Term
| 9 diseases of the external ear |
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Definition
skin cancer
external otitis -swimmers ear
osteomycosis
cerumen impaction
eczema
TMJ capsulitis
auricular hematoma
necrotizing milignant external otitis
osteomas of the extranal canal |
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Term
| basal cell carcinoma: disease process, how to recognise (2) |
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Definition
o Not malignant, local invasion
o Cell circumscribed margins
o Raised margins with depressed center |
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Term
| squamous cell carcinoma: disease process, metastazise patterns, how to diagnose, how to get |
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Definition
o Malignant – if they metastasize they go to the neck
o Ulcerated with everted edges
o Excessive sun exposure leads to solar keratoses |
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Term
| external otitis: definition, common cause |
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Definition
• Inflammation of the external ear canal
• Commonly due to infection with pseudomonas aeruginosa |
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Term
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Definition
o Auricular tenderness
o Swollen canal
o Pain |
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Term
| external otitis: 5 treatments |
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Definition
o Oral antibiotics if severe - ciprodex
o Acid drops – pseudomonas needs a basic pH to live
o Steroids
o Old time cure
o Otowic – allows drops to get into length of canal |
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Term
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Definition
Push back until you see top and put drops in it and it will expand
if you cant see the eardrum the drops cannot penetrate |
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Term
| what is the old time cure for external otitis, what percautions, why does it work |
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Definition
Vinegar – to lower pG
Alcohol – to dry the ear out
Ok as long as there isn’t a hole or tube in the drum |
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Term
| cpirodex issue, alternative |
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Definition
| many insurance dosent cover it so use cipro HC for external otitis |
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Term
| otomycosis: definition, cause, sign |
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Definition
• Fungal infection of the external ear
Prolonged treatment with antibiotic drops
Painful, can erode through the drum and cause holes in tympanic membrane |
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Term
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Definition
o Frequent cleaning
o Difficult
o Antifungal drops, ointment works better |
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Term
| who normally gets cerumen impaction |
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Definition
| elderly, common for everyone though |
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Term
| cerumen impaction causes and signs |
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Definition
o Cotton swabs pushing wax back
o Conductive hearing loss
o Complete meatus obstruction |
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Term
| what is the weak part of the ear drum |
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Definition
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Term
| cerumen imaction treatment |
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Definition
| o Irrigation – remove wax first so you know if there is a hole you cannot see |
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Term
| eczema of the external canal signs 4 |
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Definition
o Dry external canal
o Very little cerumen
o Extremely itchy
o Infections due to digging at ears – usually pseuxomonas |
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Term
| eczema of the external canal treatment |
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Definition
| o Steroid creams or drops |
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Term
| TMJ capsulitis: definition, 4 signs |
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Definition
inflammation of TMJ
o Ear pain (otalgia)
o Flat or broken teeth due to clenching or grinding
o Unilateral pain with palpation
o Clicks |
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Term
| treatment TMJ capsulitis 5 |
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Definition
o NSAIDS, steroids
o Low mechanical diet, bite guards
o Dental exam |
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Term
| auticular hematoma causes and process and signs |
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Definition
o Trauma
o Cartilage gets blood from perichondrium and it separates the perichondrium from the cartilage
o If it occurs on both sides and the cartilage gets no blood at all this is a big problem
o Can cause necrosis of the cartilage and ear deformity (cauliflower ear) |
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Term
| what is the most common presentation of TMJ capsulitis, what do you then ask |
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Definition
present with ear pain
does it hurt when you chew? |
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Term
| auricular hematoma treatment |
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Definition
| early incision or drainage |
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Term
| necrotizing milignant external otitis causes 4 |
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Definition
o Diabetes
o Immunosupression
o Stubborn otitis external causes osteomyelitis of the skull bone
o Usually pseudomonas aeruginosa and aerobes |
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Term
| necrotizing external otitis signs 2 |
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Definition
o Painful
o Involvement of CN VII, IX-XII |
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Term
| who usually gets necrotizing external otitis, what is the prognosis |
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Definition
| • High risk of death, usually immune compromised |
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Term
| osteoma of the external canal definition cause treatment |
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Definition
• Benign bony overgrowth of the external canal
• Cause
o Frequent swimming in cold water
• Treatment
o None unless canal is occluded
clear cerumen impaction due to wax getting stuck beind
open canal with surgical incusion if needed, sometimes reoccurs though |
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Term
| eustachian tube dysfunction definition |
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Definition
| negative pressure in the middle ear, inability of the eustachian tube to ventilate the middle ear |
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Term
| how is a eustachian tube dysfunction officially diagnosed |
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Definition
| more negative than -150 is a type c tympanogram and diganosises eustachian tube dysfunction |
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Term
| eustachian tube dysfunction causes 5 |
