Term
| How big is the external auditory canal? Where does it start and end? |
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Definition
~2.5cm long and 7-9mm wide
- Extends from conchal cartilage of the auricle to the tympanic membrane |
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Term
| What makes up the external auditory canal? |
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Definition
- Lateral 1/3 is cartilagenous
- Medial 2/3 is bony |
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Term
| What does the external auditory canal contain? |
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Definition
| Hair follicles, sebaceous glands, and ceruminous glands |
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Term
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Definition
| Ear wax- a hydrophobic protective covering in the ear canal that protects it from water damage, infection, and trauma, and traps foreign particles |
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Term
| What is cerumen composed of? |
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Definition
| Secretions from sebaceous and ceruminous glands, epithelium, debris |
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Term
| What is the consistency of ear wax and what color is it normally? |
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Definition
| Almost liquid to rock hard, off white, yellow, dark red to almost black |
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Term
| What do lysozymes in cerumen do? |
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Definition
| They acidify the canal to prevent bacterial and fungal growth |
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Term
| What is cerumen impaction? |
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Definition
| Cerumen obstructing all or most of the auditory canal |
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Term
| What is the etiology of cerumen impaction? |
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Definition
| Q-tips in ears, narrowing of ear canal, failure of skin migration, overproduction, obstruction of cerumen elimination by ear canal disease |
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Term
| Describe the clinical presentation of cerumen impaction? |
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Definition
| - Sometimes otalgia, hearing loss, vertigo or disequillibrium, ear fullness, tinnitus, cerumen in ear canal |
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Term
| When does cerumen impaction become painful? |
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Definition
| Cerumen touches tympanic membrane or it injures external canal |
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Term
| When does cerumen impaction cause hearing loss? |
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Definition
| When the ear canal is completely obstructed |
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Term
| When does cerumen impaction cause vertigo? |
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Definition
| When it touches the tympanc membrane |
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Term
| What are the indication for removal of cerumen? |
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Definition
| Hearing loss, otalgia, cerumen obscures exam (75% needs to be visible) |
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Term
| What age group requires cerumen removal most often? |
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Definition
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Term
| What instruments are used for manual removal of cerumen? |
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Definition
| Curettes or cerumen spoons, metal loop, alligator clips |
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Term
| What precautions should be taken when removing cerumen? |
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Definition
| Direct visualization only, pt must remain still, keep TM distance in mind |
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Term
| What are complications of cerumen impaction removal? |
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Definition
| Pain, trauma to canal or TM |
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Term
| Describe the procedure for lavage to remove cerumen? |
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Definition
- 20-50cc syringe and warm water w/ acetic acid, alcohol, or 3% H2O2
- Flush directing stream upwards to get behind impaction
- Look w/ otoscope b/t flushings
- Alcohol or hair dryer to dry ear canal |
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Term
| When should you not use lavage to remove cerumen? |
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Definition
Suspected or known perforated TM, myringotomy tubes, vertigo, or severe external otitis
- Do not use WaterPik for teeth |
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Term
| What are complications of cerumen removal? |
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Definition
- Water retention may cause infection
- Ossicle trauma
- TM rupture
- Further impact cerumen |
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Term
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Definition
| OTC preperations of mineral oil, 3% H2O2, 6.5% carbamide peroxide (Debrox) can be used at home to remove cerumen |
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Term
| When should ceruminolytics not be used? |
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Definition
| If current infection or recent otologic surgery. Should be followed up w/ otoscopy |
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Term
| When can suction be used to remove cerumen? |
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Definition
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Term
| How would you educate a pt for cerumen removal? |
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Definition
- No Q-tips in ear
- Nothing smaller than your elbow in the ear
- Use 2 drops mineral oil once per week for recurring impaction |
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Term
| What is a foreign body in the ear? |
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Definition
| Anything, other than cerumen, in the external auditory canal |
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Term
| What is the epidemiology of foreign body in the ear? |
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Definition
- All age groups
- Common in children 1 to 6 yo
- Equal in boys and girls |
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Term
| What is the etiology of foreign body in the ear? |
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Definition
| - Insects, plastic toys or beads, cotton, paper, food, small batteries |
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Term
| Describe the clinical presentation for foreign body in the ear. |
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Definition
| - Asymptomatic, ear pain, bleeding, discomfort, decreased hearing, insect noise/movement |
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Term
| What do you do first before removing an insect foreign body in the ear? |
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Definition
| Kill any live insects before attempting removal w/ alcohol, 2% lidocaine, or mineral oil |
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Term
| What are the instruments and methods use to remove foreign bodies from the ear? |
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Definition
| MIcro alligator forceps, cerumen curettes or wire loop, suction catheter, ear irrigation (not if organic or battery) |
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Term
| What are indications for referral for foreign body in the ear? |
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Definition
- Young or delayed pts requiring conscious sedation
- Ear canal lacerations, TM injury
- Removal attempts not working
- Sharp foreign body |
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Term
| What is the etiology of pruritus? |
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Definition
- Ear canal dermatitis - contact dermatitis, neurodermatitis, seborrhea, psoriasis
- Otitis externa |
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Term
| What causes irritant contact dermatitis? |
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Definition
- Hair sprays and shampoos
- Soaps
- Local trauma (hairpins, matches, earplugs) |
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Term
| What causes allergic contact dermatitis? |
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Definition
| Poison ivy, cosmetics, nickel (earrings), rubber, topical meds (neomycin) |
