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Otitis media bugs Strep. Pneumonia, H. flu, strep. Pyogenes, moraxella catarhallis
Swimmer with ear pain, discharge: Dx = Otitis externa
Diabetic, ear pain Malignant OE, Pseudomonas, IV abx (FQ), CT head
Tinnitus and metabolic acidosis Salicylate Ingestion
Sudden dizziness, vertigo, hearing loss (usually low frequency / unilateral), tinnitus, ear fullness; episodes last 1-8 hrs Meniere disease
Dix-hallpike maneuver to tx: BPPV
Sudden vertigo with changes in head position BPPV
Sudden dizziness, N/V. NO tinnitus or hearing loss. Recent URI Vestibular neuronitis, labyrinthitis
Unilateral nerve deafness in middle- aged patient 2/2 benign IAC lesion Acoustic neuroma (8th CN schwannoma): order enhanced MRI
Sensorineural loss >50yo, M>F Presbycusis (High frequency sounds are first to go)
Vertical Nystagmus, insidious onset vertigo = Central lesion (tumor); slow onset, nonfatigable vertical nystagmus
Horizontal Nystagmus w/rotary component, acute onset vertigo: Peripheral lesion
AOM most common in: boys; formula-fed; winter; 6 mos-3 yo (esp 6-12 mos); 2nd peak at 5 yo
AOM agents Big 3; GAS; RSV, rhino, CMV
AOM in assoc w/conjunctivitis, think: H flu
AOM: ABx for: febrile children and those < 2 years
AOM: PRSP RFs Recurrent tx w/beta-lactams; Recurrent AOM; Day care; Winter; age <2 years
AOM: indication for tubes bilateral effusion for 3 mos AND a bilateral hearing deficiency
Insect in ear canal kill with oil, alcohol, or lidocaine; remove w/microscopic forceps
Malignant OE, aka ___; who & what temporal bone osteomyelitis; immunocompromised (uncontrolled DM); pseudomonas
To dx/tx Malignant OE: Noncontrast CT temporal bone and/or bone scan; ENT consult and IV Abx
TM perf Usually posterior; get audiogram; non-ototoxic ear drops (Floxin, Ciprodex)
OM with effusion Chronic ETD; Acute OM; Barotrauma; sx hearing loss, ear fullness, tinnitus
Weber test If CHL (eg, OME), will lateralize towards effusion; if SNHL, will lateralize away from affected side
Acute mastoiditis sx fever, otalgia, post auricular erythema, swelling, tenderness with protrusion of the auricle
Acute mastoiditis dx/tx CT scan to detn amount bone involvement; IV Abx, ENT consult, admit for observation; often mastoidectomy
Bullous Myringitis very painful (esp if coughing/sneezing); caused by Big 3, esp Mycoplasma pneumonia
Bullous Myringitis tx Abx (macrolide: Biaxin) & topical Abx if vesicles rupture; ST pain mgmt w/ opiate is acceptable
SNHL tx When in doubt, tx w/HD prednisone and REFER
SNHL sx No warning; often hear a pop; 30 dB loss in 3 frequencies; Needs MRI of IAC with contrast
Vertigo: lasts seconds, head movements, no hearing loss; Positive Dix-Hallpike maneuver BPPV; tx with Epley maneuvers
Vertigo, SNHL (usually low frequency / unilateral), roaring tinnitus, ear fullness; episodes last 1-8 hrs Meniere Dz
Meniere tx Diuretics; Low Na diet (avoid caffeine & EtOH); Anti-vertigo meds (Antivert 25-50, Valium 5-10mg); Surgery (to prevent vertigo): labyrinthectomy (gold std) vs 8th CN resection
Vertigo: severe disabling vertigo lasts 1-2 days, gradual recovery Vestibular neuritis (semicircular canals only) or Labyrinthitis (vertigo & HL); tx steroids & PT
Rinne test BC>AC in CHL; AC>BC in normal or SNHL
Otosclerosis is due to new bone formation in oval window => CHL
Neoplastic cause of hearing loss acoustic neuroma (vestibular schwannoma); F>M
Congenital causes of hearing loss erythroblastosis, asphyxia, maternal rubella
vertigo prognosis central poorer than peripheral
central vertigo etiology (MAIM) MS, acoustic neuroma, ischemia/CNS lesion (TIA), migraine
vertigo w/tinnitus & hearing loss & poss nystagmus more likely peripheral; nystagmus unidirectional & horizontal (only neuro sxs)
peripheral vertigo causes (AMPLITUDE): Acoustic neuroma, Meniere, BPPV, Labyrinthitis, Infection, Trauma, U=psychogenic causes, Drugs, Endocrine
Maneuvers to dx BPPV Nylen-Barany Maneuver, Dix-Hall Pike Maneuver
Vestibular schwannoma; benign schwann cell tumor (nerve, cerebellum, brainstem); unilateral (sensorineural) hearing loss acoustic neuroma; MRI; excision vs stereotactic radiotherapy; VEGF if hereditary syndrome
Sudden onset of continuous vertigo, HL & tinnitus, lasting 1 wk, after URI Labyrinthitis
most common carcinoma of ear canal = squamous cell
Adult w/unilateral serous OM: need to rule out: nasopharyngeal ca
Cholesteatoma pathology/etio: Squamous epithelium lined sac develops and then fills w/desquamated keratin when obstructed
Dx studies for suspected mastoiditis: CT scan (to r/o complications of meningitis or brain abscess)
Labyrinthitis mgmt methylprednisolone, antihistamines, antiemetics, anticholinergics
Paralysis of vestibular nerve, AKA ____: etiology & pathology Labyrinthitis. Usually viral -> labyrinth infxn -> edema & inflammation: vestibular neural input disrupted to cerebral cortex & brainstem
Meniere Dz pathology Endolymphatic hydrops: imbalance of secretion & absorption of endolymphatic fluid that causes fluid buildup in cochlea & distention
Abrupt onset upper & lower (ipsilateral) facial paresis/ paralysis, mastoid pain, hyperacusis, dry eyes, altered taste: sxs of = Bell palsy
Sinusitis Emergencies Periorbital cellulitis; Brain Abscess; orbital abscess
Acute sinusitis: etiology Big 3, SA
Extrusive dental luxations Reposition tooth manually & splint into place ASAP
commonly associated with an alveolar bone fracture Lateral luxations
Intrusive luxations Most serious; do not manipulate initially, allow it extrude itself or refer (orthodoontist)
Nystagmus in vertigo: peripheral vs central lesions Nystagmus is horizontal or rotary in peripheral lesion. Vertical or bidirectional in central lesion
Vertigo pathology Inner ear (labyrinthitis, Meniere), 8th CN (acoustic neuroma, vasculitis, mets), CNS dz (occulsion of vert art or post inf cerebellar art; cerebellar dz, brainstem dz), meds
Vertigo workup R/O systemic dz (low BS, migraine/HA, postural hotn, seizure, lytes, anemia); ENG, MRI, vesitbular evoked myogenic potentials; caloric stimulation; audiometry
Created by: Adam Barnard Adam Barnard