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ENT > Disorders of Ear > Flashcards

Disorders of Ear Flashcards

1
Q

Eustachian Tube Dysfunction

  • general explanation
  • what may cause acute ETD?
  • chronic ETD may cause?
  • what is patulous ET?
A

General: blockage of the ET, it does not open or close properly in response to pressure changes within the middle ear or outside the ear.

Acute causes: pressure changes such as plane travel, upper airway inflammation such as URI or sinusitis.

Chronic may cause: serous effusions, otitis media, adhesive otitis media, cholesteatoma

Patulous ET is failure of ET to close, ET is floppy. Manifested as autophony (own breathing and voice sounds excessively loud.

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2
Q

ET functions

A

ventilation/regulation of middle ear pressure

protection from nasopharyngeal secretions

drainage of middle ear fluid

*ET closed at rest and opens with yawning, swallowing, and sneezing.

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3
Q

pressure differences can cause what type of hearing loss by decreased motion of the tympanic membrane and ossicles of the ear.

A

conductive

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4
Q

Explain what happens when negative pressure develops in the middle ear?

A

serous exudate is drawn from the middle ear mucosa or refluxed into the middle ear if the ET opens momentarily if negative pressure develops in the middle ear.

infection of static fluid causes edema and release of inflamm mediators which exacerbates cycle of inflamm and obstruction.

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5
Q

ETD

  • MC in what age? why?
  • can be associated with what disorders?
A

MC age is less than 5 b/c their ET tube is more horizontal.

Associated with URI, adenoid hypertrophy, allergic rhinitis, GERD

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6
Q

ETD Risk factors

  • adult
  • pediatric
A

Adult:

  • tobacco
  • GERD
  • Sleep apnea
  • FHx
  • Altered Immunity

Peds:

  • 2nd hand smoke
  • prematurity and low birth weight
  • prone sleeping position
  • prolonged bottle use
  • young age
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7
Q

More commonly associated conditions with ETD

A
  • hearing loss
  • middle ear effusion
  • cholesteatoma
  • allergic rhinitis
  • chronic sinusitis
  • URI
  • adenoid hypertrophy
  • Cleft palate
  • Down Syndrome
  • Obesity
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8
Q

ETD Tx

A

-initiate tx based upon individuals sx and cause.

first line: decongestants for less than 3 days. (avoid in pts with HTN or cardiac risk factors)

  • phenylephrine
  • pseudoephedrine
  • afrin

Nasal steroids:
-Rhinocort (Budesonide), Beclomethasone (Beconasee), Fluticasone (Flonase)

2nd generation H1 antihistamines:
-loratadine (claritin), cetirizine (zyrtec), allegra (fexofenadine)

Antihistamine nasal spray:
-astelin, olotpatadine

Abx (not routinely used unless ETD is associated with acute OM); amoxicillin is 1st line, tx for 10days.

*if TM perforation or ventilation tube present consider topical abx drops with topical steroid (Neomycin-polymyxin-hydrocortisone suspension, ciprofloxacin-hydrocorticosone suspension/Cipro HC)

Pain control=anti inflammatory; acetaminophin, NSAIDS

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9
Q

Otitis Media

-what are the 3 types?

A
  • acute otitis media (AOM)
  • recurrent AOM
  • Otitis Media w/ Effusion (OME)
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10
Q

How many middle ear infections are needed to be dx with recurrent AOM?

A

-3 or more in 6months or 4 or more in 1 year.

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11
Q

Otitis Media

  • definition
  • risk factors
A

Def: infection of the middle ear with acute onset, presence of middle ear effusion, and signs of middle ear inflammation

risk factors:

  • bottle feeds while supine
  • day care
  • formula feeding
  • smoking in house
  • male gender
  • family Hx of middle ear dz
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12
Q

Otitis Media
-signs and sx
-otoscopic exam findings
-

A

Signs and sx:

  • earache (discomfort, pressure)
  • ear pain
  • tugging on ears
  • fever (most often afebrile, not required for dx)
  • URI sx
  • irritability
  • diff sleeping
  • hearing loss

Otoscopic findings;

  • decreased visibility of landmarks
  • decreased TM mobility
  • bulging** red, opaque TM
  • pus in middle ear
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13
Q

Bacterial causes of otitis media

A
  • strep pneumo *
  • h. flu
  • m. cat
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14
Q

Otitis Media

  • expected course/prognosis
  • tx
A

course: sx usually spontaneously resolve in 2/3 or children by 24hrs and 80% at 2-10days

Tx:
Abx:
-amoxicillin if strep pneumo.
-augmentin, cephalosporins, erythro/azithro

pain & fever:

  • ibuprofen
  • tylenol
  • auralgan
  • *DONT use aspirin (reyes syndrome)

Follow up:

  • failure to improve after 48-72hrs of abx
  • if sx resolve re-examine in 14-21 days after initial presentation.
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15
Q

what children get abx and which abx specifically with otitis media?

