Ears MDT Flashcards by Bryan Servillon

What is auricular hematoma?

Accumulation of blood in the subperichondrial space, secondary to blunt trauma

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What can auricular hematoma result in?

Cauliflower ear

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What will you find on physical examination of Auricular Hematoma?

Loss of landmarks

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Separation of perichondrial blood vessels in auricular hematoma can result in what?

Necrosis

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How should auricular hematoma be treated?

incision should be made not to violate perichondrium
incision should be on inner curvature of helix or antihelix

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What should be done after auricular hematoma drainage?

Splinting of ear
Apply Neosporin BID

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How should live objects be dealt with in the ear?

2% lidocaine solution to drown them

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Sx of ear foreign body

specific MOI
muffled sounds
severe pain
hearing distrubances

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What temperature should water for ear irrigation be?

Room-temp

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What equipment can be used to assist in ear foreign body removal?

cerumen loops/scoops
right angle alligator/alligator forceps

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If you cannot see the TM, should you still irrigate?

No, unsure if TM is perforated

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What are some c/c of patients with cerumen impaction?

decrease hearing
sensation of pressure or fullness

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What worsens cerumen impaction?

Q-tips

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What equipment can you use for cerumen impaction?

Loops and scoops

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If irrigating the ear, what is the procedure?

18 gauge IV catheter
Body temp water
irrigate along superior portion utilizing pressure of stream to help break up/dislodge impaction

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What medication can assist cerumen impaction?

Carbamide Peroxide (Debrox) 2-5 drops BID for max 4 days

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What is a common injury after ear irrigating?

TM Perforation

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What is mastoiditis?

Mastoid cavity becomes a closed space after a blockage occurs

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Mastoiditis is normally a complication of what condition?

Otitis media

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What will you find on physical examination of mastoiditis?

Post auricular pain, erythema with spiking fever
obliteration of post auricular crease
protrusion of the auricle

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What radiologic studies should be done with mastoiditis?

Mastoid radiography
CT

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What lab should be done with mastoiditis?

Culture of drainage

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Medications for mastoiditis

Ceftriaxone
Levofloxacin
Cefazolin

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What should be done with mastoiditis after MEDEVAC?

Admission
I&D
possible mastoidectomy

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What is otitis externa?

Diffuse inflammation of external ear canal with or without inflammation of auricle and/or TM

What are most common organisms associated with otitis externa?

Staphylococcus (10-70%) Pseudomonas (20-60%)

Findings leading to otitis externa?

- purulent exudate - hx of recent water exposure or mechanical trauma

What lab should be done for otitis externa?

Gram staining of discharge

How should you dry otitis externa?

50/50 mix isopropyl alcohol/white vinegar

What medications can you give for otitis externa?

Neomycin/Polymxin B Ciprofloxacin Otic

What is otitis media?

Bacterial infection of mucosal lined, air containing spaces of the temporal bone

Otitis media is precipitated by what condition?

URI

Common pathogens of otitis media?

- strep pneumonia - hib - strep pyogenes

Physical findings of otitis media

TM bulging, mastoid tenderness

Labs for otitis media

Tympanocentesis Fungal culture

Medications for otitis media

Amoxicillin Augmentin PCN Allergy Cefrtriaxone Doxycycline Nasal decongestants

What is Eustachian tube dysfunction?

Disorders involving impairment in the functional valve of the Eustachian tube of the middle ear

What is patulous Eustachian tube dysfunction?

Excessively open or dilatory dysfunction

What kind of sensation does Eustachian tube disorder have?

Full ness or underwater sensation

Treatment for Eustachian tube dysfunction?

Pseudoephedrine Oxymetazoline Flonase Cetirizine Fexofenadine

TM perforations are secondary to what conditions?

Barotrauma, blunt/penetrating/acoustic trauma or lightning strikes

Where on the TM is perforation most likely to occur?

Pars tensa

Signs of TM perforation?

Visible perforation, otorrhea from canal

How does the TM heal?

Spontaneous healing occurs in most cases

If foreign material is suspected in TM perforation, what medications should be given?

Antibiotics - Augmentin - Doxycycline

Perforations secondary to trauma should be referred where?

ENT (otolaryngologist)

What is cholesteatoma?

Benign tumor in the middle ear or mastoid

What is the most common cause of cholesteatoma?

Eustachian tube dysfunction

What structures get eroded as cholesteatoma expands?

Ossicular chain, bony labyrinth or facial nerve canal

How is cholesteatoma treated?

Surgery

What is barotrauma?

Damage to the TM due to rapid changes in pressure

What is dx o f barotrauma based on?

Accurate hx and physical exam

Most common cause of barotrauma?

Flying

Sx of barotrauma

- Hearing loss -Middle Ear pain

Severe cases of barotrauma present with what findings?

- Sensorineural hearing loss - Vertigo

What is found upon physical exam of barotrauma?

- Conductive hearing loss - TM Perforation/Bulging - May have fluid

How would you treat barotrauma?

Treat predisposing conditions

How does mild cases of barotrauma resolve?

Spontaneously

When should patients with barotrauma be referred?

- Inner Ear exposure - Sensorineural hearing loss

What is sudden hearing loss divide into?

Sensorineural and conductive

What structures are involved with sensorineural hearing loss?

Cochlea, Auditory nerve or Central Auditory processing

What structures are involved with conductive hearing loss?

External ear, TM, Ossicles

What is conductive hearing loss more likely due to?

Reversible causes such as: - Otitis media - Serous Otitis - Cerumen Impaction

What is sensory hearing loss more likely due to?

Irreversible causes, such as disease of the cochlea

What is the most common cause of sensory hearing loss?

Progressive, high-frequency loss with advancing age (presbyacusis)

What frequency does noise trauma begin?

4000hz

What tests should be done with patients with hearing loss?

- Audiogram - Weber and Rinne

What treatments should be done for hearing loss?

- Remove member from exposure - Earplug education - Referral to ENT if further eval is needed

What causes tinnitus?

Damaged hairs may move randomly sending impulses to the brain

What are some objective causes of tinnitus?

Turbulence in carotid artery or jugular vein and TMJ problems

Is the precise pathophysiology of tinnitus known?

Nope

What are the 2 types of tinnitus?

Objective and subjective

Sx of tinnitus

- "Ringing noise" - Conductive hearing loss - Noise intolerance

Ears MDT Flashcards

(73 cards)