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137 Cards in this Set
- Front
- Back
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What is disease of the external ear referred to?
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Otitis externa
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How does the ear canal guard agains infection?
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By producing cerumen-- prevents water from remaining in canal
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What can happen if there is an increase in the level of cerumen?
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Retention of water and debris
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What are the major etiologies of otitis externa?
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Bacterial-- pseudomonas, staph, strep
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What are some risk factors for developing otitis externa?
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swimming, sweating, high humidity, insertion of foreign objects, removal of cerumen, eczema, psoriasis, seborrheic detmatitis
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What are the clinical manifestations of otitis externa?
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1-2 day hx of progressive otalgia/otorrhea, fever, pain with tragal/auricle movement, canal edmatous and obscured with debris/discharge/blood, inflammation, pruritis, full feeling. Conductive hearing loss. Preauricular adenititis
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What are some complications of otitis externa?
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DM pts can develop chronic cases due to increased sugar in bodily secretions-- haven for bacteria
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What are some differential diagnoses for otitis externa?
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Basal cell carcinoma, squamous cell carcinoma
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How should otitis externa be managed?
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topical antibiotics (ciprodex = best), otic steroids (polymyxin + neomycin + steroid), analgesics. Wick used if bad infx
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What type of ear infection does this patient have?
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Otitis externa
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What type of ear infection would someone with a TM like this have?
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Otitis externa
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What type of infection does this patient have?
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Chronic otitis externa
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What type of infection does this patient have?
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Chronic otitis externa
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Malignant otitis externa
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foreign body in ear canal
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Normal TM
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Perforated TM
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Acute otitis media
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Otitis media with effusion
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chronic otitis media
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Cholesteatoma
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Barotrauma
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Mastoiditis
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What are some patient education issues that should be discussed upon dx of otitis externa?
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Swimmer prophylaxis, discourage use of q tips, instuctions on keeping canal dry, should improve within 48-72 hours
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What causes chronic otitis externa?
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Repeated local irritation with middle ear infections and persistent drainage.
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How long does a case of otitis externa have to last to be classified as chronic?
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4 weeks or more or happen more than 4 times each year
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What are some possible etiologies of chronic otitis externa?
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Fungal, allergic, inadequate care for acute otitis externa, psoriasis, recent tympanostomy
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What are some clinical manifestations of chronic otitis externa?
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Erythematous, scaling dermatitis, persistant drainage from the ears, pruritis, conductive hearing loss, lichenification possible
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How is chronic otitis externa diagnosed?
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Clinical-- Upon seeing white debris from the ear canal
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How should chronic otitis externa be managed?
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Treat as otitis externa include corticosteroids-- cover fungi with clotrimazole.
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What is a ddx of chronic otitis externa?
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Basal cell or squamous cell carcinoma, foreign bodies, otitis media
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What is malignant otitis externa?
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Aggressive and potentially life threatening disease. Begins in external canal and progresses slowly over weeks to months. Difficult to distinguish from chronic otitis externa. Inflammation and damage of bones and cartilage at the base of the skull
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What is the etiolog of malignant otitis externa?
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Pseudomonas
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What are the clinical manifestations of malignant otitis externa?
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Severe otalgia, malodorous otorrhea, granulation tissue in external auditory canal near junction fo the bone and cartilage, trismus, fever, facial and CN palsies
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How is malignant otitis externa diagnosed?
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Culture and sensitivity of ear discharge, biopsy of granulation tissue, CT
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What are some complications of malignant otitis externa?
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Sepsis, cranial nerve palsies, meningitis, brain abscess, osteomyelitis of temporal bone and skull
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How is malignant otitis externa managed?
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Need IV antibiotics againt quantified pathogen. May need surgical debridement.
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What is the recurrence rate if the patient is non compliant?
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100%
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What is cerumen impaction?
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Cerumen gets pushed down into the deeper crevases of the ear.
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What are the most common causes of cerumen impaction?
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Attempts to clean the ear or by excessive water in the canal
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What are the clinical manifestations of cerumen impaction?
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Progressive conductive hearing loss, stuffed or full ear feeling, pain
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How should cerumen impaction be managed?
