Term
| 3 most common causes of secondary/referred ear pain |
|
Definition
c spine
tmjd (costen's syndrome)
GERD |
|
|
Term
Which CN are responsible for these distributions?
___: meatus and ear drum
___: upper medial portion of ear drum + upper helix
___: vestibulochoclear apparatus |
|
Definition
VII, IX, X
V
VII and VIII |
|
|
Term
red, painful, ulcerated lesion that usually occur in elderly men
tx? |
|
Definition
| chondrodermatitis nodularis chronicicis helicus - excision |
|
|
Term
inflammation fo the ear canal that can extend to the auricle
narrow swollen meatus, slight erythema
tx? |
|
Definition
otitis externa
tx: insert wick into ear canal to keep topical abx + steroid on skin. apply drops 3-4 x a day |
|
|
Term
| tx for lichenified ear canal |
|
Definition
domeboro-soaked cotton ball on ear 10 min a few times a day then use steroid drop once a day
will heal in 3 weeks |
|
|
Term
acute or chronic aggressive, invasive, and destructive inflammatory process that eats away ear canal to expose bone
very painful, more common in immunocompromised
can penetrate into brain and kill you |
|
Definition
| malignant (necrotizing) otitis externa (MOE) |
|
|
Term
fungus that causes cheesy, creamy exudate wtih black/brown spots in the ear canal. need to be cleaned/irrigated then throoughly dried with alcohol
tx? |
|
Definition
otomycosis
tx: topical antifungal cream + domeboron or alcohol and viegar. |
|
|
Term
| how do you treat blockage of ear canal? |
|
Definition
| irrigation/chemical dissolution |
|
|
Term
| when should you never irrigate an ear? |
|
Definition
hx of chronic ear dz
hx of TM perforation
only hearing ear |
|
|
Term
benign bony formation of ear canal that can result in conductive hearing loss due to occlusion of canal
is associated with cold water exposure (swimmers) |
|
Definition
|
|
Term
| kids wtih facial paralysis/paresis... its due to ___ until proven otherwise |
|
Definition
| otitis medial with effusion |
|
|
Term
URI
chronic sinusitis
AR
adenoid hypertrophy
tobacco smoke
reflux
radiation
clef palate
all causes of ? |
|
Definition
|
|
Term
cholestatoma
retraction pocket
effusion
atelectasis
all complications of ____ |
|
Definition
| eustachian tube dysfunction |
|
|
Term
popping/crackling sound with yawning/swallowing
retraction of TM and decreased mobiliy
may cause AOM |
|
Definition
| eustachian tube dysfunction |
|
|
Term
inflammation of the middle ear
most commonly caused by strep pneumonia, haemophilus influenza, moraxella catarrhalis
sx: otalgia, otorrhea, hearing loss
tx? |
|
Definition
acute otitis media
tx:
1st line: amoxicillin
2nd line: augmentin
3rd line: quinalone (lovfloxacin or moxifloxacin) |
|
|
Term
| unilateral otitis media in an adult without preceeding URI or a URI that fails to resolve is ___ until proven otherwise |
|
Definition
|
|
Term
| Pt presents with right ear pain x24 hr, PMH significant for ear infections in childhood, PE significant for angry, red, bulging, TM with loss of landmarks |
|
Definition
| acute otitis media with effusion |
|
|
Term
| most common causative organism for AOM? |
|
Definition
|
|
Term
| common indications for ear tubes (T&T) |
|
Definition
severe AOM wtihout pain relief
HL > 30 db with OME
poor response to abx
OME > 3 mos
recurrent epidsodes > 3 in 6 mos or 4 in 12 mos |
|
|
Term
64 y/o male presents with plugged sensation in ear. no hx of cold. unilateral, painless, annoying.