A
  • all children under 23mo get abx
  • bilateral involvement
  • between 23mo and 7yo discuss abx use with parents.

Amoxicillin is DOC!

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16
Q

Otitis Media w/ Effusion

  • aka
  • defined as
  • sx
  • PE findings
  • single best diagnostic method to establish this?
A

aka: Serous Otitis Media, ear glue

defined as the presence of middle ear effusion in the absence of acute signs of infection.

sx:
- hearing loss
- fullness in ear
- tugging at ear
- delayed speech and language development or unclear speech
- unsteady gait
- pain rarely occurs

PE: TM is dull and retracted (usually not bulging)

  • NO mobility of TM
  • straw or tan color of eardrum or translucent gray
  • sterile fluid in middle ear

-pneumatic otoscopy

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17
Q

Otitis Media with effusion

-tx

A

Tx:

  • watchful waiting, most resolve on own in 3mo.
  • test hearing after 3mo of watchful waiting
  • re-examine every 3-6 mo until the effusion is resolved
  • surgery: tympanostomy and tube
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18
Q

chronic and suppurative otitis

  • defined as?
  • cause
  • risk
  • sequelae
  • sx
A

defined as a perforated tympanic membrane with persistent drainage from the middle ear
(untreated or inadequately treated OM that leads to TM perforation, and subsequent contamination and infection leading to otorrhea.)

Cause:

  • pseudomonas
  • staph
  • klebsiella
  • proteus

Risk:

  • hx of multiple episodes of AOM
  • living in crowded conditions
  • daycare

Sequelae: conductive hearing loss and intracranial complications.

Sx:

  • otorrhea, fetid (smelling extremely unpleasant), purulent
  • fever, pain, and vertigo may indicate intracranial complications
  • external canal may/may not be edematous
  • usually not tender
  • middle ear mucosa visualized thru the perforated TM
19
Q

Chronic suppurative otitis

  • labs
  • imaging
  • other test
  • tx
A

Labs: culture the drainage for sensitivity

Imagining: CT scan, MRI, usually not done unless suspecting neoplasm, cranial complications

Other: audiogram

Tx:

  • remove the exudate from canal w/o pressure.
  • abx otics, if these fail you give systemic ciprofloxacin PO
20
Q

Cholesteoma

  • what is this?
  • cause
  • presentation
A

What: skin growth that occur in the middle ear behind the eardrum, increases in size and destroys surrounding delicate bones of middle ear.

Cause:
-repeated infection, poor ET function

presentation:
- otorrhea
- fullness or pressure in ear
- hearing loss
- achy ear especially at night
- dizziness
- facial weakness on affected side d/t CN VII dysfunction

21
Q

Cholesteoma

  • dx
  • tx
A

dx: otoscopy, audiometry, XRAY and CT of mastoid may be necessary, refer to ENT.

Tx:
-surgery

22
Q

Otitis Externa

  • defined as?
  • causes
  • bacterial culprits
  • signs and sx
A

Defined as inflammation of the external auditory canal or auricle

Cause: infectious, allergic, and dermal dz

Bacteria:
-steph, pseudomonas , proteus

Sx and signs

  • otalgia
  • pain at tragus or when auricle is pulled
  • pruritis
  • discharge
  • hearing loss
23
Q

Otitis Externa

  • PE findings
  • Tx
A

PE:

  • edematous and erythematous ear canal
  • yellow, brown, white or grey debris
  • no middle ear fluid
  • TM should be mobile,

Tx:

  • cleaning of ear canal; irrigation w/o pressure at body temperature
  • treat inflammation and infection w/ Cipro HC, cortisporin, torbadex
24
Q

Malignant External Otitis/Necrotizing Otitis Externa

  • defined as?
  • cause
  • sx
  • PE exam findings
  • complications
  • dx
  • tx
A

Defined as an invasive infection of the external auditory canal and skull base
*MC seen in elderly w/ DM and immunocompromised pts.