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Remove cerumen if hearing loss, otalgia or if cerumen obscures exam, irrigate ear with one part peroxide and one part water ** only if TM is intact and no tubes, debrox and cerumen drops, manual removal with currette
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What are the most common foreign bodies that become lodged in the ear canal?
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Toys, beads, nails, vegetables, insects
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What is the most important of the determining factors for damage done to the ear by foreign body?
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Time that the body has been in the ear
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What are the clinical manifestations of a foreign body being lodged in the ear?
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May present with purulent discharge, pain, bleeding, conductive hearing loss, feeling of bubbling or crawling in the ear
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What are some complications of foreign bodies becoming lodged in the ear?
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Internal injury
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What are some ddx for foreign bodies being lodged in the ear?
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Cholesteatoma, cerumen impaction, otitis externa
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How should you manage a foreign body in the ear?
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Irrigation ** only if TM is intact, kill insect with litocaine or mineral oil, irrigate and suction liquid, alligator forceps
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What is bullous myringitis?
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Vesicles develop on the TM second to previous viral or bacterial infections. Associated with middle ear infections. May extend into canal (bacteria)
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What are the clinical manifestations of bullous myringitis?
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Sudden onset of severe pain, NO fever, NO hearing impairment, bloody otorrhea possible, inflammation to TM and canal, multiple reddened inflamed blebs possibly filled
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What are some ddx of bullous myringitis?
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squamous cell or basal cell carcinoma, AOM
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What are some complications of bullous myringitis?
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Temporary hearing loss
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How should bullous myringitis be managed?
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Hard to differentiate viral from bacterial, so give broad spectrum antibiotic (macrolide). If the pain is severe, refer to ENT to pop vesicles, analgesics
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What is the TM?
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Tympanic membrane-- stiff but flexible translucent diaphragm-like structure between the external and middle ear.
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What cranial nerve is the TM associated with?
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CN VIII (vestibulocochlear)
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What is the etiology of TM perforation?
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Direct trauma, pressure build up, infection
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What is TM perforation a CI for?
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Irrigation for cerumen impaction or removal.
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What are the clinical manifestations of TM perforations?
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Hearing loss, otorrhea, otoscopic exam reveals tear in TM, possible view of ear bones, lateralization of Weber test, vertigo- middle ear injury
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What are some ddx of perforated TM?
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AOM, COM
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What are some complications of a perforated TM?
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Secondary infection into inner ear and permanent hearing loss
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How should a perforated TM be managed?
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AVOID EAR DROPS CONTAINING: gentamycin, neomycin, tobramycin. Use cipro or ciprodex (topical or systemic), tympanoplasty
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What is acute otitis media?
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Middle ear infection
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What is the function of the Eustachian tube?
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clear mucous from the middle ear to the nasopharynx-- normally closed.
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What can lead to an inflammed ET?
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Viral respiratory infection
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What happens when the ET is blocked?
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Fluid collects within the middle ear
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Why does otitis media occur more often in children than adults?
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Because the ET is shorter and parallel to the ground rather than slanted
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What is the bacterial etiology of AOM?
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strep, h. flu, m. cat
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What are some risks for developing AOM?
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URI, smoking at home, allergies, cleft palate, adenoid hypertrophy, bottle feeding, barotrauma
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What are some clinical manifesations of AOM?
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Otalgia, conductive hearing loss, vomiting, diarrhea, fever, TM bulging and erythematous, decreased or poor cone of light, decreased visible landmarks, cloudy purulent material behind TM, decreased TM mobility, TM injection/redness
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How is AOM diagnosed?
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Tympanometry
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What are some ddx of AOM?
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TM perforation, tympanosclerosis, recurrent AOM, mastoiditis
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How should AOM be managed?
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Analgesics, antipyretics, auralgan, antibiotics, decongestants
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What antibiotics should be used for AOM?
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Amoxicillin for cases less than 2 days, 2nd/3rd gen cephalosporins for cases >2 days, Augmentin, Erythromycin if PCN allergy
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What should be included in your patient's education of AOM?
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Myringotomy in patients with hearing loss, poor response to therapy, or intractable pain. Discuss with patient importance of not smoking and avoiding bottle feeding
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What are some complications of AOM?
