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Session 4 ER -2
ER -2- Ear
| Question | Answer |
|---|---|
| What are the primary causes of otalgia | trauma, infections, foreign bodies, cerumen impaction, cholesteatoma, neoplasms |
| What are the secondary causes of otalgia | TMJ disease, abscessed teeth, malocclusion, bruxism, trauma, tonsillitis, abscess, neoplasms |
| What are the predisposing factors for developing otitis externa | trauma to skin of external auditory canal, elevation of local PH, constant contact with water/humid environments |
| What are the most likely organisms to cause otitis externa | pseudomonas and staph aureus are most common also consider otomycosis in immunocompromised patients (DM, HIV and CA) |
| What is the tx for otitis externa | analgesia, cleansing of EAC, acidifying agents, topical antimicrobials. Cortisporin Otic |
| What for of Cortisporin Otic should you use always because of ototoxicity concern when you use it to tx otitis externa | always use suspension and not solution |
| What is a good med to treat both the staph and pseudomonal causes of otitis externa | quinolones only topical Ofloxacin is approved by FDA for tx of TM if perforation exists |
| What is the potentially life threatening form of otitis externa | malignant otitis externa which extends from EAC into basilar skull, |
| What is the most common cause of malignant otitis externa | P. Aeruginosa |
| What is the progression of malignant otitis externa | starts as simple OE and then extends into the cartilage, periosteum, bone |
| What factors generally predispose a pt to developing malignant OE from just normal OE | elderly diabetic or Aids patient |
| If you have been tx a patient for Otitis externa and they have not started to improve after 2-3 weeks of meds what should you suspect may be happening | malignant otitis externa |
| What is the tx for malignant otitis externa | IV antibiotics, consult with ENT and get them admitted |
| What are the usual causes of otitis media | Strep Pneumoniae, H. Flu, M. Cat |
| What are some complications of otits media | TM perf, mastoiditis, meningitis, brain abscess, sinus thrombosis, cholesteatoma |
| What do you need to do if a pt presents with pain over the mastoid, post auricular erythema, swelling and protrusion of auricle | CT of mastoid check for mastoiditis |
| What tx would you likely give for mastoiditis | IV Ab, tympanocentesis and myringotomy |
| When would a bullous myringitis likely form | after an URI, they are very painful with a bulla forming on the TM and deep external auditory canal |
| What are the likely causes of bullous myringitis | mycoplasma pneumoniae, chlamydia psittaci or viral causes |
| What is the tx for bullous myringitis | warm compresses, analgesia, and Ab |
| If pt has a complete laceration of the external ear what should you do | probably refer to plastics or ENT as the cartilage has be approximated with 5-0 or 6-0 absorbable sutures |
| What is the rule of using Silvadene | no Silvadene above the clavicles due to skin pigmentation changes |
| When should you avoid irrigation to remove a foreign body | when you can't visualize the TM or perf is suspected or organic material that may expand if moistened |
| Where is the most likely place to have a TM perf | par tensa which is only a few cell layers thick |
| What may a pt complain of with TM perforation | acute onset of pain and hearing loss and possible bloody otorrhea may also complain of tinnitus, vertigo these may indicate injury to inner ear |
| T/F most TM perfs will heal on their own | T |
| IF the perforation is in the posterior superior quadrant what should you be concerned about | possible ossicular disruption so refer to ENT |
| Pt has a honey crusted lesion on their skin what is the likely cause | impetigo from strep pyogenes, group A strep or Staph aureus |
Created by:
smaxsmith
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