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72 Cards in this Set
- Front
- Back
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What is the location and function of the External Ear |
Auricle (pinna) - funnels sound into EAM External auditory canal; separated from the middle ear by the TM - funnels sound
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What is the location and function of the Middle Ear
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Air filled cavity in the temporal bone containing the middle ear space, tympanic membrane, and ossicles
Transmit sound vibrations from the TM to the oval window of the inner ear. |
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What is the location and function of the Inner Ear
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Vestibule
Cochlea: 3 chambers and organ of court (end organ of hearing) scala vestibule, scala media, scala tympani - Transmits sound to CN VIII Semicircular Canals - 3 canals oriented in 3 different planes; determine balance and motion Auditory Nerve: transmits sound to CN VIII |
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What is the location and function of the Eustachian tube? |
-Tube that connects the middle ear to the nasopharynx -Provides ventilation and drainage of the middle ear. It is normally closed, opening only during swallowing or yawning. |
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Acute Otitis Media: General Pathogens |
Moderate to severe TM bulging with or without new onset of otorrhea not due to otitis externa Pathogens: Viral and Bacterial - 2/3rds of infections have both h. influenzae m. catarrhalis s. pneumonia |
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What is the key criteria (S/S) in diagnosing acute otitis media? What do you have to SEE to Diagnose it? |
Moderate to severe Tympanic Membrane (TM) bulging With or without otorrhea ***You have to see the TM to diagnose*** |
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What is the treatment recommended for Non-Severe AOM if there is diagnostic certainty? In what age group is there an observation option prior to administering a Rx for AOM? What are the criteria for this? |
Antibiotics - if diagnostic certainty 6 months - 2 years Delayed Rx for ABX to fill 3 days later if not better or if gets worse |
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What are the criteria (S/S) for a Severe AOM? What do you treat with? |
1. Moderate to severe otalgia (most common complaint) 2. Temp > 39 degrees C (102.2 F) 3. Otalgia >48 hours Antibiotics - Amoxicillin |
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What is the Drug of Choice for Acute Otitis Media treatment?
What is the Drug of Choice if the AOM is at high risk for resistance? If the patient is allergic to this drug, what is an alteranative? |
Amoxicillin amoxicillin/clavulanate (Augmentin) or Ceftriaxone Ceftriaxone, cefidinir, cefuroxime, cefpodoxime |
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What conditions are considered a low risk for resistance when prescribing amoxicillin for AOM? Are ABX prescribed for non-severe cases? |
1. Not received beta-lactam antibiotic in previous 30 days 2. Conjuntivitis 3. No history of repeated infections resistant to amoxicillin If high diagnostic certainty is present - yes |
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What is the most frequent diagnosis in sick children visiting a clinicians office and accounts for the most common reason for administration of antibiotics? |
Acute Otitis Media |
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What is the etiology/risk factors for AOM?