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TM perforation, tympanosclerosis, recurrent or chronic OM, persistent middle ear effusion, mastoiditis, bacteremia, bacterial meningitis
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What is recurrent OM?
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Three episodes of AOM in 6 months or 4 episodes in 12 months
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How is recurrent OM managed?
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Antibiotic prophylaxis, pneumovax, tympanostomy tubes, adenoidectomy
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What is OM with effusion?
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Fluid accumulation behind the TM in the middle ear without manifestations of infection. Build up of negative pressure and fluid in the ET.
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What are some of the clinical manifestations of OM with effusion?
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Hearing loss, fullness, pressure, popping, TM neutral of retracted (gray/pink), landmarks visible or dull, decreased TM mobility, usually no fever or pain
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How is OM with effusion diagnosed?
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Tympanometry and audiometry
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What are some ddx of OM with effusion?
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AOM, malignant tumors to nasal cavity, CF
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What is the management for OM with effusion?
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Patient education, decongestants, oral steroids, nasal steroids, antibiotics (cipro/macrolide), myringotomy or adenoidotomy
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What are some complications of OM with effusion?
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Hearing loss, speech or developmental delays
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What is chronic OM?
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Inflammation or infection of the middle ear that persists
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What are some risk factors for developing chronic OM?
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allergies, multiple infections, ear trauma, swelling to adenoids
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What are some common bacteria which cause chronic OM?
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pseudomonas, proteus, staph, some anaerobes
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What are some long term effects that can be a result of chronic OM?
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Severe retraction/perforation of Tm, scaring or erosion of ear bones, erosion of mastoid, chronic drainage from ear, thickening of mucous in ET, cholesteatoma, persistent OME
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What are some clinical manifesations of chronic OM?
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Mild ear pain, fullness to ears, purulent discharge, hearing loss, dullness, redness or air bubbles behind TM, balance problems
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How is chronic OM diagnosed?
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Clinical, audiometry, tympanometry, CT, MRI
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What are some ddx for chronic OM?
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AOM, cholesteatoma
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What are some complications of chronic OM?
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Bony destruction, sclerosis of mastoid air cells, facial paralysis
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What is the management for chronic OM?
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Aural irrigation (peroxide + water), antibiotics (macrolides, fluoroquinolones), combo steroid + antibx, myringotomy (if press on TM), surgical tympanoplasty, masoidectomy, removal of granulation tissue
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What is a cholesteatoma?
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Epithelial cyst consisting of desquamating layers of scaly or keratinized skin from repeated infection
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What are the two types of cholesteatoma?
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Acquired and congenital
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What is the difference between acquired and congenital cholesteatoma?
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Acquired is due to tears in the TM, TM retraction or TM infection. Congenital is spontaneously occuring
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What are some clinical manifestations of cholesteatomas?
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Perforation of the TM filled with cheesy white squamous debris, possible conductive hearing loss, drainage and granulation tissue not responding to antibiotic therapy**
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What are some ddx for cholesteatomas?
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Squamous cell carcinomas, tympanosclerosis, middle ear osteoma, chronic OM
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How is a cholesteatoma diagnosed?
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Clinically-- distorted cone of light, CT
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How should a cholesteatoma be managed?
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Cleaning of debris, topical antibiotics, large should be surgically removed. ENT referral
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What are some complications of cholesteatoma?
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Erosion of the bone, further infections leading to meningitis, brain abscess, paralysis of facial nerve.
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What is barotrauma?
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Injury resulting from inability to equalize the barometric stress on the middle ear
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What is the etiology of a barotrauma?
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Negative pressure in the middle ear that causes ET collapse.
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What happens as a result of air not being able to pass back through the ET?
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Hearing loss, discomfort, TM perforation
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What are some risk factors that can result in barotrauma?
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Air travel, underwater diving
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What are some ddx for barotrauma?
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Serous, acute, chronic OM, bullous myringitis
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What are some clinical manifestations of barotrauma?
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Hearing loss, sensation of fullness, otalgia, dizziness, ruptured TM, bulging inward pull of TM, other signs of decompression sickness
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How should barotrauma be managed?
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Auto-inflation by yawning, swallowing or chewing gum to facilitate opening of ET to equalize pressure, decongestants, antihistamines, steroids, myringotomy, antibiotics (severe), patient education
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What is mastoiditis?