PE: nothing blocking ET, nose is ok. gave pt abx which did not clear it up in 10 days.
dx? |
|
Definition
|
|
Term
in ___ hearing loss, you will prob see difference between ears
in ___ hearing loss, it is usually low frequency
sudden SNHL, do what? |
|
Definition
conductive
Sensorineural
refer |
|
|
Term
|
Definition
abx drops with very low dose steroid - tobramycin or quinolone
pain meds
NEVER alcohol |
|
|
Term
| suspected perforation of the pars flaccida is ___ until proven otherwise |
|
Definition
|
|
Term
|
Definition
|
|
Term
| white-yellow scarring of TM usually due to repeated ear infections in childhood |
|
Definition
|
|
Term
perforation
milky/yellowish discharge
mastoiditis
hearing loss
usually caused by strep pneumonia |
|
Definition
|
|
Term
keratininzing stratified squamous epithelium and accumulation of desquamating epithelium of keratin wtihin the middle ear or other pneumatized portions of the temporal bone. often occurs in pars flaccida
can destroy bones and get into brain
most common sx is hearing loss
complications include dizziness (erosion into semicircular canal), subperiosteal abscess, facial nerve palsy, meningitis, brain abscess
usually caused by P. aeruginosa
management - observe, may need surgery |
|
Definition
|
|
Term
14 y/o comes to your office complaining of painless right ear drainage. he is otherwise healthy. hx of PE tubes as a child. on exam, you find slightly turbid drainage from hole in TM.
tx?
what if he comes back in 2 weeks and still has a hole in TM? |
|
Definition
abx drops for pseudomonas infection
if still hole - do hearing test and refer for tympanoplasty |
|
|
Term
pain behind ear
fever
ear on one side seems more prominent
associated wtih OM that hasn't completely resolved
dx?
tx? |
|
Definition
acute mastoiditis - DO NOT ASSUME IT'S AN ABCESS
refer to ENT for CT and surgical I&O |
|
|
Term
ear pain & headaches
sensation of water in ear
linea alba on buccal mucosa
scalloped tongue
hypertrophied masseter
normal ear exam
dx?
tx? |
|
Definition
TMJ dysfunction
tx: massage, wrap, ice, elavil, bite plate |
|
|
Term
elongated styloid process that causes throat and ear pain
neck may get "stuck" |
|
Definition
|
|
Term
| most common sx of inner ear problems |
|
Definition
|
|
Term
| the "hallucination" of movement |
|
Definition
|
|
Term
which is peripheral and which is central vertigo?
1. severe, sudden onset, lasts seconds to minutes, is positional and fatigable, tinnitus is common, combined horizotal and torsional nystagmus. due to problem with inner ear.
2. mild, gradual, lasts weeks to months, not positional or fatigable, neurological/visual sx rare, tinnitus rare, vertical, horizontal, or torsional nystagmus. due to problem iwth brain |
|
Definition
|
|
Term
| multisystem, dynamic fxn that keeps the body upright over its base of support |
|
Definition
|
|
Term
acute labyrinthitis
acute vestibular neuronitis
BPPV
cholesteatoma
ramsay hunt syndrome
meineier's disease
otosclerosis
perilymphatic fistula
all are causes of ___ vertigo |
|
Definition
|
|
Term
cerebellopontine angle tumor (CPA)
cerebravascular disease/sroke
migraine
ms
dm
are all causes of ___ vertigo |
|
Definition
|
|
Term
| nystagmus and true vertigo caused by loud noises or sounds at a particular frequency |
|
Definition
|
|
Term
positional, crescendo-decrescendo vertigo lasting 20-30 sec
often caused by rolling over in bed
no hearing loss
no tinnitus
+ nystagmus
+ nausea, - vom
dx?
tx?
cause? |
|
Definition
BPPV - benign paroxysmal positional vertigo
dx via dix-hallpike maneuvers. do MRI to r/o CNS disease
tx: particle repoisitioning treatments (epley maneuvers)
caused by otoconia (ca-carbonate crystals) in balance canals |
|
|
Term
sudden onset of severe room-spinning vertigo with severe N/V that lasts 24-48 hours
NO auditory sx (plugging, tinnitus, hearing loss)
NO neuro signs
recent or concurrent URI
dx?
possible causes?
tx?
