Term
| What are the borders of the middle ear? What is contained within it? |
|
Definition
| TM laterally and eustachian tube anteromedially (location of ossicle) |
|
|
Term
| Why do children tend to have problems of the middle ear than adults? |
|
Definition
| Children's eustachian tube is more horizontal (10 degrees) than adult's (45 degrees) |
|
|
Term
| What is the fuxn of the eustachian tube? |
|
Definition
-Leads from tympanic cavity to nasopharynx
-Enables equalization of pressure
- Ventilation and drainage of middle ear
-Protects from nasopharyngeal secretions |
|
|
Term
| What is eustachian tube dysfunction (ETD)? |
|
Definition
| -Tube too open or closed assoc. w/ abnormal pressure, classically a blockage |
|
|
Term
|
Definition
| Pressure changes, allergies, viral URI |
|
|
Term
| What is the epidemiology of ETD? |
|
Definition
| Children <5yo, 70-90% before 2yo |
|
|
Term
|
Definition
-Negative pressure in middle ear
-Serous exudate refluxed into middle ear
-Infxn of static fluid cause edema and release of inflammatory mediators |
|
|
Term
| What are pediatric risk factors of ETD? |
|
Definition
| 2nd hand smoke, young age, prematurity, LBW, craniofacial abnormalities, pacifier, prone sleeping, prolonged bottle use, short breastfeeding |
|
|
Term
| What are adult risk factors of ETD? |
|
Definition
| Tobacco, allergies, chronic sinusitis, GERD, sleep apnea, adenoid hypertrophy, h/o ETD, immunocompromised |
|
|
Term
|
Definition
| Fullness or pressure in ears, otlagia, hearing impairment, tinnitus, dizziness |
|
|
Term
|
Definition
| retraction of the TM, decreased mobility on pneumatic otoscopy |
|
|
Term
|
Definition
| Decongestants if /p viral illness, antihistamines or oral steroids if allergies, autoinflation (unless infxn), avoid flying or diving |
|
|
Term
| What is patulous eustachian tube? |
|
Definition
| Overly patent ET, uncommon, exagerrated ability to hear oneself speak or breathe |
|
|
Term
|
Definition
| Avoid decongestants, poss insertion of ventilating tube, rarely surgical narrowing of tube |
|
|
Term
|
Definition
| Injury of certain organs, esp. the ear d/t change in Patm caused by iniability of ET to equilibrate the middle ear pressure |
|
|
Term
| What is etiology of barotrauma? |
|
Definition
| Flying (most common), diving, blast injuries |
|
|
Term
| What are the s/s of barotrauma? |
|
Definition
| Pressure to pain from TM stretching, hearing loss d/t deformation and decreased mobility of TM, bleeding into TM, serous or hemorrhagic effusion, tinnitus |
|
|
Term
| What is the tx of barotrauma? |
|
Definition
-Swallow, yawn during descent
-decongestants 30min before flight
-nasal decon, 1hr before arrival
-myringotomy for immediate relief
-vent tubes if frequent |
|
|
Term
| What are the ossicles of the middle ear? |
|
Definition
|
|
Term
| What are the 3 parts of the malleus? |
|
Definition
| Short and long process, umbo |
|
|
Term
| What is the fxn of the ossicles of the middle ear? |
|
Definition
| transmit sound from the TM to the oval window of the inner ear |
|
|
Term
|
Definition
| Separates external from middle ear, concave, transluscent |
|
|
Term
| What are the 3 layers of the TM? |
|
Definition
| Outer squamous epithelial layer (migratory), middle fibruous layer, inner mucosal layer |
|
|
Term
| Name the parts of the TM. |
|
Definition
-Annulus (fibruous ring)
-Pars flaccida (superior portion more flaccid)
-Pars tensa (middle portion more tense) |
|
|
Term
| What is the cone light reflex? |
|
Definition
| Cone in the ant inf quadrant of the TM, broad base ponts ant and points to end of the malleus (umbo) |
|
|
Term
| What is otitis media w/ effusion (OME)? What are other names for it? |
|
Definition
| Middle ear effusion w/o s/s infxn, glue ear or serous otitis media |
|
|
Term
| What are risk factors for OME? |
|
Definition
| - Family h/o otitis media, bottle feeding, daycare, tobacco exposure |
|
|
Term
|
Definition
| Decreased hearing, ear fullness, sleep disturbance, vertigo or imbalance poss |
|
|
Term
|
Definition
| gray or transluscent OME, TM in neutral or refracted position, fluid in middle ear, decreased TM mobility, conductive hearing loss, abnormal tympanogram |
|
|
Term
| What is the gold standard for dx of OME? |
|