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Middle ear inflammation that spreads to the mastoid air cells resulting in infection and destruction of mastoid bone.
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What is the etiology of mastoiditis?
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Strep, h. flu
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What are the clinical manifestations of mastoiditis?
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Otalgia, bulging erythematous TM, erythema, tenderness, edema over mastoid area, postauricular fluctance, auricular protrusion, fever/HA, abscess
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How is mastoiditis diagnosed?
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CBC, blood cultures, culture of fluid behind TM, CT
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What are some ddx for mastoiditis?
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OM, cellulitis, scalp infection with inflammation of postauricular nodes
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What are some complications of mastoiditis?
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Recurrence, hearing loss, destruction of mastoid bone, spread of infx to brain
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How should mastoiditis be managed?
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Acute need admission and IV antibiotics (ceftriaxone, rocephin), treat with antibiotics (clindamycin, gentamycin), myringotomy, tympanosclerosis, surgical removal of portion of mastoid
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What is labyrinthitis?
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Inflammatory disorder of the inner ear or labyrinth-- viral in most cases. Vestibuloneural input disrupted to the cerebral cortex and brain stem.
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What are some causes of labyrinthitis?
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Allergy, cholesteatoma, ingestion of drugs that are toxic to inner ear
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What are some clinical manifestations of labyrinthitis?
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Lasts 7-10 days, neuro exam normal, vertigo, unilateral hearing loss, involuntary eye movement, loss of balance, ear fullness, tinnitus, otorrhea, otalgia, CNS assessment normal
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How is labyrinthitis diagnosed?
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Audiologic testing, CT, MRI
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What are some ddx of labyrinthitis?
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Acoustic neuroma, vertigo, cholesteatoma, Meniere's disease
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What is the management of labyrinthitis?
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Seroids, Supporitive: sedatives, tigan (nausea), Pt reassurance
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What are some complications of labyrinthitis?
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Spread of infection to brain, injury from vertigo, permanent hearing loss
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What is Meniere's Syndrome?
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Characterized by recurring attacks of disabling vertigo, hearing loss, and tinnitus. Imbalance of secretion and absorption of endolymph fluid leading to over-accumulation of endolymph in the cochlea
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What are the clinical manifestations of Meniere's Syndrome?
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Episodic severe vertigo for 2-24 hours with N/V, horizontal or rotatory nystagmus, sensorineural hearing loss, tinnitus, fullness/pressure in ears
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How is Meniere's Syndrome diagnosed?
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Audiologic testing, CT (r/o other etiologies)
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What is the management of Meniere's Syndrome?
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Valium, tigan, antivert, scopolamine, HCTZ, low Na diet, labyrinthectomy if hearing has already been lost
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What is vertigo?
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Motion perceived when there is no motion. Symptom of vestibular disease.
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What are some causes of vertigo?
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Periperal or central lesions to the labyrinth, irritation to labyrinth, CN 8 dysfuntion, labyrinthitis, Meniere's disease
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What are some of the clinical manifestations of vertigo?
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N/V, nystagmus
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What direction will nystagmus be in if the lesions are peripheral? Central?
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Peripheral-- horizontal or rotational
Central-- bi-directional or vertical |
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How should a patient be evaluated for vertigo?
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Romberg test, evaluation of gait, look for nystagmus
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What are some ddx for vertigo?
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DM, hypothyroidism, drugs (alcohol, barbituates, salicylates, hyperventilation, cardiac origin)
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What is the management for vertigo?
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meclizine, promethazine, scopolamine
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What is tinnitus?
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Perception of abnormal head noises not produced by external stimuli-- can be ringing, buzzing, hissing, roaring, humming. Constant, intermittent, unilateral or bilateral. Can originate in inner, middle, or outer ear.
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What is the etiology of tinnitus?
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Damage to inner ear or choclea, middle ear infection, medication (aspirin), stimulants (nicotine), caffiene, noise induced, hypertension, presbycusis
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What is the management of tinnitus?
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Treat underlying cause, switch any ototoxic drugs, ENT referral, antidepressants, surgical intervention-- cochlear nerve section (last resort)
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Basal cell carcinoma
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Squamous cell carcinoma of the ear
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