complication? |
|
Definition
vestibular neuronitis, AKA labyrinthitis
inflammation of CN 8, herpes simplex and zoster can cause it
tx: systemic steroids + vestibular suppressants and antiemetics
complications: cogan's disease - irreversible hearing and vision loss |
|
|
Term
recurrent, spontaneous, episodic horizonto-rotary vertigo that lasts 20 min or longer characterized by:
hx of increasing ear (aural) fullness
roaring tinnitus
n/v
autonomic sx: tachycardia, HA, diaphoresis, diarrhea
fluctuating hearing loss in involved ear that can lead to permanent hearing loss
followed by sensation of blocked hearing after tinnitus stops
tx? |
|
Definition
meniere's disease
tx: transtympanic gentamicin perfusion - ablates vestibular apparatus
transmastoid endolymphatic sac producedure
transmastoid labyrinthectomy
retrosigmoid vestibular nerve section
low salt diet + diuretics to lessen amt of endylymph |
|
|
Term
dizziness, what dx?
Less than 1 min?
20 min to 4 hours?
24-48 hours? |
|
Definition
BPPV
Meniere's
vestibular neuronitis |
|
|
Term
rapidly progressive hearing loss
episodic dysequilibrium & vertigo
vasculitis and endarteritis of otic capsule
caused by syphilis |
|
Definition
|
|
Term
| ENG and ABR are what kind of tests? |
|
Definition
|
|
Term
unilateral tinnitus wtih or without associated hearing loss i is ___ until proven otherwise.
what test would you order to confirm this? |
|
Definition
acoustin neuroma
MRI with contrast |
|
|
Term
hearing loss
meniere's dz
acoustic neuroma
ototoxic meds
MS
head injury
thyroid dz
hyperlipidemia
vit B12 deficiency
depression, anxiety, fibromyalgia
arterial bruit, venous hum, av malformation, vascular tumor
palatomyoclonus, idiopathic stapedial muscle spasm
patulous ET
are all ddx with ____ |
|
Definition
|
|
Term
Atherosclerotic carotid artery disease (ACAD) <-- mot comon
benign intracranial htn (BIH)
carotid artery dissection
ddx for ? |
|
Definition
|
|
Term
| ___ is the most common site for nosebleed |
|
Definition
|
|
Term
|
Definition
| network of anterior arteries of the nasal cavity |
|
|
Term
| nose bleed that drips down the back of the throat even when leaning fwd is usually from what source? |
|
Definition
| posterior ethmoid arteries |
|
|
Term
htn
infection
trauma
env (cold)
allergy
bleeding dyscrasias (von willebrand's)
drugs
are predisposing factors for?/ |
|
Definition
|
|
Term
|
Definition
afrin (topical decongestant)
nasal tampons
NOT systemic decongestants
|
|
|
Term
| rhinitis caused by too much medicine |
|
Definition
|
|
Term
| unilateral sinusitis with bony destruction is highly suggestibve of ____ |
|
Definition
|
|
Term
sinusitis classification:
acute: up to ___ weeks
subacute: __ to ___ weeks
recurrent: __ or more episodes per year
chronic: >___ weeks |
|
Definition
acute: <4 weeks
subacute: 4-12 weeks
recurrent: >4 x a year
chronic: >12 weeks |
|
|
Term
facial pain/pressure
nasal congestion
nasal discharge
hyposmia/anosmia
cough, esp in kids
headache
rarely fever
halitosis
fatigue
dental pain
otologic sx
all sx of? |
|
Definition
|
|
Term
|
Definition
sinusitis
trigeminal neuralgia
TMJ |
|
|
Term
based on headache location, which sinus is affected?
