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46 Cards in this Set

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Otitis Externa
bacterial infection of the external auditory canal

Acute or chronic is characterized by its time course
Acute Otitis Externa
"swimmer's ear"
Pre-inflammatory Stage
Mild to moderate stage
Severe Stage
Chronic Otits Externa (COE)
Persistant symptoms >2 months
bacterial, fungal, or dermatological etiologies
COE Signs
* Asteatosis
* Dry, flaky skin
* Hypertrophied skin
* Mucopurulent otorrhea (occasional)
COE Symptoms
*Unrelenting pruritis
*Mild discomfort
*Drying of canal skin
COE Treatment
*Re-acidification
*Topical antibiotics, frequent cleanings
*Topical steroids +/-
*Surgical intervention
*failure of med treatment
*goal is to enlarge and
resurface the EAC
Cerumen Impaction
signs and symptoms
-Build up of wax/cerumen
-wax turns from liquid to solid state
-cause pain and slight hearing loss
-harder to distinguish direction
fullness
Causes of Cerumen Impaction
torchuous canal
hair dysfunction
Q-tips
bony exoctosis
Cerumen Impaction Treatments
Gentle flushing or suction
Softening agents; Cerumenex
Barotrauma
Any dysfunction
Barotrauma causes
pain
hearing loss
TM perforation
Barotrauma Treatment
decongestants
myringotomy
prevention
Tympanic Membrane Perforation
*sequel to infections
*direct trauma or barotrauma
*may be painful or pain relieving
*visible on exam; tympanometry
*acute hearing reduction is surprisingly small
*healing dependent on age, extent, location
Tympanic Membrane Perforation
Treament
*Tincture of Time
20% tear or less, will heal on it's own
*protection for small tears
*myingopalsty for large, refractory
Otitis Media
Inflammation of the middle ear; may also involve inflammation of mastoid, petrous apex, and perilabyinthine
Acute Otitis Media OAM
rapid onset of signs and sx
<3 wk course
Chronic Otitis Media COM
lasts 3 mos or longer
Subacute Otitis Media
lasts 3wks to 3 mos
Acute Otitis Media diagnosis
*proceding URI
*fever, otalgia, hearing loss, otorrhea
*may have associated constitutional sx
Chronic Middle Ear Efuusion
*possibility asymptomatic
*hearing loss
*plugged
*popping
Acute Otitis Media characteristics
*dull, red, bugling TM
*reduced light reflex (cone of light gone)
*immovable TM due to fluid buildup
Chronic MEE characteristics
+/- dull
NOT red
air/fluid level and/or bubbles
AOM treatment
most often antibiotics
need to consider drug resistant patterns
Recurrent AOM Treatment
Chemoprophylaxis; amoxicillin, ampicillin
Insertion of tubes
Adenoidectomy
Chronic Otitis MEE symptoms
>3 months or assoc w/ hearing loss
vertigo
frequency
ME pathology
discomfort
Chronic Otitis MEE-Treatment
*Antibiotics
*Antibiotics + steroids
*Myringotomy & tympanostomy +/- adenoidectomy
Mastoiditis
*inflammation of the mastoid
*mastoid air cells infected
*sequel for under or untreated otitis media
*
Mastoiditis signs & symptoms
Otitis Media symptoms PLUS:
*pain over mastoid
*+/- erythema
*fever
*xray will show air cell destruction
Mastoiditis treatment
*myringotomy for C&S
*appropriate high-level antibiotics
*Mastoidectomy for medical failure
Tinnitus
*perception of sound when thereis none in the enviroment; ringing in ears

*can be associated w/ conductive or sensorineural hearing loss

*may be 1st symptom of an acoustic neuroma

*pulsatile tinnitus associated with vascular lesions
Hearing loss due to a central auditory processing disorder results in difficulty with:
speech perception
chronic exposure to loud noise can result in:
high-frequency hearing loss
causes of conductive hearing loss include:
*cholesteatoma
*paget's disease/osteitis deformans
*otosclerosis
*cerumen impaction
Meniere's Disease
*idiopathic disease
*overproduction of endolymphatic fluid
*underabsorption of endolymphatic fluid
~results in distortions
in the inner ear
*hearing is decrease due to dilation of the cochlear duct
*vertigo due to damage of vestibular system
*usually unilateral
Meniere's disease symptoms
all three must be present
*tinnitus; continuous & low pitched. gets louder during the attacks
*vertigo; whirling
*unilateral sensorineural hearing loss-hearing loss often worse during attacks
Meniere's non-surgical treatment
*slow movements
*salt and fluid restrictions
*NO SMOKING
*DIURETICS-acts directly
*antimetics-drugs to treat nausea and vomiting
*ANTIHISTAMINES-1st choice
*antianxiety meds
Meniere's surgical treatment
*Labyrinthectomy
-result in permenant
hearing loss in that ear
*Endolympatic Decompression
-shunt placed in endolympahtic sac for drainage
Labyrinthitis
aka Vestibular Neuronitis
*common; last 7-10 days
*acute, unilateral viral inner ear infection that often proceeds a URI (1 week after cold)
Labyrinthitis symptoms
*Sudden sever rotating vertigo
*often w/ nausea and vomiting
*DO NOT have loss of hearing or tinnitus
*Nystagus common
*Ataxia occasionally
How to properly diagnose Labyrinthitis
*careful examination
*rule out other possible causes
~esp. vascular incidents in the elderly
Labyrinthitis treatment
*Meclizine: anti-vertigo
*Dramamine: anti-histamines with high anti-vertigo effects
*anti emetics
Epiglottitis
specific bacterial infection of the epiglottis
ACUTE MEDICAL EMERGENCY
Symptoms of epiglottitis
*drooling a lot
*hot potato voice
*difficulty swallowing
*fever
*eventually resp distress
AOE: Preinflammatory Stage

__1__ of stratum corneum and __2__ of apopilosebaceouos unit

Symptoms: __3__ and sense of ___4__

Signs: __5__ edema

Starts the __6__/__7__ cycle
1. Edema
2. Plugging
3. Pruitis
4. Fullness
5. itch
6. scratch
AOE: Mild to Moderate Stage

Progressive infection

Symptoms: Pain
increased __1__

Signs:
*___2___
*Increased __3__
*Canal debris; ___4____
1. Pruitis
2. Erythema
3. Edema
4. Discharge
AOE: Severe Stage

*Severe pain; worse w/ ear movement

Signs:
*Lumen ___1____
*___2____ otorrhea
*Involvement of periauricular soft tissue
1. obliteration
2. purulent