Cause: pseudomonas

Sx:
-SEVERE tolagia and otorrhea, much worse than external otitis

PE:
-granulation in the inferior portion of the external auditory canal.

Complications:

  • osteomyelitis of the basee of the skull
  • mastoiditis
  • TMJ osteomyelitis

Dx:

  • elevated ESR
  • positive culture
  • imaging

Tx:

  • Ciprofloxin 750mg PO BID for 6-8 weeks
  • no role for topical abx
25
Q

TM Perforation

  • sx
  • causes
  • tx
A

Sx:

  • clear, pus filled, or bloody drainage from ear
  • sudden decrease in ear pain followed by drainage
  • hearing loss
  • tinnitus

Cause:

  • middle ear infection
  • airplane
  • acoustic trauma (direct injury, ear struck with an open hand)
  • foreign objects in ear
  • loud sudden noise (explosion or firearm)

Tx:

  • most heal on own
  • usually no abx or topicals but can consider Cortisporin Otic of Cipro HC
  • keep ear dry
  • ear drum patch
  • tympanoplasty
26
Q

Barotrauma

  • sx
  • most frequent cause
  • Tx
  • Prevention
A

Sx: pressure in the ear

  • pain d/t stretching of the TM
  • hearing loss
  • tinnitus

Most frequent cause is flying though it could be caused by driving as well.

Tx:

  • valsalva
  • decongestatnts
  • myringotomy (incision into TM to relieve pressure)

Prevention:

  • avoidance
  • pre flight decongestants
  • chewing gum, yawning, swallowing
27
Q

Foreign Body in the Ear

-tx

A

irrigation is risky, may cause TM perforation

remove FB with loop or hook….if necessary refer to ENT.

28
Q

Cerumen Impaction

-removal techniques

A
  • hydrogen peroxide
  • debrox
  • irrigation with water at body temperature. (so we dont induce vertigo)
  • suction
  • scrapings along the roof of the ear canal.
29
Q

Mastoiditis

  • what is this?
  • sx
  • dx
  • tx
A

What: complication of otitis media, develops when middle ear inflammation spreads to the mastoid air cells resulting in infection and destruction of the mastoid bone.

Sx: post auricular pain and erythema, spiking fever, tender mass

dx & tx
-ENT consult, CT scan and MRI if intracranial involvement suspected

Patient admission for IV Abx for 21 days,

  • rocephin (ceftriaxone)
  • piperacillin and tazobactam (Zosyn)
  • Oxacillin
  • Genatmicin
30
Q

Acoustic Neuroma

  • aka
  • age at dx
  • risk factors
A

aka: vestibular schwannoma
age: 50yrs

Risk factors:

  • exposure to loud noise
  • neuorfibromatosis type 2 (tumors to form in the brain and spinal cord and nerves)
  • hx of parathyroid adenoma
  • cell phones controvesial
31
Q

Acoustic Neuroma

  • sx
  • dx
  • tx
A

sx: sx are d/t CN involvment

Cochlear nerve = hearling loss and tinnitus

vestibular nerve = unsteadiness while walking

Trigeminal nerve = facial numbness, hyperethesia and pain

Facial nerve = facial paresis and taste disturbances.

Dx:

  • Rinne & Weber, demonstration of asymmetric sensorineural hearing loss or CN deficits
  • MRI or CT
  • ENT referral
  • audiometry

Tx: surgery

32
Q

Vertigo

  • defined as
  • sx
  • causes
A

defined as a symptom of illusory movement.

Sx:

  • transient spinning dizziness
  • a sense of swaying or tilting
  • a sens of falling backwards

Causes:
-asymmetry in the vestibular system d/t damage to dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem.

33
Q

Characteristics of Peripheral vs central vertigo?

Sx?

