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36 Cards in this Set

  • Front
  • Back
- swimmers ear
- medical emergency
- infx ensues rapidly
- edema in external canal spreads to lymph in neck
- Tx - abx & topical ear drops
Acute Bacterial Otitis Externa
Causes of conductive hearing loss
- cerumen blocking sound waves
- Otitis media - inflam. of middle ear space
- Aerotitis media - eustacean tube dysfunction - ET ventilation prob - pressure problem behind ear drum
- Barotrauma - most severe form of ET dysfunction - seen in divers
- Secretory Otitis Media (w/ effusion) - Acute = extremely painful, Chronic = less painful - fluid filling middle ear space
- eustachean tube dysfx has to be present
- conductive hearing loss is almost always present
- risk factors include allergies, barotrauma, smoking, congenital risk (downs, cleft palate), immaturity of age
- Complications include tympanic membrane perf, cholesteatoma, and mastoiditis
Chronic Otitis Media
Eustachean tube
- principally made up of bone
- really can't do much to "fix" anatomical probs b/c it is in an inaccessible location
What color should the tympanic membrane be?
- white or a light color
- yellow, grey, and red indicate an accumulation of fluid
What is the annulus?
- the surface connection of tympanic membrane to canal wall
What is the only ossicle attached to the tympanic membrane?
the malleus
What can cause a ruptured tympanic membrane?
- bacteria
- infection
- trauma
What is a marginal perforation?
- a larger perforation that extends all the way to the edge of the annulus ring of the ear drum as opposed to a central perforation
- Dangerous for adults and children
- caused by Strep pyogenes, Strep pneumoniae, H. flu, and M catarrhalis
- Signs include high fever, irritability in children, rupture of ear drum, abscess formation
- 75% of pts. need treatment
- if prob persists, suggest myringotomy
Acute Suppurative Otitis Media
WHat is a myringotomy?
- draining the fluid from the ear drum
- make insicion, drain fluid out, and insert pressure equalizing (PE) tube
- causes passive expansion of air so it temporarily takes pressure away from ET so it can normalize and edema can be reduced
What happens if you don't treat Acute otitis media or acute middle ear infx in time?
Can form mastoiditis and Bezold's abscess
What is Bezold's abscess?
- abscess in the mastoid that started in the middle ear
- absolute emergency!
- need to treat right away or can become brain abscess
- Tx is to surgically incise and drain and IV abx
What is conductive hearing loss?
- sound can't get in for the nerve endings in the cochlea to hear them
- Conductive problem is the outer ear, pinna, external ear canal, eardrum, and ossicles
- Once it is in the cochlea/inner ear, it becomes sensorineural hearing loss.
What is the most common reason for conductive hearing loss in adults?
in children?
- in adults = cerumen impaction
- treat with debridement or cerumenolytics
- In children it is fluid collection (otitis media)
- vascular tumors from the jugular bulb and tympanic plexus
- non-chromaffin producing paragangliomas like carotid body tumor
- positive Brown's sign (TM pulsation inhibited by pressure of pneumatic otoscope - blanching)
- these tumors are benign, but behave malignant by local erosion and local expansion
- Can act like a foreign body and erode through portions of the inner ear
Glomus jugulare and glomus tympanicum
- ankylosis of the stapes footplate
- females 2:1
- bilateral 80% of time
- Most common form of progressive conductive hearing loss in whites
- hereditary - autosomal recessive
- form of bone deposition of the stapes bone footplate where it fuses to the surrounding bone of the inner ear - prevents NC vibration - conduction prob
What is the treatment for otosclerosis?
- f/u for at least a year to see progression
- no real medical treatment
- can try amplification (hearing aid)
- Surgery - stapedectomy
- fracture away bone deposition and stapes bone and put insert wire between incus and inner ear
- usually restores hearing completely
What is the rate of complete congenital atresia?
1:10,000 births
What is the most common congenital deformity of the ear?
- Lop ear - its a protrusion of the conchal cartilage
- treat before age 5-6
What is sensorineural hearing loss?
Nerve disorders from the oval window footplate inward including:
- cochlea
- auditory
- brainstem nuclei
- cerebral cortex
What are the types of sensorineural hearing loss?
- presbycusis
- noise induced
- auditory trauma
- congenital and at delivery (birth anoxia)
- metabolic
- autoimmune
- infectious
- ototoxic agents
- idiopathic
What are the metabolic causes of SN hearing loss?
- diabetes mellitus
- hypothyroidism
- vascular insufficiency
- Renal disease, liver disease
- Paget's disease of bone
- Osteogenesis imperfecta types I-IV (also associated with conductive hearing loss)
What are the traumatic causes of SN hearing loss?
- perilymph fistula
- temporal bone fracture - love tap perforation (usually left ear)
What are the autoimmune causes of SN hearing loss?
- Wegener's granulomatosis
- Multiple sclerosis
What are the tumors that cause SN hearing loss?
- Acoustic neuroma
- Schwannoma
- CNS malignancies
What are the ototoxic agents that cause SN hearing loss?
- Alcohol, tobacco
- Aminoglycoside abx
- Antimetabolites - cisplatin, mechlorethamine
- Diuretics - ethacrynic acid
- Salicilates - ASA, NSAIDs
What are the infectious agents that cause SN hearing loss?
- Rubella (1st trimester)
- Syphillis
- Mumps
- Meningitis
- Septicemia
What is Meniere's Disease?
- its a dilation of the membranous labrynth including the scala media and the endolymphatic sac, fistulas btwn the perilymph and endolymph, and presence of circulating immune complexes in the fluids
What are the causes of Meniere's disease?
- autoimmune
- metabolic
- anatomical
What is perilymph?
- Fluid that surrounds endolymphatic sac
- has a high Na+ concentration
What is endolymph?
- fluid inside the endolymphatic sac
- has a high K+ concentration
What are the 3 hallmarks of Meniere's Disease?
1)prostrating vertigo (fall to floor b/c so dizzy)
2)roaring tinnitus
3)hearing loss + feeling of fullness in ear
- tumors of 8th cranial nerve - 8th CN takes info from cochlea + labyrinth to brain
- 8% of intracranial tumors, freq.= 1:100,000 individuals
- Account for 80% of cerebellopontine tumors
- produce ONE SIDED high frequency SN hearing loss, tinnitus, tone decay, unsteadiness, loss of balance, and incoordination sa tumor enlarges
- Tx is surgical removal by transmastoid-translabyrinthine approach or middle cranial fossa approach
Acoustic Neuroma and Vestibular Schwannoma
What is central facial nerve paralysis usually from?
- Tumor
- blockage
What are the causes of facial nerve paralysis?
- Acute or chronic suppurativ otitis media or mastoiditis
- Cholesteatoma expansion
- Trauma or temporal bone fx
- cerebellopontine angle tumor
- CNS malignancy
- surgical trauma
- lyme disease (bilateral)
- Guilliane Barre syndrome
- Ramsay Hunt Syndrome (Herpes Zoster oticus)
- Parotid gland tumor