Term
| What example is useful to explain ear canal to pt? |
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Definition
| saran wrap that's taut and can get pushed out or sucked in |
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Term
| How do you instill eardrops in pt? |
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Definition
| warm drops so they don't vomit on you |
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Term
| how do you explain to a pt where eustacian tubes end? |
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Definition
| point to the lateral portion outside of nose above the nares |
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Term
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Definition
| hydrophobic protective covering of acidic pH to protect ear and structures from bacteria. produced by ceruminous glands (similar to apocrine sweat glands) |
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Term
| #1 thing removed from ears by pearman |
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Definition
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Term
| what moves cerumen around? |
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Definition
| cilia moves cerumen around to function properly |
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Term
| When should cerumen be removed? |
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Definition
| symptomatic pt, conductive hearing loss, potential foreign body, contact with the TM, impairment of TM visualization |
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Term
| When should cerumen not be removed? |
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Definition
| when you cannot do it safely (ie, children) |
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Term
| if you suspect tm rupture, how do you tx cerumen impaction? |
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Definition
| use warm water, nothing else |
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Term
| what are potential complications of cerumen impaction removal? |
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Definition
| ruptured tm, superficial lacerations of canal, infection (use abx ointment) |
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Term
| How do you remove cerumen? |
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Definition
| topical therapy (warm saline w/3 capfuls of hydrogen peroxide), curretage, irrigation, candlewicking |
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Term
| why do you always remove cerumen yourself? |
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Definition
| complications, and pays well |
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Term
| What are some examples of topical cerumen therapy? |
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Definition
| mineral oil, hydrogen peroxide, carbamide peroxide soln- murine/debrox, triethanolamine polypeptide oleate-condensate 10% (cerumenex) |
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Term
| cerumen curretage: procedure |
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Definition
| it's a bit tricky. someone holds ear, you can go through otoscope or have someone hold otoscope while you go under. |
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Term
| cerumen irrigation procedure: how do you position the pt? how do you prepare? what type of instrument? where in the ear do you target? what should you do frequently? what might or might not be used depending on pt comfort level? |
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Definition
| upright, comfortable position. protect the pt and yourself- this is messy. warm the soln. try to use an assistant. consider 18g IV catheter or butterfly catheter tubing. target superior canal. inspect frequently. consider anesthesia if needed, but trust the pt. (controlled not forced pressure. fluid coming out is contaminated. cut tip as a bevel. pearman prefers butterfly needle w/needle removed. cut at bevel. more pliable and wider opening, so more flow. earwax will either melt and come out yellow or come out in big glob. suturing kits have sm plastic tube for high pressure irrigation- not for cleaning ears. do not recommend or use dental pic for irrigating ear.) |
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Term
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Definition
| minature tampon. insert into ear canal, moisten and it swells, apply abx drop. use when swelling/inflammation so bad that abx might not be effective. (use suspension not solution.) |
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Term
| ear candling or warm mineral oil- thermoauricular therapy- what are the potential complication. |
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Definition
| heat melts wax in ear- when you turn it runs out. be careful about burns. warm mineral oil can be too hot |
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Term
| tic in ear. or other bugs- how do you tx? |
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Definition
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Term
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Definition
| remove bateries immediately: corrosive fluids (electrochemical burns, liquefaction necrosis w/in hrs, scarring). Refer to ED if unable to remove immediately (be careful to push farther in DO NOT use irrigation or topical medications . . . more corrosive) (when you see a battery ? on exam, pick whatever option is the most urgent.) |
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Term
| pt. comfort. foreign body composition, living insect management. appropriate use of forceps. other options. potential complications. |
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Definition
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Term
| don't irrigate these objects: |
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Definition
| things that swell: paper, bean, etc. use alligator forceps instead. |
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Term
| how do you get out beads? |
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Definition
| put superglue at end of cotton swab, attach it to the bead, pull it back out. sometimes you get lucky and can use suction. |
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Term
| tympanometry: what is it? what does it ms? what type of tool is it? what is it NOT? |
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Definition
| an electronic and acoustic msmt technique: *mss pressure, mobility of tm, and conduction bones*. an *adjunctive* tool for evaluating md ear pathologies and tm function. NOT a hearing test, but can assess type of hearing loss- conductive v. sensory. |
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Term
| how do you have to perform tympanometry? how is the pt's experience? |
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Definition
| you have to have it sealed. uncomfortable for pt b/c pressure |
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Term
| a graphic picture of the md ear function resulting from pressure varied against tTM readings based on peak pressure and compliance. |
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Definition
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Term
| What does each axis of a tympanogram represent? |
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Definition
height is mobility, width is pressure
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Term
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Definition
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Term
| negative middle ear pressure on tympanogram |
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Definition
| eustacian tube dysfunction |
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Term
| great test question: if a is normal b is tm rupture, or so much pressure nothing happens or c moving w/negative pressure what happens with course of otitis media? |
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Definition
| B- too much pressure initially, then C as it heals, and when back to normal as A |
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Term
| what does otosclerosis look like on tympanometry? |
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Definition
| bones don't move- peak comes down |
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Term
| epistaxis: what is the severity? what is important for the practitioner to know? are anterior or post nosebleeds worse? |
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Definition
| nosebleeds are serious. range from next to nothing to coding. need to know anatomy and vasculature. as long as you understand those two things, you can take out foreign bodies and stop bleeds. posterior bleeds are worse. |
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Term
