Term
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Definition
Most common for office visits in primary care
Otitis media 3rd most common and 11th in reasons among more than 500,000 patient problems
In addition ear wax, serous otitis media, and otitis externa also ranked in top 50 for visits |
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Term
| The ear is innervated by CN __, __, and __ |
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Definition
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Term
| The conchae and external canal are innervated by __ __ of CN __, the __ nerve. |
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Definition
| - somatic fibers of CN VII, facial nerve |
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Term
| Parts of the external auditory canal are innervated by the __ branch of the __ nerve. This branch is known as __ __, which contains nerve fibers from CN __, __, and __. |
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Definition
- auricular
- Vagus
- Arnold's nerve
- CN VII, IX, and X |
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Term
| The middle ear, throat, and tongue are innervated by __ _. This is why it is common for throat pain to be referred to the middle ear. |
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Definition
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Term
| What are the 4 types of otitis media? |
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Definition
1. Acute suppurative otitis media
2. Chronic suppurative otitis media
3. Acute serous otitis media
4. Chronic serous otitis media |
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Term
| most common dx made by clinicians who care for children? |
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Definition
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Term
| peak prevalence of otitis media is in children ages __ __ to __ __. |
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Definition
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Term
| Causes of acute suppurative otitis media: |
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Definition
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- group A streptococcus
(Some Have More Game) |
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Term
| The early phase of acute suppurative otitis media lasts __ to __ days and is characterized by __, __ __, and __ __. The TM shows __, __, and loss of landmarks. __ __ is common. |
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Definition
- 1 to 2 days
- fever, pulsating pain, and hearing loss
- hyperemia, opacification
- Mastoid tenderness |
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Term
| The middle phase of acute suppurative otitis media lasts _ to _ days. There is __ __, often __ __. During this time the __ and __ subside. |
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Definition
- 3 to 8 days
- purulent effusion
- spontaneous discharge
- fever and pain subside |
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Term
| The healing phase of acute supporative otitis media lasts _ to __ __. During this time the tympanic membrane and middle ear normalize. |
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Definition
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Term
| Treatment of acute suppurative otitis media: |
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Definition
- DOC: AMOXICILLIN 80-100MG/KG/DAY divided into 3 doses
The following can also be used:
- Amoxicillin-clavulanic acid
- Cefuroxime
- Trimethoprim-sulfamethoxazole |
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Term
| cannot give amoxicillin for otitis media if pt is allergic to __. |
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Definition
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Term
| For severe acute suppurative otitis media, __ may have to be performed by an ENT. This is for patients with persistent pain, high fever, facial nerve palsy, acute meningitis, labrynthitis, or mastoiditis. |
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Definition
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Term
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Definition
otitis externa
acute mastoiditis |
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Term
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Definition
otitis externa
acute mastoiditis |
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Term
| Consider acute mastoiditis when a patient with otitis media experiences worsening of symptoms along with mastoid tenderness, post auricular swelling and erythema, and prolapse or swelling of the posterior wall of the external canal. |
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Definition
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Term
Mastoiditis is very close to brain structure> can rupture> get systemic and lead to meningitis, many other problems too.
Mastoiditis caused by untreated or undertreated acute otitis media. |
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Definition
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Term
Mastoiditis is an infection of the mastoid process
It is usually caused by untreated acute otitis media
Used to be the leading cause of child mortality
Common complications include hearing loss and extension of the infectious process beyond the mastoid system
Acute mastoiditis affects mostly young children and peaks in those aged 6-13 months |
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Definition
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Term
| common complications of mastoiditis: |
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Definition
- hearing loss
- extension of infectious process beyond mastoid system |
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Term
| peak age for mastoiditis: |
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Definition
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Term
| Consider referring adults with unilateral otitis media to an otolaryngologist for evaluation of the nasopharynx if persistant |
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Definition
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Term
| Causes of Chronic Suppurative Otitis Media: |
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Definition
- Cholesteatoma
- conditions that cause irrersible changes to middle ear and lead to adhesions and congestion around the eustachian tube
infection is usually caused by Staphylococcus aureus, anaerobic bacteria, or Pseudomonas |
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Term
| Cholesteatomas can lead to __ and __ or ossicles and chronic suppurative otitis media. |
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Definition
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Term
| Bacteria causes of chronic suppurative otitis media: |
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Definition
Staph aureus
anaerobic bacteria
Pseudomonas |
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Term
| Chronic suppurative otitis media is characterized by __ discharge of __, __, __ exudate. Periods of no drainage alternating with exacerbations are common. There is __ hearing loss. Pain is __ and the general condition is good. |
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Definition
- chronic
- mucoid, purulent, odorleess
- conductive
- pain is absent |
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Term
