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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
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Causes of conductive hearing loss
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- 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 |
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- 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
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Eustachean tube
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- principally made up of bone
- really can't do much to "fix" anatomical probs b/c it is in an inaccessible location |
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What color should the tympanic membrane be?
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- white or a light color
- yellow, grey, and red indicate an accumulation of fluid |
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What is the annulus?
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- the surface connection of tympanic membrane to canal wall
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What is the only ossicle attached to the tympanic membrane?
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the malleus
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What can cause a ruptured tympanic membrane?
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- bacteria
- infection - trauma |
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What is a marginal perforation?
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- 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
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- 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
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WHat is a myringotomy?
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- 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 |
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What happens if you don't treat Acute otitis media or acute middle ear infx in time?
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Can form mastoiditis and Bezold's abscess
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What is Bezold's abscess?
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- 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 |
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What is conductive hearing loss?
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- 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. |
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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) |
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- 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
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- 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 |
Otosclerosis
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What is the treatment for otosclerosis?
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- 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 |
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What is the rate of complete congenital atresia?
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1:10,000 births
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What is the most common congenital deformity of the ear?
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- Lop ear - its a protrusion of the conchal cartilage
- treat before age 5-6 |
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What is sensorineural hearing loss?
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Nerve disorders from the oval window footplate inward including:
- cochlea - auditory - brainstem nuclei - cerebral cortex |
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What are the types of sensorineural hearing loss?
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- presbycusis
- noise induced - auditory trauma - congenital and at delivery (birth anoxia) - metabolic - autoimmune - infectious - ototoxic agents - idiopathic |
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What are the metabolic causes of SN hearing loss?
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- diabetes mellitus
- HTN - hypothyroidism - vascular insufficiency - Renal disease, liver disease - Paget's disease of bone - Osteogenesis imperfecta types I-IV (also associated with conductive hearing loss) |
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What are the traumatic causes of SN hearing loss?
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- perilymph fistula
- temporal bone fracture - love tap perforation (usually left ear) |
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What are the autoimmune causes of SN hearing loss?
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- Wegener's granulomatosis
- SLE - Multiple sclerosis |
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What are the tumors that cause SN hearing loss?
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- Acoustic neuroma
- Schwannoma - CNS malignancies |
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What are the ototoxic agents that cause SN hearing loss?
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- Alcohol, tobacco
- Aminoglycoside abx - Antimetabolites - cisplatin, mechlorethamine - Diuretics - ethacrynic acid - Salicilates - ASA, NSAIDs |
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What are the infectious agents that cause SN hearing loss?
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- Rubella (1st trimester)
- TORCH - Syphillis - Mumps - Meningitis - Septicemia - AIDS |
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What is Meniere's Disease?
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- 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
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What are the causes of Meniere's disease?
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- autoimmune
- metabolic - anatomical |
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What is perilymph?
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- Fluid that surrounds endolymphatic sac
- has a high Na+ concentration |
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What is endolymph?
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- fluid inside the endolymphatic sac
- has a high K+ concentration |
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What are the 3 hallmarks of Meniere's Disease?
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1)prostrating vertigo (fall to floor b/c so dizzy)
2)roaring tinnitus 3)hearing loss + feeling of fullness in ear |
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- 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
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What is central facial nerve paralysis usually from?
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- CVA
- Tumor - blockage |
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What are the causes of facial nerve paralysis?
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- 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) - AIDS - Parotid gland tumor |