1. behind eye, above brow
2. top of head
3. cheeks, jaw, temples. spares eyes
4. behind eyes, cheeks up to hair line |
|
Definition
ethmoid
sphenoid
maxillary
frontal |
|
|
Term
URI sx worse after 5 days or lasting >10 days
sx out of proportion to URI
purulence on exam
prolonged mucosal edema
>2 risk factors for sinusitis (facial pain/pressure, anosmia, headache, fever, cough, toothache, halitosis)
<4 weeks duration
resolves completely after medication
acute lasts up to 30 days
subacute lasts up to 3 mos
chronic lasts longer and usually has different microbiology
tx? |
|
Definition
bacterial rhinosinusitis
strep pneumoniae, haemophilus influenzae, moraxella
catarrhalis
tx: amoxicillin or trimethoprim/sulfamethoxazole for 10 days |
|
|
Term
| ___ is the gold standard for assessing sinusitis |
|
Definition
|
|
Term
| causative microorganisms and tx for nasal polyps |
|
Definition
p. aerugenosa
staph aureus
steroids, CT, surgery |
|
|
Term
| aspergillus flabus and fumigatus are both causes of ?? |
|
Definition
|
|
Term
| Tx for mild and for moderate/severe acute rhinosinusitis and chronic |
|
Definition
mild: amoxicillin or augmentin
moderate/severe: augmentin or respiratory quinolonesa
chronic: augmentin or metronidazole |
|
|
Term
| complications of sinusitis |
|
Definition
orbital cellulitis
meningitis
also:
epidural absecess
subdural absecess
cavernous sinus thrombosis |
|
|
Term
orbital cellulitis
obstructive polyps
inverting papillomas (SCC)
fungal sinusitis
mucocele
suspected neoplasm
complications of sinusitis
all are indications for ? |
|
Definition
|
|
Term
what action goes with what drug?
1. block histamines
2. local anti-inflammatory
3. stabilizes mast cells
4. vasconstrictor
5. induction of a competing or neutralizing IgG |
|
Definition
1. antihistamine
2. topical steroid
3. cromolyn sodium
4. decongestant
5. immunotherapy |
|
|
Term
| first line tx for sinusitis |
|
Definition
|
|
Term
| in what pts should you never use antihistamines? |
|
Definition
|
|
Term
first line tx for allergic rhinitis
if pt doesnt respond to this, then consider |
|
Definition
intranasal steroid spray
then allergy shots (specific desensitization therapy) |
|
|
Term
| ___ is triggered by eating, cold, or sudden briht light |
|
Definition
|
|
Term
| tx for viral rhinitis (common cold) |
|
Definition
symptomatic.
abx are NOT recommended |
|
|
Term
| it usually takes __ - __ days for a viral rhinosinusitis to resolve, where bacterial takes longer |
|
Definition
|
|
Term
| concern with frontal sinusitis |
|
Definition
veins lead from frontal sinuses to dura on opposite side so they can transmit organisms and cause frontal lobe abscess
therefore, acute frontal sinusitis with air-fluid levels require aggresive abx. most pts require admission and topical vasoconstriction or systemic steroids.
if sinusitis doesn't mprove in 24 hours, surgical drainage is indicated |
|
|
Term
| pt with severe ethmoid sinusitis that presents with orbital swelling, proptosis and double vision -- dx? |
|
Definition
| orbital ceullitis or abcsess |
|
|
Term
| ___ sinusitis can cause ophthalmoplegia, meningitis, and cavernous sinus thrombosis |
|
Definition
|
|
Term
| pt with double vision and rhinosinusitis has ___ until proven otherwise |
|
Definition
| cavernous sinus thrombosis |
|
|
Term
usually idiopathic
paroxysmal sharp pains in the face caused by peripheral stimuli
NO radiation
usually after 40 years old
pt may present with hand protecting their face
dx?