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Term
| What is neurodermatitis? Early and late? |
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Definition
- Results from chronic itching or scratching
- Early: erythema, edema, vesicles, crusting
- Late: dry, lichenified skin |
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Term
| What is the management of ear canal pruritis? |
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Definition
| Sx: oral antihistamines (diphenhydramine 25mg qhs), topical isopropyl alcohol, Vosol HC drops, mineral oil if itchy |
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Term
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Definition
| Inflammation of the external auditory canal or auricle (swimmer's ear) |
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Term
| Describe the epidemiology of external otitis. |
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Definition
- Acute 4 in 1000 in US
- 10% will develop in lifetime
- Unilateral in 90%
- Peaks 7-12 yo and decrease /p 50
- 5X more common in swimmers |
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Term
| What is the pathophysiology of external otitis? |
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Definition
- Perfect bacterial environment
- Breakdown of skin cerumen barrier is first step
- Common to follow swimming or bathing
- Devices that occlude the ear canal can predispose it |
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Term
| What is the diffential diagnosis of external otitis? |
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Definition
- Bacteral external otitis (90%)
- Fungal infection (10%)
- Malignant external otitis
- Chronic suppurative otitis media
- CA of external auditory canal
- Contact or seborrheic dermatitis
- Psoriasis |
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Term
| What bacterias cause otitis externa? |
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Definition
| - Pseudomonas aeruginosa (50%), staph, proteus, E. coli, polymicrobial dz (1/3) |
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Term
| What fungi cause external otitis? |
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Definition
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Term
| What is the most common cause of otitis media - bacteria or fungi? |
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Definition
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Term
| Describe the clinical presentation of external otitis. |
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Definition
| Pain (85%), pruritis (66%), canal swelling, otorrhea, conductive hearing loss, fever, lymphadenopathy, filaments and spores in fungal |
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Term
| What is the most important part of tx of external otitis? |
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Definition
| Cleaning the ear canal - irrigation w/ 1:1 dilution warm water and 3% H2O2 if TM intact |
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Term
| What is the benefit of using fluroquinolones as tx for external otitis? |
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Definition
| reduced dosing frequency, excellent bacterial coverage, cipro superior in tx edema, inflammation and pain control |
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Term
| What other abx are used to treat external otitis? |
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Definition
| Polymyxin and neomycin combined in Cortisporin otic, or tobramax ophthalmic and Pred-G ophthalmic |
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Term
| What antifungals are used to tx external otitis? |
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Definition
| Clotrimazole, miconazole, nystatin, gentian violet, merthiolate, and cresylate |
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Term
| What is wick placement and when is it used to tx external otitis? |
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Definition
| Use w/ severe swelling, allows topical meds to reach medial ear, compressed sponge inserted into ear canal, replace q 1-3 days |
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Term
| When whould you use systemic abx to tx external otitis? |
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Definition
| If the pt has DM, immunodeficiency, h/o XRT to ear, severe otitis externa, significant edema inhibiting topical application |
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Term
| When would you refer a pt w/ external otitis? |
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Definition
| Associated preauricular cellulitis, lymphadenopathy, fever, no response to tx in 24-48hrs, if perf TM |
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Term
| How would you educate a pt w/ external otitis? |
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Definition
| ears are self-cleaning, protect ear from water during bathing, no water sports for 7-10 d, no hearing aids or earphones until pain subsided |
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Term
| What are considerations when external otitis fails to respond to intial therapy? |
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Definition
| contact dermatitis, failure to adhere to prevention, faulty admin of topical med, immunosuppression, malignant external otitis, misdiagnosis, ototopical not effective |
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Term
| What is malignant (necrotizing) external otitis? |
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Definition
| An invasive infxn of the external auditory canal or skull base |
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Term
| What is the epidemiology of malignant (necrotizing) external otitis? |
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Definition
- Elderly DM most at risk
- >90% w/ dz have glucose intolerance
- Immunocompromised
- Rare in children |
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Term
| What is the etiology of malignant (necrotizing) external otitis? |
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Definition
| Pseudomonas aerugionosa in >95% |
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Term
| What is the clinical presentation of malignant (necrotizing) external otitis? |
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Definition
- Severe otalgia, greater at night
- Persistent foul otorrhea
- Granulation tissue on ear canal floor
- Edema, erythema, frank necrosis of ear canal
- Progressive CN palsies (VI, VII, IX, X, XI, XII) |
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Term
| What lab values are altered in malignant (necrotizing) external otitis? |
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Definition
| Elevated erythrocyte sedimentation rate (ESR) |
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Term
| What does CT/MRI of a pt w/ malignant (necrotizing) external otitis show? |
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Definition
| Bone erosion and/or soft tissue abnormalities |
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Term
| What is the tx for malignant (necrotizing) external otitis? |
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Definition
- Refer to otolaryngologist
- IV Cipro
- Surgical debridement of infected bone
- 90% cure rate w/ prompt dx and tx |
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Term
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Definition
| Benign cartilage or bony growth, no tx unless touches eardrum |
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Term
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Definition
| Benign bony growths which are usually multiple and have a wide base |
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Term
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Definition
| Chronic exposure of the ear canal to cold |
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Term
| What causes perichondritis? |
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Definition
| Ear piercing of the cartilage |
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Term
| What group most often have keloids and how are the tx? |
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Definition
| Black people, tx w/ steroid injections |
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Term
| What are the s/s of CA of external auditory canal? |
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Definition
| Abnormal tissue growth or lack of prolonged tx for otitis externa, bloody ottorhea and pain, friable ear lesion w/ purulence, very aggressive |
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Term
| What is the most common type of CA in the external ear? |
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Definition
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