A

Peripheral:

  • sudden onset of vertigo
  • horizontal nystagmus
  • visual fixation inhibits nystagmus

Central:

  • onset of vertigo is gradual
  • nystagmus in any direction usually vertical
  • visual fixation does NOT stop nystagmus

Sx of Peripheral:

  • blurred vision
  • fatigue, HA
  • palpitations
  • imbalance
  • inability to concentrate
  • increased risk for motion sickness
  • N/v
  • sensitivity to bright lights and noise
  • sweating from sympathetic stimulation

Sx of Central:

  • double vision
  • HA
  • impaired conciousness
  • inability to speak d/t muscle impairment
  • lack of coordination
  • n/v
  • weakness
34
Q

Benigns Paroxysmal Positional Vertigo

  • defined as
  • causes
  • course of disorder
  • sx
  • test for dx
A

defined as disloged otoliths that move into the semicircular canals which causes the semicircular canals to become sensitive to head position changes it would normally not respond to, which is what makes you feel dizzy.

Causes:

  • utricle damage by head injury
  • infection
  • advanced age

Course:
-recurrent brief episodes (lasting less than 1 minute)

Sx:

  • predictable head movements or positions precipitate sx
  • horizontal nystagmus
  • no neuro auditory sx

Tests:

  • Dix-hallpike maneuver
  • romberge
  • weber-rinne
35
Q

What is the Dix-hallpike maneuver?

A

-person brought from sitting to supine position with the head turned 45 degrees to one side and extended 20 degrees backwards.

Positive test consists of a burst of nystagmus.

36
Q

Tx of Benignt paroxysmal positional vertigo?

A
  • wait it out

- epley maneuver

37
Q

What is the epley maneuver ?

A

-aka particle repositioning procedure.

involve sequential movement of the head into four positions, staying in each position for 30 seconds.

38
Q

Vertigo: labrynthitis

  • defined as
  • clinical course
  • cause
  • tx
A

defined as inflammation of the inner ear

course:
- vertigo - sensation of spinning or whirling that may cause n/v. Gradually goes away over a period of several days to weeks
- may have accompanied hearing loss that is temporary.

Cause:
- often triggered by an upper resp infection (viral)

Tx:

  • goes away on its own after several weeks
  • medications for N/V :
  • -Compazine
  • -Meclazine
  • -Diazepam/Lorazepam
39
Q

Vertigo: Meniers

  • aka
  • what is this?
  • sx
  • dx criteria
A

aka: endolymphatic hydrops
what: vertigo that results from distention of the endolymphatic compartment of the inner ear.

Sx:

  • episodic vertigo lasting 1-8hrs
  • rotary or rocking
  • low frequency sensorineural hearing loss
  • tinnitus
  • sensation of aural pressure

Dx criteria:

  • 2 spontaneous episodes of rotational vertigo lasting at least 20 minutes
  • audiometric confirmation of sensorineural hearing loss
  • tinnitus and/or preception of aural fullness.
  • test pt for syphillis?

Tx:

  • dietary restriction; caffiene, tobacco, salt
  • Meds:
  • -diuretics, antiemetics, anxiolytics, antihistamines, scopolamine
40
Q

Presbycusis

  • what is this?
  • characteristics
A

What: sensorineural hearing loss in elderly individuals, histologic changes associated with aging occur from the hair cells of the cochlea to the auditory cortex in the temporal lobe of the brain.

Characteristics: bilateral high-frequency hearing loss associated with difficulty in speech discrimination and central auditory processing of information

41
Q

Elderly individuals may rely on their hearing to overcome limitations of impaired vision and slowed reaction time, T/F?

Arthritis and impaired dexterity may limit their ability tot take advantage of the amplification devices used in rehabilitation of age associated hearing loss, T/F?

A

True and True

42
Q

Describe each of the following types of Presbycusis

  • sensory
  • neural
  • metabolic
  • mechanical
A

Sensory: epithelial atrophy with loss of sensory hair cells and supporting cells in the organ of corti

Neural: atrophy of nerve cells in the cochlea and central neural pathways.

Metabolic: atrophy of the stria vascularis (maintains the chemical and bioelectric balance and metabolic health of the cochlea)

Mechanical:thickening and secondary stiffening of the basilar membrane of the cochlea.

43
Q

Presbycusis

  • presentation
  • tx
A

Presentation:

  • varies
  • diff hearing

Tx:

  • amplification devices; hearing aids
  • lip reading
  • cochlear implants
  • assistive listening devices (amplification of telephone and TV via microphone in pt ear)
  • follow up

ENT (10 decks)

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