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Patients unvaccinated for pneumonia Patients not exclusively breastfed for first six months Second hand tobacco exposure Pacifiers Viral Upper Respiratory Infection -causes inflammation edema of the eustachian tube which obstructs to secretions of the middle ear causing them accumulate. Virus/Bacteria enter the middle ear by aspiration, reflux, or insufflation and microbial growth begins in it. This leads to suppurations and clinical signs of AOM. |
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What are the criteria for duration of treatment to AOM is 1. Age <2, TM perforation or hx of recurrent infection 2. > or = 2-5 years, no perforation or chronic history? 3. > or = 5 years? |
1. 10 days 2. 7 days 3. 5 days |
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What is meant by "Obeservation does not equal no treatment" mean in AOM? |
Give analgesics for pain Give information about care Give Delayed Antibiotic Rx to fill within 3 days if no better or gets worse (2/3 patients won't fill the RX) |
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What are Causes of treatment failure in AOM and what are options in this occurrence? |
Failure to improve within 72 hours: Causes: Combined viral and bacterial infection Bacteria are resistant Misdiagnosis Options: Treat with Augmentin or Ceftriaxone Refer |
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What is recurrent AOM defined as? When do you refer to an ENT? |
3 or more infections < 6 months OR 4 infections in < 12 months AND have persistent effusion and/or flat tympanograms Refer!!! to discuss Tympanostomy Tubes -reduce rate of infections by about 3 episodes/year - parent/patient preference |
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What can be done as prevention of AOM? |
Exclusive breastfeeding for first 6 months No second hand tobacco exposure No pacifiers |
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What are the common complications of Acute Otitis Media? |
Mastoiditis Cholesteatoma due to chronic/recurrent infections (abnormal skin growth in the middle ear behind the ear drum) TM perforation |
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What is serous otitis media (Otitis media with Effusion)? What are possible causes of it? |
Presence of fluid in the middle ear without signs or symptoms of acute ear infection. Poor eustachian tube functions, Inflammatory response following AOM |
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How long does a serous otitis media take to resolve? If fluid does not clear in children in what time frame; what should you do? |
Many resolve spontaneously within 3 months 30-40% will have recurrent AOM 5-10% of episodes will last 1 year or longer In 4-6 weeks; Tympanostomy & Tube placement |
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What is the appearance of the TM is serous otitis media? What method is used for diagnosis? Persistent effusion may result in what? |
-Fluid in middle ear -TM will appear cloudy with impaired mobility -Air-fluid level or bubbles may be visible in the middle ear. -No s/s of acute ear infection "Redness" alone not criteria to rx antibiotics - present in 5% of patients Dx - pneumatic otoscopy or tympanogram Persistent effusion may result in hearing loss and speech/language delays |
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What are complications of serous otitis media? |
Hearing loss Speech language delays |
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What is considered a chronic suppurative otitis media? (chronic otitis media with effusion) |
> or = 4 episodes/ year or unresolved serous otitis media. |
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What is malignant external otitis? |
A rare and serious form of otitis external to which the elderly, diabetics, and immunocompromised are particularly susceptible NOT A CANCER but a condition more common in immunocompromised, the elderly and diabetics |
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What are the pathogens in malignant external otitis? |
Pseudomonas aeruginosa and other anaerobes |
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What are the S/S of malignant external otitis? |
Invasive infection of external auditory canal and skull base Severe otalgia Severe otorrhea: not responsive to topical measures. Potentially Fatal!!! |
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What is the treatment for Malignant external otitis? |
Intense intravenous antibiotics (IV fluoroquinolone) Potential surgical drainage |
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What are complications of Malignant External Otitis? |
Mastoiditis Osteomyelitis of skull base/TMJ Cranial Nerve Palsies |
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What is Otitis externa? What are common manifestations? |
Common painful infection of the outer ear canal. Otalgia, Pain, erythema, edema, itching, fullness, discharge, and hearing loss. May have regional lymphadenopathy Exostosis: edema of external ear canal May have Exudate Possible Fever |
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What are the risk factors for Otitis external? |
Water exposure Trauma Q-tip abuse |
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What is the causative pathogens of otitis external? |
Pseudomonas aeruginosa- 60% staph aureaus - 15% Fungi - 10% |