| DDx of chronic suppurative otitis media: |
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Definition
- tuberculosis
- carcinoma |
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Term
| Tmt of chronic suppurative otitis media caused by cholesteatoma: |
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Definition
| refer to ENT for surgical tmt |
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Term
| Tmt of chronic suppurative otitis media NOT caused by cholesteatoma: |
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Definition
| - resolve infection with irrigation and antibiotics to avoid mastoidectomy |
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Term
| whitish debris at or behind the TM indicates ___ |
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Definition
| cholesteatoma: refer for mastoidectomy |
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Term
| Acute serous otitis media often precedes or follows an episode of __ __ __ __. It may also be associated with conditions that cause __ __ __. |
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Definition
- acute suppurative otitis media
- eustachian tube dysfunction |
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Term
| Acute serous otitis media presents with a feeling of __ or __ in the ears, often accompanied by __ __ and __ or __ while swallowing. On otoscope exam, the TM may be __ and an __ color can be appreciated behind it, with or without air bubbles. |
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Definition
- fullness or pressure
- hearing loss
- crackles or popping
- hyperemic
- amber |
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Term
| To diagnose acute serous otitis media, __ or __ should be used. A __ configuration will be seen with __ and ___ will be seen with ____. |
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Definition
- tympanometry
- pneumo-otoscopy
- flat configuration
- hypomobility |
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Term
| DDx of acute serous otitis media: |
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Definition
- acute suppurative otitis media
- leakage of CSF into middle ear or mastoid air cells |
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Term
| Tmt of acute serous otitis media: |
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Definition
Address cause of eustachian tube dysfunction and eradicate causative organism:
- Antihistamines: for pts with allergic rhinitis
- Decongestants: for pts with viral rhinosinusitis
- Antibiotics: warranted to ensure sterilization |
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Term
| Refer adult pts with acute serous otitis media, especially when it is __ and not associated with an _ __ _. Need to rule out __ of the __ __ by a __ __. |
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Definition
- unilateral
- URI
- obstruction of the eustachian tube by a nasopharyngeal mass |
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Term
| With chronic serous otitis media, the effusion must be present for at least __ __. |
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Definition
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Term
| Causes of chronic serous otitis media: |
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Definition
- eustachian tube dysfunction
- allergies
- adenoid/sinus/nasopharynx abnormalities |
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Term
| Clinical manifestations of chronic serous otitis media: |
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Definition
- feeling of fullness in the ear
- hearing loss
- NO pain |
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Term
| DDx of chronic serous otitis media: |
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Definition
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Term
| Chronic serous otitis media tmt: |
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Definition
| Treatment: Address underlying cause of eustachian tube dysfunction and eradicate infection with 10- to 14-day course of antibiotics |
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Term
| follow-up and referral of chronic serous otitis media: |
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Definition
Refer appropriate patients to otolaryngologist:
Adenoidectomy: Helpful in older children with chronic serous otitis media
Myringotomy: For patients with vertigo, hearing loss, or an effusion that has persisted for much longer than 3 months |
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Term
| Otitis externa is aka __ __. |
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Definition
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Term
| homemade swimmers ear drops: |
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Definition
- 1 part alcohol + 1 part white vinegar
Vinegar kills the organsims by making more acidic and the alcohol dries out the ear. |
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Term
| when does swimmer ear occur? |
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Definition
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Term
| Otitis externa is caused by breakdown of the protective barrier normally formed by __ and __. |
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Definition
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Term
| Most common pathogens causing otitis externa: |
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Definition
- Pseudomonas aeruginosa
- Staphylococcus aureus |
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Term
| 4 major symptoms of otitis externa: |
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Definition
1. Pain (severe)
2. Pruritis
3. Hearing loss
4. Fullness/plugged sensation |
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Term
| If otititis externa and canal is too swollen and closed, meds won’t get in> do ear wick. Ear wick= triangle shaped cotton- put in small ear opening and then put meds on cotton so it can get in. |
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Definition
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Term
| Pain when pressure is placed on the tragus, strongly suggests __ __. |
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Definition
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Term
| Inflammation and swelling of the __ itself is indicative of a more serious infection. What should you do? |
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Definition
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Term
| Otitis externa is characterized by what 2 stages? |
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Definition
- Acute Inflammatory Stage
- Chronic Inflammatory Stage |
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Term
Otitis externa Acute inflammatory stage
Bacterial infection occurs; patient experiences pain in the affected ear
As infection becomes more severe, pain and swelling in the external auditory canal increase |
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Definition
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Term
| The chronic inflammatory stage of otitis externa is marked by __ of the skin of the __ __ __. Examination reveals flakes of __ __ __ and lumen of the canal is usually __. |
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Definition
- thickening
- external auditory canal
- dry scaly skin
- narrowed |
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Term