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Definition
o Adenoid hypertrophy
o Inflammation
o Infection
o PND
o allergies |
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Term
| signs of eustachian tube dysfunctions |
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Definition
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Term
| tympanosclerosis cause, presentation 3 |
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Definition
• Hyaline degeneration followed by calcification
• Cause
o Repeated infections
o Ventilation tube insertion |
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Term
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Definition
o Chalk patches – don’t vibrate, bad transmission of sounds
o Ossicular fixation |
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Term
| tympanic membrane perforation types |
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Definition
o Marginal or central
o Wet or dry |
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Term
| tympanic membrane perforation causes 4 |
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Definition
o Trauma
o Infection
o Ventilation tubes
o Previous surgery |
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Term
| tympanic membrane perforation indication for repair 3 |
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Definition
o Restoring hearing
o Maintaining a dry ear
o Preventing cholestatoma |
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Term
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Definition
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Term
| serous oritis media: causes, presentation 3 |
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Definition
• Serous fluid in the middle ear space
• Cause
o Eustachian tube dysfunction
o Allergy |
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Term
| describe the fluid in serous otitis media, how long is it present, how does it change over course of disease |
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Definition
two components: serous, mucous
o Acute: Amber color seen in middle ear structures
o Chronic: clear serious fluid in middle ear structures
The longer it stays it gets a mucous look
o Fluid can stay 8-10 weeks |
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Term
| serous otitis medial treatment 5 |
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Definition
o Antibiotics – not always. Doesn’t change outcome
o Decongestants
o Antihistamines
o Steroids – if allergy is the cause
o Suspect nasopharyngeal tumor in unilateral otitis media in adult |
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Term
| suppurlative otitis media: cause, presentation |
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Definition
• Infected middle ear fluid
• Engorged vessels begin at the wall and dip into the umbo. The drum is pushing towards sometimes ruptures and relives pressure and pain |
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Term
| what is the most common childhood infection |
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Definition
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Term
| suppurative otitis media signs 5 |
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Definition
o Pain
o Fever
o Red bulging TM
o Hearing loss – due to fluid
o Purulent discharge if the TM ruptures |
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Term
| where does nasopharyngeal tumor in adults usually hide, why is this an issue, what types of tumor can it be |
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Definition
especially without hx of serous otitis
hides in rosenmueler’s fossa: mass compresses Eustachian tube orifice closed and it cannot function
primary lymphoma, squamous cells |
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Term
| cholesteatoma: cause, signs 10 |
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Definition
• Squamous epithelium trapped in the middle ear space and traps in retraction pockets and grows and localy destories
• CHRONIC DRAINING EAR, Slow expansion due to desquamation, Local destruction, If big enough: facial paralysis, vertigo, brain abscess
aural polyp - sign of draining
granulation tissue - proud flesh
inability to see drum somtimes
whitish lesion |
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Term
| ossicular fixation: cause, 2 signs |
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Definition
• Inability of ossicles to vibrate due to fixation to oval window or other ossicles
• Signs
o Conductive hearing loss
o Tympanosclerosis association |
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Term
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Definition
• Normal osteoclastic activity
• Abnormal osteoblastic activity causing spongy bone to be laid down around foot plate margins on stapedius
• Sporadic or inherited (autosomal dominant with incomplete penetrance) |
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Term
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Definition
o Bilateral conductive hearing loss
o More common in females around 20s or 30s
o Stapedial reflex absent
Protects inner ear on loud noise by contracting
o Van de Hoeve’s disease: otosclerosis and osteogenesis imperfect
Brittle bones and blue sclera
o Normal TM and tympanogram |
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Term
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Definition
o Nothing
o Hearing aid
o Stapedectomy or laser stapedotomy – never corrects it all the way |
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Term
| how is otsclerosis officially diagnosed |
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Definition
As tympanogram
A is normal
S is stiff |
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Term
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Definition
o Intermittent
o Vertigo, tinnitus, aural fullness, hearing loss
o Endolymphatic hydrops
o Initial low frequency hearing loss
o More women than men usually 30-35
o Usually unilateral |
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Term
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Definition
o Low sodium, diuretics
o Vestibular suppressants
o Allergy management – slows progression of hearing loss
o Surgery – endolymphatic sac decompression, labrynthectomy, vestibular nerve section |
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Term
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Definition
o Vertigo
o Temporary hearing loss, tunitus, aural fullness
o Sudden onset, duration minutes to hours, resolves in two weeks, self limiting
o Worsened by movement
o Association with upper respiratory infection |
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Term
| vestibular neuronitis signs 7 |
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Definition
o Sudden onset severe vertigo
o Initial episode is severe – hospitalization
o Acute attack lasts 2-5 days, dysequlibrium lasts several weeks, relapse 6 mo later
o No associated ear symptoms
o Previous URI 6-8 weeks prior |
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Term
| vestibular neuronitis treatment |
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Definition
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Term
| benign paroxysmal positional vertigo cause |
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Definition
| • Cupulolithiasis – free floating otlith in semicircular canal. One ear puts out more impulses and the world is perceived as spinninig |