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What are potential complications of otitis external? |
-Stenosis, -TM perforation, -Local extension of infections - chondrites, parotitis, malignant external otitis |
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What treatment is done with otitis external? |
May attempt to clean canal of debris (very painful) **DO NOT Irrigate*** Most Common: ABX drops and Corticosteroid: Cipro HC, Cortisporin, Ciprodex and Ear wicks may help if severe swelling. *most do not need oral antibiotic unless signs of local extension or other toxicity* |
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What is barotrauma? Risk Factors/ Etiology? |
Traumatic inflammatory disorder of the middle ear produced by sudden and severe pressure differential Eustacian tube dysfunction Risk factors: Divers, Fliers |
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What are the clinical indicators of barotrauma? |
Hx of otalgia during ascent/descent Hemorrhage of the TM Hearing loss Aural fullness TM perforation Tinnitus, Vertigo Nausea, Vomiting |
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What treatment is done for barotrauma? |
**Most cases will resolve spontaneously** -Abstinence from activity -Pressure equalization techniques: yawning, swallowing, valsalva, chew gum, frenzel -Topical nasal decongestants -Oral Decongestants -Nasal steroid sprays -Oral steroids -Antibiotic Therapy in some circumstances |
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What are the risk factors/etiology of Eustachian tube dysfunction? |
Nasal congestion Turbinate hypertrophy |
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What are the clinical s/s of eustachian tube dysfunction? |
Negative pressure in middle ear Fullness in ear Hearing impairment Retracted TM |
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What testing is done for Eustachian tube dysfunction? |
When the tube is partially blocked the ear will pop and click |
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What is the treatment for eustachian tube dysfunction? |
Oral steriods Oral decongestants Topical nasal decongestants Nasal steroid sprays Valsalva |
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A skin growth that occurs in an abnormal location, the middle ear behind the eardrum. Usually due to repeated infection, which causes ingrowth of the skin in the eardrum. |
Cholesteatoma |
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What is Cholesteatoma? S/S? |
-Chronic negative inward pressure draws upper flaccid portion of the TM in -Creates a sac full of desquamated keratin which sheds and becomes chronically infected -Keratin debris -Granulation tissue -Tumor growing in a small space(migration of epithelium into the middle ear via posterior marginal perforation) |
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What are the risk factors/etiology of cholesteatoma? |
Chronic (repeated) otitis media Prolonged eustachian tube dysfunction |
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What are appropriate treatment options for cholesteatoma? |
Marsupialization (cutting a slit into it to make a continuous surface) Complete removal - a mastoid bowel is created which must be periodically cleaned |
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What are complications of cholesteatoma? |
Hearing Loss Facial Paralysis due to Facial Nerve Damage Dizziness Can continue to grow and erode bones of middle ear and skull base (mastoiditis) |
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When does a hematoma of the external ear occur? What does it appear as? What is treatment? |
Occurs when shearing trauma separates the cartilage from the perichondrium creating a space for blood to collect Cauliflower ear: fibrotic changes; deformity Ear should be excavated Compressed for one week ABX |
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What is pericondritis? |
A painful red and swollen pinna accompanied by fever, following trauma or surgery, suggests infection. (spares lobules as it does not contain cartilage) |
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What causes (risk factors/etiology) perichondritis? |
Infection of the skin and tissue surrounding the outer ear Injury to the ear -surgery -piercing ear cartilage -contact sports -burns -acupuncture |
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What is the pathogen that causes perichondritis? What is the treatment? What are the complications? |
pseudomonas aeruginosa Adults: Levofloxacin Children: Augmentin Chondritis; cauliflower ear with sever cases |
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What are risk factors/etiology for sensorineural hearing loss? |
Involves the inner ear, cochlea, and/or auditory nerve - damage to the hair fibers and nerve damage that cannot be reversed -Age -Noise exposure -Acoustic neuroma -Congenital hearing loss -Family hearing loss -Syphilis -Rubella -Meningitis |
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What are the s/s of sensorineural hearing loss? What tests are done? What are possible treatment options? |
Diminished hearing Tinnitus Misinterpretation of speech Basic Comp (hearing test), Tympanogram to check for movement of ear drum, MRI of IAC's with contrast to R/O acoustic neuroma Hearing aid Appropriate treatment if acoustic neuroma |
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What are risk factors/etiology of conduction hearing loss? |
