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Ear
EENT
| Question | Answer |
|---|---|
| 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 onset of post-viral/URi vertigo, dizziness, N/V, WITHOUT tinnitus or hearing loss = | Vestibular neuronitis, labyrinthitis |
| Unilateral nerve deafness in middle- aged patient 2/2 benign internal auditory canal 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 internal auditory canal 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 |
| 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); EMG, MRI, vestibular evoked myogenic potentials; caloric stimulation; audiometry |
| Most common mastoiditis organism | Staph aureus |
Created by:
Abarnard
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