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35 Cards in this Set

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What should normally happen w/a Weber Test?
Sound should not lateralize.
Conductive loss-sound lateralizes to impaired ear.
Sensorineural loss-sound is lateralized to good ear.
What should normally happen w/a Rinne test?
Conductive loss-BC=AC or BC>AC

Sensorineural loss-AC>BC
Sensory hearing loss;
(Meniere's dz) Due to disorders in the inner ear, speifically the cochlea.
Neural hearing loss;
Problem w/the auditory nerve, most important cause acoustic neuroma, benign tumor that grows on the vestibular nerve, & presses on the auditory nerve.
Test-Acoustic reflex
Conductive hearing loss;
Results from external or middle ear problem. Causes; otitis media, cerumen impaction, & otoclerosis.
Indications for ear lavage;
Totally occlusive cerumen (prevents visulization of the TM), Pain, Itching, Reduced hearing, Tinnitus, Otitis externa (if ear suctioning is not available)
Otitis Externa;
(gram-)Pseudomonas, Proteus, Fungus. Painful manipulation of auricle & tragus. TM/Red, canal edematous, TM responds to pneumatic O. Otic ABX & steroid (make sure med can get in)
Estacian Tube Dysfunction;
Due to inflammitory process in; Nasopharynx, allergic manifestations, hypertrophic adenoids, benign or malignant Neoplams. Tx; Sudafed (restores patency to tube), Correction of underlying problem.
Damage due to pressure changes (pressure in middle ear is lower than ambient pressure), Membrane is retracted, Nasovasoconstrictor applied topically 30-60min before decent (prophylatic)
Barotrauma Etiology;
A transudate of blood from the vessels in the lamina propria of the mucous membran forms in the middle ear. If pressure differenc becomes great ecchymosis & subepithelial hematoma may develop in the mucous membrane of the middle ear & TM.
Cholesteatoma Etiology;
A benign tumor that destroys the incus, staples & malleus. During the healing of acute necrotizing otitis media, epithelium of the ear canal migrate to cover the denuded areas. Once the epithelium is established in the middle ear it begins to desquamate & accumulate resulting in a cholesteatoma.
Cholestetomas actively erode bone. Hearing loss, discharge (bad smell). Tx; ABX (po & gtts), Weekly cleaning undert the surgical microscope, surgical removal.
Common cause of progressice conductive hearing loss, normal bone is replaced by spongy, vascular bone that hardens (anterior oval window), addition of bone causes the stapes to become immobile & unable to transmit sound to the cochlea.
Otosclerosis S/Sx;
Conductive hearing loss, Pinkish or rosy tint on TM (Schwartz sign), Air-bone gap, 85% bilateral, Excellent speech discrimination, 70% tinnitus, 25% Vertigo, hears better in noise.
Otosclerosis Tx;
Na flouoride, hearing aids, Stapedectomy (removal of stapes) 97%-99% effective.
Perception of sound in its absence, Indicates sensory hearing loss, Damage to inner ear, middle ear inf, any ear disorder, Aneurysm's, hardening of arteries, Med toxicity.
Tinnitus Tx;
Tx underlying cause, background music, hearing aid, avoid further damage.
Meniere's Dz;
Characterized by; recurrent vertigo, sensory hearing loss, tinnitus, feeling of fullness in ear. Lesion on & Distention of endolymphatic compartment. Tx; empirical, surgery for severely affected people, Anticholinergic drugs, antihistamines, barbituates, Na restrictions, no caffeine, no smoking, exercise.
Acoustic Neuroma;
Derived from schwann cells, account for 7% of intracranial tumors, tumor presses on 5th & 7th cranial nerve. S/Sx; Sensorineural Hering loss & tinnitus, dizzinesss (no true vertigo), >impairment of speech discrimination, Acoustic reflex decay, marked vestibular hypoactivity. MRI & gadolinium enhancement. Tx; Surgery.
Sensorineural hearing loss ocurs as pt ages, (>65) Men>women.
Tx; hearing aid
Purulent Labyrinthitis;
Invasion of the inner ear by bacteria. Frequently followed by meningitis. May be secondary to Acute OM or Purulent meningitis. Characterized by; Severe vertigo, Nystagmus, Complete hearing loss, Cholesteatoma, Facial Paralysis. Tx; IV ABX & Labyrinthectomy to drain the inner ear or radical mastoidectomy.
Noise Trauma;
Any noise >85dB is damaging. High freq tinnitus usually accompaines hearing loss.
Vestibular Neuronitis;
Benign disorder, Viral, 1st attack of vertigo is severe, (nausea & vomiting) for 7-10days. Nystagmus on affected side, self limiting. Tx; Anticholinergic drugs, antihistamines, barbituates, Na restrictions, no caffeine, no smoking, exercise. IV fluids & electrolytes for fluid replacement PRN.
Drug of choice for Acute Otitis Media?
High dose Amoxicillin90mg/kg qd divided q 8-12hrs.
Nasal decongestionant helps w/sx.
Bacterial inf in the mastoid process. Extension of acute purulent otitis media, can cause destruction of mastoid process. Streptococcal mastoiditis proceeded by perforation of TM & profuse otorrhea. Pneumococcal mastoiditis may be less symptomatic. Onset >2wks p untreated acute OM, Abscess, Pinna is displaced laterally & inferiorly, creamy profuse d/c.
Mastoiditis Tx;
ABX (same as for OM), C&S to determine ABX, IV therapy, Mastoidectomy, Meningitis.
Acute otitis media;
Inflammation of middle ear w/rapid onset of sx. Pathogens; Strep, Pneumoniae, & HiB.
Acute otitis media S/Sx;
Are nonspecific & often result from an URI. Decreases TM mobility, Bulging TM, Impaired visibility of ossicular landmarks, TM red or yellow, Exudate on the membrane & bullae.
Acute otitis media complications;
Tympanosclerosis, Adhesions, Ossicular erosions, Perforations, Cholesteatoma, Mastoiditis, Osteomyelitis, Meningitis, Sinus Thrombosis, Facial Paralysis.
Serrous otitis media;
Auditory tube remains blocked for a prolonged peroid. Neg pressure results in transudation of fluid. Plugged ear feeling.
Serrous otitis media findings;
Visualization of air-fluid levels, clear or amber middle ear fluid, diminished membrane mobility, Air bubbles, conductive hearing loss.
Serrous otitis media Tx;
Po corticosteroids, Po ABX, if no improvement Ventilation tubes.
Chronic Otitis Media;
Develops as a result of recurrent otitis media. Bacteria; Pseudomonas aeruginosa, Proteus, Staph aureus & mixed anaerobin inf. Purulent aural d/c.
Chronic Otitis Media Tx;
Removal of debris, no H2O exposure, Topical ABX (only floxin indicated for perforated TM. Surgical repair of TM.
Perforated TM;
May repture as result of untx TM, due to increases pressure. Complications; Conductive hearing loss, exacerbations of otorrhea, labyrinthitis, facial paralysis, intracranial suppuration. Tx; ABX, C&S, Surgical removal of debris (& cholesteatoma) middle ear reconstruction.