Ear Disorders

***BE ABLE TO INTERPRET WEBER AND RINNE EXAM FINDINGS***

External Ear

Cerumen Impaction

MCC of conductive hearing loss

Do NOT use cue-tips for cerumen removal

Use hydrogen peroxide to soften wax then irrigate or use tiny curette 

Otitis externa

MCC Pseudomonas

Pain when pulling pinna or tragus

Tx: Topical Abx

 

Inner Ear

Acoustic Neuroma

Unilateral Sensorineural Loss

Vague symptoms of headache, dizziness, ears ringing

Dx: MRI test of choice

Tx: Surgery

Eustachian Tube Dysfunction

Pressure difference from the inner to outer ear

This happens when you take off on an airplane and you see people around you yawning or chewing gum (which is the treatment to help equalize the pressure)

Vertigo / Labyrinthitis / Meneires Disease

The table and break down of vertigo in PANCE Prep Pearls is unmatched. It breaks down the symptoms and presentations for patients with Central vs Peripheral Vertigo and the pathologies associated with them. 

Middle Ear

Cholesteatoma

Gradual onset of symptoms

Abnormal tissue starts to erode the middle ear ossicles over time leading to hearing loss

**PAINLESS discharge**

Otitis Media

MCC Strep Pneumo

More common in younger kids / toddlers because Eustachian Tube is shorter and more horizontal making it easier to colonize

**Exam reveals: Angry, red, bulging TM, with decreased movement on pneumatic otoscopy**

Tx: Oral Abx

TM perforation

Acute hearing loss / pain

Visualized on physical exam

Tx: COVER EAR IN SHOWER UNTIL HEALED

Other abnormalities of the ear

Mastoiditis

Infection of the mastoid bone behind the ear

(Look for the kid with the anterior protruding ear)

Dx: CT scan

Tx: IV Abx

Tinnitus

Ringing of the ears

Could be symptom of another pathology

(Think about the ototoxic drugs that cause tinnitus: Aspirin, NSAIDS, aminoglycosides, Loop diuretics)

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