| kiesselbach's plexus- why is posterior epistaxis worse |
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Definition
| anterior is more capillaries- posterior is arteries, therefore worse |
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Term
| posterior nosebleed might have no blood coming out of nose- where might it be seen? |
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Definition
| it might just come out of pharynx |
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Term
| foreign body in nose turbinates: what does it cause? what do you administer to counteract this effect? |
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Definition
| causes swelling: give vasoconstrictors to decrease swelling- greater chance of getting it out |
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Term
| how do you remove nasal foreign bodies- what instruments do you use? |
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Definition
| nasal speculum to view (pain sensors in nose- be careful) nasal speculum dilates the nares. nasal suction (not very good suction- not very useful). alligator foreceps |
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Term
| why must you be careful with removing foreign objects from nose? |
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Definition
| be careful that you don't push it back farther, make it bleed (septal hematoma is an emergency), or put a hole in it. |
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Term
| one of the best ways of getting out foreign body |
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Definition
| mom: have mom occlude other nare and have mom give nice forceful breath like CPR |
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Term
| good instruments for removing foreign bodies |
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Definition
| nasal speculum, forceps, lighting (head lamp), curette, parent, endoscope, etc. |
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Term
| what are 2 vasoconstrictors useful when removing foreign bodies? |
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Definition
| phenlephrine (neo-synephrine), cocaine, others have wait period |
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Term
| what are 3 topical analgesics useful when removing foreign bodies? |
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Definition
| aeroslized lidocaine, benzocaine, cocaine |
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Term
| slide lubricated foley just up and beyond, blow up balloon, gently retract down |
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Definition
| extra trick for removing foreign bodies |
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Term
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Definition
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Term
| where are 3 places epistaxis bleeding comes from? |
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Definition
| nostril, nasal cavity, nasopharynx |
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Term
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Definition
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Term
| when would the following information be gathered: htn, easy bruising, systemic disese. vascular abnormalities: sclerotic vessels, a-v malformations. neoplasms. coagulaopathy. septal perforation (cocaine abuse) injury. allergies/recent illness. type of heat (kerosine) |
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Definition
| whe getting a good hx from patient for epistaxis (also note duration of hemorrhage and side, meds, self-tx, and nausea) |
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Term
| What are 3 medications that cause epistaxis? |
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Definition
| coumadin, nsaids, asa, etc. |
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Term
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Definition
airway
breathing
circulation |
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Term
| Where are the following found: topical medications, injectable medications, nasal tampon, silver nitrate (topical coagulant- cauterizes sm bleeds- remember it is creating burn, let pt knows it will burn, not too long or you will burn through septum) suction |
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Definition
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Term
| When is the following procedure used: maintain pt upright. have an excellent light source/suction. insert soaked cotton/pledget or spray anesthetic/vasoconstrictor- allow appropriate time. have pt blow their nose/consider suction. attempt to locate bleeding utilizing nasal speculum/light source. consider cautery. |
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Definition
| management of anterior epistaxis |
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Term
| when is the following used: silver nitrate-unilateral use only, apply for 5-sec, monitor. |
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Definition
| management of anterior epistaxis |
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Term
| what are the following: hydrocoloid/balloon combination. nasal tampon. balloon catheter. impregnated gauze. |
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Definition
| types of nasal packing. (risks include necrosis, infection. remember: they go in with the pt upright. if you don't remove clot, you may not see bleed- see if it's bleeding down back) |
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Term
| for what nosebleeds do you have to be credentialed? |
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Definition
| credentialed for posterior nosebleeds. not for anterior nosebleeds. |
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Term
| much less common than anterior, multiple techniques for control, must manage abc's also manage contributing factors: bp and coagulopathy |
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Definition
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Term
| manage nosebleeds: method |
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Definition
| assemble all supplies- assume the worst. pt sitting upright, ask them to gently blow nose, immediately have supplies ready and find and tx bleed. wait. tape gauze over nose and check later. |
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Term
| posterior epistaxis management |
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Definition
| similar general procedure- recognize when ENT involvement is necessary |
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Term
| complications of epistaxis |
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Definition
| sinusitis. septal hematoma/perforation. external nasal deformity. mucosal pressure necrosis. vasovagal. otitis. balloon migration (fall out or airway obstruction) CONSIDER PROPHYLAXIS. ARRANGE CLOSE FOLLOW-UP. |
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Term
| flexible nasolaryngoscopy/mirror laryngoscopy |
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Definition
| used for removing fishbones, see vocal cords, larynx, eustacian tube. |
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Term
| if direct pressure w/drugs fail or cautery unsuccessful in tx anterior epistaxis, what do you do? |
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Definition
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Term
| types of packing used in anterior epistaxis include: |
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Definition
| traditional packing, epistaxis balloon, prefabricated nasal sponge/nasal tampon |
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Term
| Of what should you be aware when dealing w/anterior epistaxis? |
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Definition
| understand the risks, contraindications/complications |
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Term
| initial management of epistaxis |
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Definition
| be prepared. cosider pt comfort. involve attending if severe. position the pt. direct compression- at least 5 min up to 20 min, consider ice. assess hemodynamic stability and address, obtain access if indicated- THINK ABCs. Make every attempt to locate the source of bleeding. |
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Term
| What ages show a peak incidence of epistaxis? |
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Definition
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Term
| epistaxis more common in what climates and time of yr? |
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Definition
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Term
| what factors contribute to post epistaxis? |
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Definition
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