| Otitis externa treatment: |
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Definition
- Neomycin/polymixin B ear drops
- Oxyfloxin ear drops |
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Term
| If a pt with otitis externa has a ruptured TM or you cannot see the TM, you CANNOT give them __ and __ b/c these are __. |
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Definition
- aminoglycosides
- neomycin
- ototoxic |
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Term
| Potentially fatal ear infection usually found in elderly and immunocompromised: |
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Definition
| Necrotizing external otitis |
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Term
| A long standing case of otitis externa that continues to get worse despite adequate treatment suggests __ __ __. |
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Definition
| necrotizing external otitis |
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Term
| Necrotizing external otitis pts have __ ___ and __ __ or __ pain. __ ___ __ may be detected of physical exam. |
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Definition
- ear discharge
- severe deep or boring pain
- cranial nerve deficits |
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Term
| tmt of necrotizing external otitis: |
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Definition
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Term
| Perichondritis and chondritis are infections of the __ or __ of the ear. These are serious and require prompt attention. Pts with this will present with __ __ and very __ __. |
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Definition
- perichondrium and cartilage
- diffusely swollen and very tender pinna |
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Term
| With perichondritis or chondritis, if the ear gets too swollen they may lose part of their ear b/c the __ __ gets cut off. __ commonly cause this. |
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Definition
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Term
| Perichondritis/chondritis tmt: |
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Definition
- refer
- administer IV antibiotics covering both anaerobic and aerobic bacteria
- surgical debridement of necrotic cartilage may be necessary |
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Term
| Furunculosis is __ __, which may be single or multiple, in the __ __ of the __ auditory canal. |
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Definition
- circumscribed swellings
- cartilagenous portion
- external |
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Term
| Furuncle swellings may be __ and tenderness is often noted when the __ is pulled and __ inserted. |
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Definition
- fluctuant
- tragus
- speculum |
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Term
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Definition
- drain fluctuant areas and apply topical antibiotics
- systemic antibiotics only if cellulitis or systemic symptoms noted |
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Term
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Definition
Contact allergy of the ear can be acute, chronic, or both
1. Clinical manifestations
Acute stage: Inflammatory findings with associated pruritus, desquamation, weeping
Chronic stage: Skin of external auditory canal is atrophic, dry, scaly |
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Term
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Definition
| - steroid creams/solutions |
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Term
| Severe cases of contact dermatitis can be treated with: |
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Definition
- Betamethasone valerate
- Fluocinonide
(These can only be applied for short period of time. If too long, atrophy of epithelium will occur) |
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Term
| Chronic contact dermatitis tmt: |
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Definition
| - 1% hydrocortisone cream/solution on a daily basis until rash disappears |
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Term
| Herpes zoster oticus is aka __ __ __. |
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Definition
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Term
| Herpes zoster oticus is Caused by infection of the cranial nerve ganglia, most likely by the virus that causes chicken pox. |
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Definition
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Term
| Painful herpetic lesions on auricle and in external auditory canal: |
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Definition
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Term
| Severe cases of herpes zoster oticus can result in __ __ __, __ __, __ __. These occur b/c of damage to CN __, __, and __. |
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Definition
- facial nerve paralysis
- hearing loss
- balance disorders
- VII, VIII, and IX |
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Term
| Bell's Palsy caused by herpes zoster oticus can progress to complete facial nerve paralysis. How do you treat these pts? |
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Definition
- Prednisone 60 mg/d PO tapered over 3 weeks
- Valacyclovir (Valtrex) 1000 mg PO q8h x7 days
- Analgesics: Ibuprofen, Narcotics
REFER |
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Term
Valcyclovir- expensive- 3 x day for 7 days
Acylcoivir- ggeneric, cheaper, 5 times a day for 10 days, poor compliance |
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Definition
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Term
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Definition
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Term
| Otomycosis is a fungal infection of the external auditory canal. |
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Definition
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Term
| Otomycosis has symptoms similar to __ __ but __ is more common than pain. A whitish exudate and black spots suggest __ __ infection. |
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Definition
- otitis externa
- itching
- Aspergillus niger |
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Term
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Definition
- acidify the ear canal
Itraconazole (Sporanox): 200-400mg/d PO with food or cola
Ketoconazole 200-400 mg/d |
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Term
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Definition
Otits media
Cerumen impaction
Otitis externa
Referred pain from
throat/ temporal bone
Acoustic trauma
External ear dermatitis
Perichondritis
Foreign body in the canal
Furunculosis
Mastoiditis
Ear tumors
(eosinophyllic granulomas, rhabdosarcomas |
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Term
| Non-infectious causes of ear pain: |
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Definition
- Foreign bodies: PAIN
- Cerumen impaction- usually hearing loss, occasionaly pain from so much pressure causing mucosal irritation
- local trauma
- dermatoses
- tumor |
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Term
| How do you get an insect out of the ear? |
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Definition
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