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Term
| benign paroxysmal positional vertigo signs 4 |
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Definition
o Sudden onset with head movement or positional changes
o Short duration (less than 1 min)
o No other ear symptoms
o Positive dix-hallpike maneuver |
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Term
| benign paroxysmal positional vertigo treatment |
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Definition
| o Canalith reposition exercises (Epley maneuver) |
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Term
| perilymphatic fistula signs 6 |
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Definition
o Sudden onset vertigo
o Progressive sensorineural hearing loss
o Tinnitus
o Aural fullness
o Rupture of oval or round windows and perilymph leakage
o Sudden pressure changes associated with straining, sneezing, diving, blowing nose, flying, etc |
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Term
| perilymphatic fistula treatment 3 |
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Definition
o Surgery to patch any leaks
o Bed rest – avoid straining
o Probably over diagnosed |
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Term
| vestibular insufficiency (VBI) cause, what exacerbates it |
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Definition
• Inadequate supply through vertebral and basilar artery (PICA and AICA) to vestibular nuclei and surrounding structures
• Occurs with extension of neck or positional changes |
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Term
| vestibular insufficiency (VBI) signs 6 |
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Definition
o Vertigo
o Visual changes,
o Slurred speech
o Headaches
o Emesis
o Hemiparesis |
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Term
| vestibular insufficiency (VBI) treatment and diagnosis |
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Definition
o Seen on carotid Doppler
o asprin |
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Term
| how is benign paroxysmal positional vertigo officially diagnosed |
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Definition
| o Positive dix-hallpike maneuver – sit patient up and drop them back and turn head to the side. If they have nystagmus then it is positive. Try on both sides. diagnosis |
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Term
| what is the eplay maneuver, why does it work, for what disease |
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Definition
o Canalith reposition exercises (Epley maneuver) – trying to get otlith out of the semicircular canal into a position that dosent make you dizzy
benign paryxysmal positional vertigo |
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Term
| atherosclerotic cardiovascular disease: cause 6 |
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Definition
• athlerosclerosis of cerebral circulation causing narrow vessels
• decreased blood to labrynth
• increased in diabetes, hypertension, hyperlipidemia
• usually over 50 yo |
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Term
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Definition
• aminoglycosides
• diruetics
• salicylates
• chemotherapeutic agents |
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Term
| multiple sclerosis: 9 signs |
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Definition
o vertigo in 10% - 33%
o unsteadiness
o vertical nystagmus
o bilateral internuclear opthalmoplegia
o ataxic eye movements
o carcot triad (nystagmus, scanning speech, intention tremor)
o ENG can be normal with central or peripheral signs |
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Term
| acustic neuroma: aka, signs 5 |
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Definition
vestibular schwannoma
• Usually on superior division of the vestibular nerve
• Signs
o Unilateral symptoms
o Hearing loss, tinnitus, poor discrimination score
o May involve CN V or VII
o Cay cause brainstem compression |
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Term
| central causes for ear issues |
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Definition
MS
acustic neuroma / vestibular schwannoma
cerebrovascular accidents (stroke)
intracranula malignancies |
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Term
| what is a bad sign in the eye, why |
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Definition
| vertical nystagmus, it is a central sign |
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Term
| what are the common causes of acute mastoiditis 3 |
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Definition
| • Commonly S. pneumonia, S. pyogenes, S. aureus |
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Term
| acute mastoiditis signs 10 |
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Definition
o Post auricular pain, edema, erythema, tenderness
o Pinna pushed forward
o Edematous ear canal
o May be unable to see TM
o Febrile, possibly toxic
o Past history or otorrhea |
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Term
| treatment for acute matoiditis 2 |
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Definition
o Antibiotics have decreased frequency
o Surgical intervention probably needed |
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Term
| chronic mastoiditis signs 5 |
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Definition
o May not have mastoid or ear pain
o Opacification of air cells
o Sclerotic mastoid
o Poor pneumatization of air cells
o Persistent draining ear |
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Term
| subperiosteal abscess: location, signs 6 |
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Definition
o Post auricular pain, swelling, erythema
o Displacement of auricle
o Ferbile
o Elevated WBC |
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Term
| bezolids abscess: cause, 4 signs |
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Definition
• Mastoid abscess erodes through tip of mastoid into soft tissues of the neck (SCM)
• Signs
o Pain
o Fluctuant mass in upper neck with other signs of mastoiditis
o Elevated WBC
o febrile |
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Term
| what is the first rule of mastoiditis |
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Definition
| dont believe the CAT scan report. ossificied mastoid is immediate diagnosis and it dosent mean if they have mastoiditis |
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Term
| what areh the 4 mastoid diseases |
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Definition
acute mastoiditis
chronic mastoiditis
bezold's abscess
subperiosteal abscess |
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Term
| what does poorly pneumonitized mastoid mean |
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Definition
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Term
| why is there fluid in the ear if there is fluid in the mastoid |
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Definition
| fluid in the ear means fluid in the mastoid because it is an air reserve for the middle ear |
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Term
| how can you tell the difference between subperiosteal abscess and mastoiditis |
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Definition
CAT scan shows clear mastoid, puss pocket is outside
slice into subperiosteal and you get puss and directly beneath is bone |
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