue - cough - ETD - sinuses TTP - hyponasal voice

Describe the diagnostic criteria and treatment of acute viral sinusitis

<10d - purulent drainage - severe obstruction - facial pain/pressure **saline irrigation 2-3x/day, nasal steroids (flonase)**

Describe the diagnostic criteria and treatment of acute bacterial

+10d - purulent drainage - severe obstruction - facial pain/pressure - double worsening 7+ days amox+clav, cephalexin, doxy

Describe the diagnostic criteria and treatment of chronic bacterial sinusitis

12+ weeks of inflammation and 2 of: - mucopurulent drainage - obstruction - facial pressure/pain - loss of smell 21+ days abx and 10+ days oral steroid taper

What are these HINTS test results indicative of? **N**ystagmus: positive **T**est of **S**kew: positive **H**ead **I**mpulse: negative

central vertigo - single episode lasting 24+ hrs - CNS etiology: acoustic neuroma, TIA posterior circulation, cerebellar hemorrhage

What does the HINTS exam stand for

**H**ead **I**mpulse, **N**ystagmus, **T**est of **S**kew

What is a positive head impulse on HINTS testing indicative of?

peripheral vertigo - vestibular neuritis/labyrinthitis

What is the etiology and timeframe of Meniere's disease symptoms

Intermittent vertigo d/t an excess of endolymph fluid in the inner ear - +/- permanent hearing loss seen on **audiometry** - triggered by stress, work, fatigue, pressure change - **vertigo lasting several minutes but less than an hour**

What is the maneuver that elicits nystagmus in BPPV

Dix-Halpike maneuver

Describe what may be indicated in a positive and negative refixation/catch of saccade

Positive: peripheral, nerve problem Negative: central, brain problem

Describe a positive test of skew

Ask pt to maintain gaze on providers nose. A positive result will be the deviation of one eye while it is being covered, followed by correction after uncovering it. (positive = ominous for central, move to head impulse test)

Describe the dix-halpike maneuver

- elicits nystagmus in BPPV - repetitive beating of eyes with dizziness (horizontal or rotational) - (nystagmus diagnostic for BPPV, no nystagmus may be indicative of uncommon BPPV) - can continue into treatment if positive with the Epply

Describe what the Epply's Maneuver does

dislodges crystals from the semicircular canals and brings them back to the utricle to relieve vertigo

Ear, Nose, Sinus Flashcards

(56 cards)