sensorineural hearing loss is defined as
a lesion in the organ of Corti or in the central pathways including the CM VIII pg 276
age related hearing loss is termed
presbycusis and is a form of sensorineural hearing loss pg 276
Otitis Media (AOM, OME)
Otitis Externa
Paroxysmal Positional Vertigo
Meniere's disease
Presbycusis
Cerumen impaction
Common ear conditions (ppt week 2)
Pain
Discharge
Vertigo
Dizziness
Tinnitus
Hearing Loss
clinical presentation of ear disorders (ppt week 2
Focus on symptom of concern
Otalgia - deep ear pain or superficial pain
Also ask about associated symptoms
Examine external ear
Otoscopic exam & pneumatic otoscopy
Other tests: Weber, Rinne, Romberg, Audiometry
History, Exam, and Testing (ppt week 2)
Recent, abrupt onset (<48 hrs) of symptoms
Middle ear effusion, and
Signs or symptoms of inflammation of the middle ear
All 3 criteria must be present - A red TM is not enough
Risk factors: tobacco smoke, URIs
Complications: perforation, mastoiditis, loca
definition of Acute Otitis Media (AOM) (ppt week 2)
Middle ear effusion indicated by:
Bulging of TM
Decreased or no mobility of TM OR
Air fluid level
Otorrhea
Inflammation indicated by:
Distinct erythema OR
Distinct otalgia that interrupts normal activities
Acute Otitis Media (AOM (ppt week 2)
History - URI, otalgia, fever +/-, diminished hearing on the affected side, purulent drainage (if TM perforated)
Pneumatic Otoscopy
Organisms:
pneumoniae,
H. influenzae,
Moraxella catarrhalis,
viruses
exam findings in AOM (ppt week 2)
Definition - fluid in middle ear without signs of inflammation
Caused by blockage of Eustachian tube
Decreased hearing may result
Difficult to distinguish from AOM
May persist 3 months to 1 year following AOM
otitis media with effusion (OME) (ppt week 2)
May be asymptomatic
Symptomatic
Otalgia without fever - usually does not interfere with normal activities
Fullness, tinnitus, vertigo, hearing loss
Popping or cracking sounds when yawning or blowing nose
Otoscopic exam: effusion, no inflammation
Presentation of OME (ppt week 2)
No benefit to antihistamines or decongestants demonstrated unless allergy
If eustachian tube dysfunction caused by allergy symptoms:
Nasal steroids, antihistamines, decongestants
If effusion persists >3 months, single course of amoxicillin/clavulanate
Ref
Management of OME (ppt week 2)
Inflammation of the lining of the auditory canal
A bacterial, viral, or fungal infection of the ear canal is one of the most common causes of otalgia in adults
OE occurs when the "acid mantle" and cerumen of the ear fail to protect.
Other symptoms: prurit
Otitis Externa or swimmer's ear (ppt week 2)
Manipulation of pinna and tragus cause pain
Ear canal may be swollen and inflammed with white or green discharge
Most common pathogens: Pseudomonas, S. aureus, S. epidermidis, various fungi
Laboratory tests are rarely needed - culture of discharge if diag
Examination findings in OE (ppt week 2)
In OE Ciprofloxin & Dexamethasone (Ciprodex) 4 gtts bid x7 days
May be used with perforated TM (ppt week 2)
Presbycusis - bilateral high-frequency sensorineural hearing loss
most common pattern of hearing loss in older adults
Differential Diagnosis of Other Causes
Cerumen or foreign body impaction
AOM, OME, perforation of TM, OE
Meniere's disease
Ototoxic Medic
Geriatric Considerations Hearing Loss (ppt week 2)
Differential diagnosis - distinguish between conductive and sensorineural causes
Determine if problem with spoken word
Medication history, family history, noise exposure
PE - HEENT, hearing tests, Weber, Rinne
If screening tests suggest impairment, refer
evaluation of hearing loss (ppt week 2)
What is the easiest way to differentiate between otitis externa and otitis media?
With otitis externa, movement or pressure on the pinna is extremely painful
Acute otitis media is diagnosed when there is:
Fluid in the middle ear accompanied by otalgia and fever.
The antibiotic of choice for beta-lactamase coverage of otitis media is:
Amoxicillin and potassium clavulanate
The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient's mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient
Rinne test
Otitis Media with Effusion (OME) is defined as
presence of middle ear fluid without acute signs of illness or inflammation of the middle ear mucosa (uptodate)
the standard method of diagnosis of AOM is by
a hand-held otoscope, the pneumatoscopy allows evaluation of tympanic membrane motion and is highly recommended for diagnosis (uptodate)
Acute rhinosinusitis (ARS) is defined as
symptomactic inflammation of the nasal cavity and paranasal sinueses lasting less than four weeks (uptodate)
The most common causes of acute rhinosinusitis (ARS) is
a viral infection (uptodate)
acute bacterial rhinosinusitis should be suspected in patients presenting with the following three features:
persistent symptoms or signs of ARS lasting 10 or more days with no clinical improvement
onset with severe symptoms fever >39C/102F and purulent nasal discharge or facial pain lasting at least three consecutive days at the beginning of illness
onset with