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Otolaryngology
Clinical Medicine I
| Question | Answer |
|---|---|
| Where is Cerumen produced | glands in the EAC |
| Sxs caused by a cerumen impaction | Conductive HL, dizziness, aural fullness, tinnitus, peri-aural anesthesia |
| What is crucial in preventing ear infections | ventilation to the ear canals |
| At home tx for cerumen removal | Mineral oil drops, Murine (OTC), Debrox to loosen prior to manual removal |
| Ways to manually remove cerumen | cerumen curette, alligator forceps (experts), otomicroscope exam |
| TM perforation causes | Traumatic, Tube perf, COM |
| Tx of TM perforation | keep ear dry to avoid infx, ear drop Abx: Cipro, Floxin |
| Will a TM perf heal? | Traumatic will usually heal, tube and COM probably won’t heal, REFER |
| How long do we give the TM to heal? Tx if doesn’t heal? | 2-3m, Tympanoplasty |
| Causes of auricular hematoma | wrestlers, blunt trauma, seroma-as blood clot absorbed, plasma remains |
| Tx of auricular hematoma | I&D/aspirate, Bolster pressure dressing, and Abx to cover S. aureus |
| Complication of untreated auricular hematoma | Cauliflower ear: dense hard fibrous tissue |
| Removal of Foreign Body in ear canal | Try once, then refer to ENT/surgery: otomicroscope, suction, irrigation, drops, cerumen loops |
| Tx for complex pinna laceration | YOU can suture it! Approximate cartilage and skin, pressure dressing, Abx for complex |
| BPPV | Benign Proxismal Positional vertigo |
| 4 main causes of vertigo | BPPV, Meniere’s, Vestibular neuronitis/labyrinthitis, Migrane associated vertigo |
| Causes of BPPV | >50% idiopathic, otoconia (stone) is displaced into PSCC |
| Hallpike maneuver | dx for BPPV, head back 30 degrees laying flat with head turned sideways:vertigo |
| Tx BPPV | can fatigue it with the hallpike maneuver/sitting up, Epley, sermount maneuvers, Brandt-Daroff exercises |
| 4 sxs of Meniere’s dz | Intermittent vertigo, low frequency: fluctuating SNHL, buzzing (low frequency) or roaring tinnitus, aural fullness (feels plugged) |
| Causes of Meniere’s Syndrome | Autoimmune diseases |
| Non-destructive tx of Meniere’s | Diet, meds: diuretics, betahistine, IT steroids, ELS decompression |
| Destructive tx of Meniere’s | IT gentamicin, labryrinthectomy, vestibular neurectomy |
| Sudden onset of severe vertigo, lasting days to weeks, No HL or pain | Vestibular Neuronitis (inflammation of vestibular nerves) Common |
| Severe vertigo + hearing loss | Labyrinthitis, bacterial (or viral) infx inner ear |
| Why is labyrinthitis so dangerous | has direct route to CNS can cause meningitis |
| Spinning, nausea, Nystagmus, Inner ear dysfunction | Vertigo |
| Lightheaded, imbalance, gait disturbance, orthostatic hypotension, medical | Dizzy |
| Progressive or sudden SNHL, low discrimination, imbalance | Acoustic Neuroma |
| Dx of Acoustic Neuroma | MRI or CT |
| Diff b/w Meniere’s Dz and syndrome | syndrome has an identifiable cause, dz idiopathic |
| Predisposing factors of OM | Viral URI, allergy, Eustachian tube dysfunction |
| RF’s for OM | Cleft palate, premature birth, males, NA, socioeconomic status, genetics, Fhx, day care, no breast feeding |
| Questionable RF’s for OM | supine bottle feeding, eliminating pacifier after age 6m, household smoking |
| Main pathogens in OM, MC? | MC: S. pneumonia, H. flu, M cat. |
| Describe an infected tympanic membrane | Bulging and opaque w/ edema and erythematous, and loss of landmarks |
| Sxs of OM in kids | Fever, Irritable, crying, tugging at ear, guarding of the ear, turning away, otorrhea |
| Non-pharm tx | observe healthy children over 6m old for 48-72 hrs based on pt assessment |
| Pharm tx | acetaminophen 10-15mg/kg q 4-6 hrs, or ibuprofen 5-10mg/kg q 6-8hrs, Amoxicillin 80-90mg/kd/day, Augmentin, Bactrum |
| Etiology of serous effusion of TM | post AOM, fluid goes from purulent to serous, retracted ear drum, prominent anatomical features |
| Sxs for serous effusion of the ear | fullness sensation, no fever, no pain, kids may still be guarding, tugging on ear |
| Most accurate way to dx serous effusion | typanogram |
| PE tubes | pressure equalization tubes (into eustacian tubes ) |
| Indication for PE tube\s | >3mos OME, or Recurrent AOM: >4 episodes AOM/yr |
| Complications of OM | meningitis, mastoiditis, lateral sinus thrombosis, temporal bone abscess, facial nerve paralysis, TM perf, COM, cholesteatoma |
| Erythema and Pit edema w/ possible pain in post auricular area | Acute mastoiditis w/ subperiosteal abscess |
| Collection of squamous epithelium in the middle ear space, rectraction of TM pocket where a cyst will form | Cholesteatoma |
| Signs of cholestatoma | odorous painless otorrhea, HL, tx: surgical |
| Longstanding recurrent COM/ Chronic mastoiditis causes what | TM perf (usually very large) |
| Sxs of acute otitis externa | Severe pain, swelling and redness of EAC (skin) |
| Pathogens of swimmer’s ear | Pseudomonas aeruginosa (lives in ear canal) and S. aureus |
| Tx of AOE | Topical: Cipro w/ dexamethasone drops, Ear wick, analgesis (narcs?) |
| If AOE resistant to drop Cirpro, try what | Oral Cipro |
| Widening of the Eustachian tube, causes autophony | Patchulus Eustachian tube, dt wt. loss |
| Causes of COE | Psoriasis, Type I DM, :can lead to necrotizing external otitis: bone scan dx REFER, Allergies, Fungus |
| MC pathogen for fungal COE, tx | Aspergillus: cotton w/ black spores tx: lotrimin anti-fungal |
| Signs for TMJ | Crepitus, unilateral ear pain, malocclusion, bruxism, |
| Frequent throat clearing, lump in back of throat, and ear pain | think Laryngeal pharyngeal reflux |
| Imaging for Acoustic neuroma and COM | AN: MRI, COM: CT |
| Idiopathic facial paralysis | Bell’s Palsy, dx of exclusion |
| Inflammation of CN 7 at labyrinthine segment, HSV, tx? | Bell’s Palsy, tx w/ steroids and Valtrex (anti-viral) |
| Severe pain, HL, vertigo caused by Herpes Zoster | Ramsey-Hunt syndrome tx: steroids and Valtrex |
| AOM bacterial or viral | usually bacterial, but can clear w/o Abx |
| 40 you female w/ 20 yr hx of painless otorrhea L ear, HL, developing vertigo | Cholesteatoma, could be eroding into lateral semicircular canal |
| 26 yo male w/ deep R ear pain, ear exam nl, no HL, clenches teeth at night, crepetis | TMJ syndrome |
Created by:
becker15
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