tx? |
|
Definition
trigeminal neuralgia (tic douloureux)
carbamazepine (tegretol) |
|
|
Term
| which branch of the trigeminal nerve is most commonly affected by trigeminal neuralgia? |
|
Definition
|
|
Term
most commonly seen in V3
nerve-like, burning pain
precipitated by trauma like facial fracture or removal of impacted teeth |
|
Definition
| trigeminal neuropathic pain |
|
|
Term
episodic bursts of sharp, stabbing, shock-like burning pain that radiates to parotids, ear, and pos pharynx
pt often presents holding their ear
pain on swallowing
could cause sudden death due to impact on cn x
tx? |
|
Definition
glossopharyngeal neuralgia
tx: hospitalization, tegretol |
|
|
Term
spontaneous, idiopathic facial paralysis/paresis
higher bp = worse prognosis
pt often wakes up drooling in the AM and looks in the mirror to find that one side of their face is paralyzed |
|
Definition
|
|
Term
facial nerve paralysis due to herpes zoster in the ear
tx? |
|
Definition
ramsay-hunt's syndrome
antivirals (acyclovir) and oral steroids |
|
|
Term
| asymmetrical (unilateral) SNHL, tinnitus, vertigo are signs of ____ |
|
Definition
| acoustic neuroma (schwannoma) |
|
|
Term
| untreated hematoma of the ear can progress to ___ if not treated. needs to be referred asap. |
|
Definition
|
|
Term
___ is the most commonly fxed facial bone
___ is the most common type of facial fx |
|
Definition
nasal
tripod (zygomaticomaxillary complex) |
|
|
Term
| facial fxs are graded based on the ____ system |
|
Definition
|
|
Term
nasal fx wtih pain far worse than expected
if untreated for 24 hours, can result in ____ |
|
Definition
septal hematoma
can result in saddle nose deformity |
|
|
Term
| raccoon eyes + battle's sign + hemotympany after trauma |
|
Definition
|
|
Term
| to be called bell's palsy, the facial nerve paralysis must be ____ |
|
Definition
|
|
Term
| gradual onset of facial paralysis that doesnt begin to recover by several months or recurrent sx on the same side suggest? |
|
Definition
| tumor - get MRI with contrast |
|
|
Term
| which is longer, the left or right recurrent laryngeal nerve? |
|
Definition
|
|
Term
|
Definition
protection
respiration
phonation |
|
|
Term
| 4 most common cause of hoarseness |
|
Definition
vocal abuse
viral infection
GERD
hypothyroidism |
|
|
Term
any process affecting the larynx that lasts <2-3 weeks and has findings of a typical inflammatory response
viral causes?
bacterial causes?
tx? |
|
Definition
acute laryngitis
viral: cold, RSV, flu, mono
bacterial: M. catarrhalis, mycoplasma, pyogenic bacter
tx: rest + fluids. NEVER antihistamines or decongestants |
|
|
Term
high grade fever
severe myalgia
profound fatigue
hoarseness
dx?
tx? |
|
Definition
|
|
Term
acute laryngotracheitis
tonsillar erythema/exudate
fever
sore throat
non-productive cough
aphonia
tx? |
|
Definition
mycoplasma pneumonia
Tx: rest and water
abx if pneumonia develops |
|
|
Term
| recurrent laryngitis - think ____ |
|
Definition
|
|
Term
hoarseness
cough
sore trhoat
epiglottitis
needs immediate referral |
|
Definition
| mycobacterium tuberculosis |
|
|
Term
normal inhabitant of the GI tract that presents as thrush when grown in the pharynx
due to abx use and immunosuppression
laryngeal involvment by extension
tx? |
|
Definition
candida
tx: nystatin, mycelex troches |
|
|
Term
| sore throat + fluids go out through nose when drinking |
|
Definition
| epiglottitis (supraglottitis) |
|
|
Term
posterior laryngitis
cricoarytenoid joint fixation
laryngomalacia
functional voice disorders
posterior glottic stenosis
laryngospasm
contact ulcer of larynx
reinke's edema
contact granuloma
leukoplakia
ca of true vocal cords
subglottic stenosis
chronic laryngitis
all are cuased by? |
|
Definition
|
|
Term
| hoarseness of two weeks or longer requires? |
|
Definition
| adequate visualization of vocal cords |
|
|
Term
| most common causes of pharyngitis (microorganisms) |
|
Definition
1. viral
2. GABHS - group A beta hemolytic strep (strep pyogenes) |
|
|
Term
fever
oropharyngeal exudate
anterior cervical adenopathy
absence of cold sx - cough/runny nose
complications of this?
