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Common Ear and Nose
Clinical Skills and Therapeutics, Module 2
64
Medical
Graduate
06/10/2009

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Cards

Term
What example is useful to explain ear canal to pt?
Definition
saran wrap that's taut and can get pushed out or sucked in
Term
How do you instill eardrops in pt?
Definition
warm drops so they don't vomit on you
Term
how do you explain to a pt where eustacian tubes end?
Definition
point to the lateral portion outside of nose above the nares
Term
cerumen: what is it?
Definition
hydrophobic protective covering of acidic pH to protect ear and structures from bacteria. produced by ceruminous glands (similar to apocrine sweat glands)
Term
#1 thing removed from ears by pearman
Definition
tips off of qtips
Term
what moves cerumen around?
Definition
cilia moves cerumen around to function properly
Term
When should cerumen be removed?
Definition
symptomatic pt, conductive hearing loss, potential foreign body, contact with the TM, impairment of TM visualization
Term
When should cerumen not be removed?
Definition
when you cannot do it safely (ie, children)
Term
if you suspect tm rupture, how do you tx cerumen impaction?
Definition
use warm water, nothing else
Term
what are potential complications of cerumen impaction removal?
Definition
ruptured tm, superficial lacerations of canal, infection (use abx ointment)
Term
How do you remove cerumen?
Definition
topical therapy (warm saline w/3 capfuls of hydrogen peroxide), curretage, irrigation, candlewicking
Term
why do you always remove cerumen yourself?
Definition
complications, and pays well
Term
What are some examples of topical cerumen therapy?
Definition
mineral oil, hydrogen peroxide, carbamide peroxide soln- murine/debrox, triethanolamine polypeptide oleate-condensate 10% (cerumenex)
Term
cerumen curretage: procedure
Definition
it's a bit tricky. someone holds ear, you can go through otoscope or have someone hold otoscope while you go under.
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?
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.)
Term
ear wicking
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.)
Term
ear candling or warm mineral oil- thermoauricular therapy- what are the potential complication.
Definition
heat melts wax in ear- when you turn it runs out. be careful about burns. warm mineral oil can be too hot
Term
tic in ear. or other bugs- how do you tx?
Definition
drown it with alcaine
Term
emergency objects in ear
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.)
Term
pt. comfort. foreign body composition, living insect management. appropriate use of forceps. other options. potential complications.
Definition
ear foreign body removal
Term
don't irrigate these objects:
Definition
things that swell: paper, bean, etc. use alligator forceps instead.
Term
how do you get out beads?
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.
Term
tympanometry: what is it? what does it ms? what type of tool is it? what is it NOT?
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.
Term
how do you have to perform tympanometry? how is the pt's experience?
Definition
you have to have it sealed. uncomfortable for pt b/c pressure
Term
a graphic picture of the md ear function resulting from pressure varied against tTM readings based on peak pressure and compliance.
Definition
tympanogram
Term
What does each axis of a tympanogram represent?
Definition

height is mobility, width is pressure

 

Term
tm rupture tympanogram
Definition
flat line
Term
negative middle ear pressure on tympanogram
Definition
eustacian tube dysfunction
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?
Definition
B- too much pressure initially, then C as it heals, and when back to normal as A
Term
what does otosclerosis look like on tympanometry?
Definition
bones don't move- peak comes down
Term
epistaxis: what is the severity? what is important for the practitioner to know? are anterior or post nosebleeds worse?
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.
Term
kiesselbach's plexus- why is posterior epistaxis worse
Definition
anterior is more capillaries- posterior is arteries, therefore worse
Term
posterior nosebleed might have no blood coming out of nose- where might it be seen?
Definition
it might just come out of pharynx
Term
foreign body in nose turbinates: what does it cause? what do you administer to counteract this effect?
Definition
causes swelling: give vasoconstrictors to decrease swelling- greater chance of getting it out
Term
how do you remove nasal foreign bodies- what instruments do you use?
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
Term
why must you be careful with removing foreign objects from nose?
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.
Term
one of the best ways of getting out foreign body
Definition
mom: have mom occlude other nare and have mom give nice forceful breath like CPR
Term
good instruments for removing foreign bodies
Definition
nasal speculum, forceps, lighting (head lamp), curette, parent, endoscope, etc.
Term
what are 2 vasoconstrictors useful when removing foreign bodies?
Definition
phenlephrine (neo-synephrine), cocaine, others have wait period
Term
what are 3 topical analgesics useful when removing foreign bodies?
Definition
aeroslized lidocaine, benzocaine, cocaine
Term
slide lubricated foley just up and beyond, blow up balloon, gently retract down
Definition
extra trick for removing foreign bodies
Term
# 1 cause epistaxis
Definition
nosepicking
Term
where are 3 places epistaxis bleeding comes from?
Definition
nostril, nasal cavity, nasopharynx
Term
prevalence of epistaxis
Definition
1 in 7 people
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)
Definition
whe getting a good hx from patient for epistaxis (also note duration of hemorrhage and side, meds, self-tx, and nausea)
Term
What are 3 medications that cause epistaxis?
Definition
coumadin, nsaids, asa, etc.
Term
abc's:
Definition
airway
breathing
circulation
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
Definition
nasal tray contents
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.
Definition
management of anterior epistaxis
Term
when is the following used: silver nitrate-unilateral use only, apply for 5-sec, monitor.
Definition
management of anterior epistaxis
Term
what are the following: hydrocoloid/balloon combination. nasal tampon. balloon catheter. impregnated gauze.
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)
Term
for what nosebleeds do you have to be credentialed?
Definition
credentialed for posterior nosebleeds. not for anterior nosebleeds.
Term
much less common than anterior, multiple techniques for control, must manage abc's also manage contributing factors: bp and coagulopathy
Definition
posterior nosebleeds
Term
manage nosebleeds: method
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.
Term
posterior epistaxis management
Definition
similar general procedure- recognize when ENT involvement is necessary
Term
complications of epistaxis
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.
Term
flexible nasolaryngoscopy/mirror laryngoscopy
Definition
used for removing fishbones, see vocal cords, larynx, eustacian tube.
Term
if direct pressure w/drugs fail or cautery unsuccessful in tx anterior epistaxis, what do you do?
Definition
pack the nose
Term
types of packing used in anterior epistaxis include:
Definition
traditional packing, epistaxis balloon, prefabricated nasal sponge/nasal tampon
Term
Of what should you be aware when dealing w/anterior epistaxis?
Definition
understand the risks, contraindications/complications
Term
initial management of epistaxis
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.
Term
What ages show a peak incidence of epistaxis?
Definition
2-10 y/o; 50-80 y/o
Term
epistaxis more common in what climates and time of yr?
Definition
cool mos, dry climates
Term
what factors contribute to post epistaxis?
Definition
bp and coagulopathy
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