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Clinical Medicine I

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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