tx? |
|
Definition
GABHS
complications: acute rheumatic fever, glomerulonephritis, neck abscess
tx: usually none, can give penicillin or c-chlor |
|
|
Term
dry throat
thirst
malaise
fever/chills
pain radiating to ears
fullness of throat
odonaphagia
dysphagia
microbiology?
tx? |
|
Definition
tonsillitis
most commonly cause by GABHS and anaerobes (bacteroides melaninogenicu)
tx: rest, fluids, analgesics, antipyretics, abx |
|
|
Term
| NEVER treat mono with ___ |
|
Definition
|
|
Term
pt presents with fever, lethargy, sore throat, enlarged lymph nodes
neg monospot
tx them with amoxicillin
they return 2 days later with hives
dx? |
|
Definition
|
|
Term
|
Definition
symptomatic
steroids
abx (NOT amoxcillin) if secondary strep |
|
|
Term
| 90% of peritonsillar abscesses are where? |
|
Definition
|
|
Term
progressive odonyphagia
cervical lymphadenopathy
neck tilted to same side
pain radiates to ear
drooling
fever/malaise
dehydration
trismus (won't open mouth wide)
displaced uvula
dx?
tx? |
|
Definition
peritonsilar abscess
tx: I&D, most likely tonsillectomy |
|
|
Term
calculus (deposiiton of calcium) of tonsil
discomfort
foul breath odor
ulceration |
|
Definition
tonsillolith
tx: get it out with water pick
tonsillectomy for recurrence |
|
|
Term
yellowish or white swellings in tonsils
secondary to entrapement of debris
usually asymptomatic
more common in elderly
I&D for discomfort
tonsillectomy for recurrence |
|
Definition
|
|
Term
| unilateral tonsillar hypertrophy is ___ until proven otherswise and needs to be excised |
|
Definition
|
|
Term
adult > 40 that presents with neck mass, ___ should be #1 ddx
<40 ? |
|
Definition
>40: neoplasia
<40: inflammatory, congenital, neoplasia |
|
|
Term
| do __ & ___ on any suspicious neck mass |
|
Definition
|
|
Term
| 3 common granulomatous dz that can present in head and neck |
|
Definition
|
|
Term
midline neck cyst that rises when pt sticks out tongue?
midline neck cyst that doesn't rise when pt sticks out tongue? |
|
Definition
thyroglossal duct cyst
branchial cleft cyst |
|
|
Term
| mostly benign mass of parotid gland that can undergo malignant transformation if untreated for many years and thus needs MRI and FNA |
|
Definition
|
|
Term
| the ___ runs through the parotid and must therefore be closely watched during parotid surgery |
|
Definition
|
|
Term
| 4 primary malignancies of head and neck |
|
Definition
thyroid
salivary
lymphoma
sarcoma |
|
|
Term
| most common site of unknown primary neck cancers? |
|
Definition
| waldeyer's ring - tongue base, tonsils, nasopharynx |
|
|
Term
| a high risk pt who has otalgia in context of normal otologic exam should be considered to have ___ util proven otherwise |
|
Definition
| aerodigestive tract malignancy |
|
|
Term
| ____ accounts for 95% of head and neck cancers. ___ is second most |
|
Definition
squamous cell carcinoma
lymphoma |
|
|
Term
|
Definition
| primary sjogrens' - systemic autoimmune disorder of exocrine glands that has NO connective tissue disorder associated |
|
|
Term
50 y/o female with bilateral facial palsy, xeropthalmia, xerostomia, raynaud's, arthralgia, myalgia, fatigue
dx? |
|
Definition
| sjogren's with CN VII palsy |
|
|
Term
| 6 weeks of hoarseness in an adult should be considered ___ until proven otherwise |
|
Definition
|
|
Term
| the most common cause of ear pain with a normal ear exam is? |
|
Definition
|
|
Term
| pt with sudden SNHL: give them ___ immediately |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| asthma, aspirin allergy, nasal polyposis |
|
|
