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EENT
Middle Ear
64
Medical
Graduate
08/26/2009

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Cards

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
What causes acute ETD?
Definition
Pressure changes, allergies, viral URI
Term
What is the epidemiology of ETD?
Definition
Children <5yo, 70-90% before 2yo
Term
What occurs in ETD?
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
What are the s/s of ETD?
Definition
Fullness or pressure in ears, otlagia, hearing impairment, tinnitus, dizziness
Term
What is on PE for ETD?
Definition
retraction of the TM, decreased mobility on pneumatic otoscopy
Term
How is ETD tx?
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
How is patulous ET tx?
Definition
Avoid decongestants, poss insertion of ventilating tube, rarely surgical narrowing of tube
Term
What is barotrauma?
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
Malleus, incus, stapes
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
Describe the TM.
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
What are sx of OME?
Definition
Decreased hearing, ear fullness, sleep disturbance, vertigo or imbalance poss
Term
What are signs of OME?
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
What is the tx for OME?
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
What are sx of AOM?
Definition
otalgia, hearing loss, vertigo, rubbing of ear, feeling of blocked ear, irritability
Term
What are signs of AOM?
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
How is AOM dx?
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
How is AOM tx?
Definition
SX tx: acetaminophen, ibuprofen or topical antipyrine otic suspension
Term
What is the first-line abx for AOM?
Definition
Amoxicillin
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
penicillin allergy
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
Intracranial neoplasm
Term
The presence of what is usually present in chronic otitis media (COM) and not AOM?
Definition
Perforation of the TM
Term
What bacteria are responsible for COM?
Definition
P. aeurginosa, proteus, staph, mixed anaerobes
Term
COM develops as a consequence of what?
Definition
Recurrent AOM.
Term
Name the s/s of COM.
Definition
1) Purulent aural discharge* 2) Pain uncommon except under AE 3) COnductive hearing loss
Term
How is COM treated?
Definition
1) Remove infected debris 2) Protect a/g H2O exposure 3) Topical abx drops for AE 4) Surgical definitive tx
Term
What is cholesteatoma?
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
How is cholesteatoma tx?
Definition
Surgical excision
Term
What is mastoiditis?
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
Surgery - mastoidectomy
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