Definition
| Pneumatic otoscopy, immobility of the TM w/ (+) pressure in the absence of acute signs of inflammation |
|
|
Term
| What can OME lead to if not tx? |
|
Definition
| Conductive hearing loss leading to speech, language or learning problems |
|
|
Term
|
Definition
| ABX, autoinflation, tympanostomy tubes |
|
|
Term
| What is not recommended to tx OME? |
|
Definition
| Antihistamines, decongestants, corticosteroids, adenoidectomy and tonsillectomy |
|
|
Term
| What is acute otitis media (AOM)? |
|
Definition
| presence of fluid in the middle ear accompanied by acute signs of illness and s/s of middle ear inflammation |
|
|
Term
| Describe the epidemiology of AOM. |
|
Definition
-60-80% of infants by 1 yo
-6-24mths of age highest
-infrequent in school age children
-slightly more in boys than girls |
|
|
Term
| What are risk factors for AOM? |
|
Definition
| Age (6-18m), daycare, breastfeeding, tobacco, pacifier, race and ethnicity, developing areas, family/genetic hx |
|
|
Term
|
Definition
| otalgia, hearing loss, vertigo, rubbing of ear, feeling of blocked ear, irritability |
|
|
Term
|
Definition
| bulging, cloudy, white or pale yellow, or red TM, decresed TM mobility, URI, fever, conjunctivitis |
|
|
Term
| What is the most common cause of AOM? |
|
Definition
| Bacteria - s. pneumo, H influ, mcat |
|
|
Term
| What are viral causes of AOM? |
|
Definition
| Rhinovirus, RSV, influenza, adenovirus |
|
|
Term
|
Definition
| acute onset, s/s of middle ear inflammation, middle ear effusion |
|
|
Term
| What is the most critical characteristic in distinguishing AOM from OME? |
|
Definition
| Position of TM - neutral, refracted, full, or bulging - sign of inflammation |
|
|
Term
| what are complication of AOM? |
|
Definition
| hearing loss, TM perforation, mastoid inflammation |
|
|
Term
|
Definition
| SX tx: acetaminophen, ibuprofen or topical antipyrine otic suspension |
|
|
Term
| What is the first-line abx for AOM? |
|
Definition
|
|
Term
| What is the second line drug for AOM? When is it used? |
|
Definition
| Augmentin, recurrent AOM, prophaylactic amoxycilin, abx in pat mth, concurrent purulent conjunctivitis |
|
|
Term
| When would you use azithromycin for AOM? |
|
Definition
|
|
Term
| What are sx of AOM in adults? |
|
Definition
| otalgia, ear drainage, diminished hearing, sore throat |
|
|
Term
| what would you suspect in a pt w/ unilateral middle ear effusion >2 mth? |
|
Definition
|
|
Term
| The presence of what is usually present in chronic otitis media (COM) and not AOM? |
|
Definition
|
|
Term
| What bacteria are responsible for COM? |
|
Definition
| P. aeurginosa, proteus, staph, mixed anaerobes |
|
|
Term
| COM develops as a consequence of what? |
|
Definition
|
|
Term
|
Definition
| 1) Purulent aural discharge* 2) Pain uncommon except under AE 3) COnductive hearing loss |
|
|
Term
|
Definition
| 1) Remove infected debris 2) Protect a/g H2O exposure 3) Topical abx drops for AE 4) Surgical definitive tx |
|
|
Term
|
Definition
| Abnormal growth of squamous epithelium in the middle ear and mastoid |
|
|
Term
| What does cholesteatoma generally occur as? |
|
Definition
| A consequence of prolonged eustachian tube dysfunction |
|
|
Term
| What happens in cholesteatoma? |
|
Definition
| (-) middle ear pressure draws upper flacid portion of TM inward creating a cyst filled w/ dead skin cells which sets up chronic inflammation causing destruction of bony structures |
|
|
Term
| What are s/s of cholesteatoma |
|
Definition
| 1) White mass behind TM 2) Deep retraction pocket /c or /s granulation 3) Focal granulation on TM 4) New hearing loss in post-op pt 5) Ear drainage >2wks |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Infection of mastoid bone |
|
|
Term
| What occurs during mastoiditis and when does it occur? |
|
Definition
| Honey-comb structure of mastoid fills w/ infected material becoming deteriorated, evolves /p sev. wks of untx AOM |
|
|
Term
| What organisms are responsible for cholesteatoma? |
|
Definition
| Same as AOM(strep pneumo, H influ, M cat) |
|
|
Term
| What are the s/s of mastoiditis? |
|
Definition
| Otalgia, drainage, postauricular erythema/swelling, fever, hearing loss, HA |
|
|
Term
| What is the tx for mastoiditis? |
|
Definition
|
|