Any cause that in some way limits the amount of external sound from gaining access to the inner ear. TM perforation Fluid in middle ear space Severe tympanosclerosis Ossicular chain fixation Cerumen impaction Exostosis |
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What is the most common cause to conductive hearing loss? |
Cerumen Impaction |
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What are the clinical s/s of conductive hearing loss? |
Diminished hearing TM perf Cerumen impaction Fluid in middle ear space Bulging TM Tympanosclerosis Exostosis |
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What are the tests conducted for conductive hearing loss? What are appropriate treatments? |
-Basic hearing test, -tympanogram to check for movement of the ear drum -Tympanoplasty -ABX if middle ear is due to infection -Tympanostomy and tubes if meets criteria -Cerumen removal -Tx of exostosis with aural steroid/ABX drops |
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What is Ramsay-Hunt Syndrome (Herpes Zoster Oticus)? (Etiology/Risk factors) |
Infection of the facial nerve ganglion by herpes zoster |
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What is the general pathogen in Ramsay- Hunt syndrome? What are the clinical s/s? |
Reactivation of Herpes Zoster virus Vesicular rash affects pinna and pre-auricular region of face (sometimes TM and oral mucous membrane) -facial palsy -facial pain -otalgia -vertigo -tinnitus -hearing loss - (sensori-neural deafness) -vesiculation and ulceration of ipsilateral 2/3 of tongue and soft palate. |
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What is the appropriate treatment for Ramsay-Hunt Syndrome? What complications? |
Acyclovir Not a guaranteed recovery of facial palsy and hearing loss/deafness. |
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What is erysipelas? What are the s/s? What is the causative agent? What treatment? |
Superficial form of cellulitis occurring on the cheek,(may include the ear) well-defined, raised erythema which may spread to involve the whole face, may or may not have vesicles or bullae Often accompanied by fever and malaise (edematous, hot, erythematous, central face freq involved, pain, chills, systemic toxicity) Caused by beta - hemolytic streptococci (GABHS) entering fissures in the skin near the orifice of the ear meatus Rapidly clears with penicillin (severe - IV ABX) |
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What are the risk factors/etiology of a Tympanic Membrane perforation? |
Barotrauma Impact Trauma (traumatic blow to head) Severe Otitis Media Explosive acoustic trauma (blast injury) Sudden application of force to the TM Penetrating injury |
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What ar the clinical s/s of a Tympanic Membrane Perforation? |
Pain Hemorrhage of TM Hearing Loss Otorrhea (small amount of bleeding) |
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What is the treatment for Tympanic membrane perforation? |
Most will heal on their own unless very large or they become infected Central perforations heal more quickly, marginal perks have the risk of development of cholesteatoma |
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What are complications of a tympanic membrane perforation? |
Monitor margins for non-healing or increase in size Cholesteatoma If patient presents with significant hearing loss, tinnitus, nystagmus, or vertigo: Consider disruption of ossicular chain - surgical emergency |
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What is a risk factory/etiology of cerumen impatiens? |
Down's syndrome Genetic tendency Abnormally or misshapen EAC Excessive hair growth in EAC Elderly- lose oil component of cerumen - becomes drier |
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What are clinical s/s or cerumen impaction? What is treatment for it? |
Otalgia Aural fullness Conductive hearing loss Ear irrigation (not recommended) Suction Removal with curette Softening drops: Debrox, mineral oil |
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Cerumen impaction is the most common cause of what? |
Conductive hearing loss |
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What is acute mastoiditis (etiology)? What causes it - risk factors and pathogens? |
Inflammation of the mastoid air cells Malignant otitis externa Otitis Media - typical cause of it if OM unresolved Cholesteatoma h. influenza s. pneumonia s. pyogenes |
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What are s/s of acute mastoiditis? |
Fever Otalgia Postauricular pain/swelling and erythema Headache Hearing Loss Patient Looks Sick!!! |
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How would you test for Acute Mastoiditis? How would you treat it? |
CT scan w/o contrast IV ABX Severe cases - surgery |
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What are the s/s of labyrinthitis? |
-Sudden onsets of vertigo lasting several minutes to hours -Recovery is gradual over several weeks -May or may not have sudden drop in hearing -N/V |
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What tests are done for labyrinthitis? |
R/O stroke or cardiovascular event MRI Audio VNG (vestibular neurography) |
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What are the treatment options for labyrinthitis? |
Acute: Valium, Meclizine, Oral Steroids Recovery Phase: Vestibular therapy, Referral to ENT |
