Audiology Assessment: Cerumen Impaction & Otitis Externa

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Questions and Answers

In the assessment of the adult with cholesteatoma, which of the following findings was noted?

Normal tympanic membrane

Acute pain

Foul-smelling discharge (correct)

Severe dizziness

Which treatment is suggested for adults with moderate ear issues due to seasonal allergies?

Auto-insufflation

Short term nasal steroids (correct)

Watchful waiting

T-tubes placement

What condition is associated with the 42-year-old male's history of recurrent ear infections?

Eustachian tube dysfunction

Cholesteatoma (correct)

Otosclerosis

Meniere's disease

Which of the following was NOT a reported symptom for the adult with cholesteatoma?

Vertigo Signup and view all the answers

What action should be avoided when treating a patient with a lodged object in the ear if they have a perforated tympanic membrane?

Irrigate the ear Signup and view all the answers

What is a common cause of acute otitis media in children?

Streptococcus pneumoniae Signup and view all the answers

Which symptom is NOT typically associated with otitis media with effusion?

Ear discharge Signup and view all the answers

What plan should be considered for a child with acute otitis media without perforation?

Observation and possible use of antibiotics Signup and view all the answers

What is the expected treatment for chronic otitis media due to Pseudomonas aeruginosa?

Topical antibiotic drops and debris removal if necessary Signup and view all the answers

In the case of a child experiencing reduced hearing and a history of nasal congestion, what is the likely issue?

Otitis media with effusion Signup and view all the answers

What symptom should be monitored due to its association with acute otitis media in young children?

Difficulty sleeping Signup and view all the answers

Which action is NOT part of the management plan for a child diagnosed with acute otitis media?

Counsel to wear ear plugs Signup and view all the answers

What is the primary causative organism for malignant external otitis in this patient?

Pseudomonas aeruginosa Signup and view all the answers

Which treatment plan is appropriate for a patient with severe otitis externa?

Topical antibiotic plus glucocorticoid for 7 days Signup and view all the answers

What is the recommended management to avoid complications in ear recovery after treatment?

Protect the ear and refrain from water sports Signup and view all the answers

In the case of a foreign body in the ear canal, what was the initial symptom reported by the child?

Mild discomfort Signup and view all the answers

What would be the first step in assessing malignant external otitis in this patient?

CT/MRI/bone scan Signup and view all the answers

Which of the following is NOT a common organism associated with otitis externa?

Neisseria gonorrhoeae Signup and view all the answers

What initial treatment was attempted for the patient with cerumen impaction?

Cerumenolytic, irrigation, or manual removal Signup and view all the answers

What symptom did the 75-year-old male with cerumen impaction NOT report?

Significant pain Signup and view all the answers

In the case of otitis externa, what notable symptom did the child report?

Clear discharge from the ear Signup and view all the answers

What did the physical examination reveal in the 7-year-old girl with otitis externa?

EAC edema and erythema Signup and view all the answers

Which factor likely contributed to the development of otitis externa in the child?

Swimming during a beach vacation Signup and view all the answers

What is the advised frequency for routine cleanings by a healthcare professional for cerumen impaction?

Every 6 to 12 months Signup and view all the answers

What does the Rinne test show in the 75-year-old male with cerumen impaction?

Bone conduction greater than air conduction in the affected ear Signup and view all the answers

What symptom did the 28-year-old female with Eustachian tube dysfunction report experiencing during altitude changes?

Popping sensations Signup and view all the answers

What was the primary assessment for the 28-year-old female's condition?

Eustachian tube dysfunction Signup and view all the answers

What treatment was recommended for the 28-year-old female with Eustachian tube dysfunction?

Topical antihistamines and nasal steroids Signup and view all the answers

What was a notable finding on the physical exam of the 28-year-old female with Eustachian tube dysfunction?

Retracted tympanic membrane with decreased mobility Signup and view all the answers

What symptom did the 45-year-old female with acoustic neuroma experience while in noisy environments?

Difficulty understanding conversations Signup and view all the answers

Which of the following statements pertains to the hearing assessment of the acoustic neuroma patient?

Weber's test lateralized to the unaffected side Signup and view all the answers

What additional symptom did the 45-year-old female report that is commonly associated with auditory disorders?

Persistent tinnitus Signup and view all the answers

What medical history detail was pertinent to the 28-year-old female's case of Eustachian tube dysfunction?

Recent upper respiratory infection Signup and view all the answers

What is the most likely triggering factor for the dizziness experienced by the 62-year-old female patient?

Positional changes Signup and view all the answers

What diagnostic test is indicated if the cause of the patient's symptoms is not obvious?

MRI/CT Signup and view all the answers

What symptom was notably absent in the 62-year-old female patient presenting with dizziness?

Headache Signup and view all the answers

What observation was made during the physical examination of the 62-year-old female patient?

Intact cranial nerves Signup and view all the answers

Which of the following best describes the nature of the 72-year-old male’s hearing loss?

Gradual worsening Signup and view all the answers

What might the 72-year-old male do to compensate for his hearing loss?

Increase volume on devices Signup and view all the answers

What is one characteristic of the 72-year-old male's hearing loss?

Equally affects both ears Signup and view all the answers

Which additional test may be necessary for further evaluation of the 62-year-old female patient's condition?

Serologic testing Signup and view all the answers

Study Notes

Cerumen Impaction

A 75-year-old male presented with two-week history of decreased hearing in the left ear.
He experienced fullness and mild discomfort, but no significant pain or fever.
Symptoms began gradually after using cotton swabs for cleaning.
Physical exam showed an occluded external auditory canal (EAC) with hard, dark cerumen.
No visible tympanic membrane (TM).
Weber test lateralized to affected side (AS).
Rinne test showed bone conduction greater than air conduction (B>A) on affected side (AS).
Treatment involved attempts to remove cerumen via cerumenolytic agent, irrigation, or manual removal.
Patient was educated about avoiding cotton swabs for ear cleaning.
Referral to ENT if impaction not removable.
Routine ear cleanings by a healthcare professional every 6-12 months recommended.

Otitis Externa (Swimmer's Ear)

A 7-year-old female presented with five-day history of progressive right ear pain.
Pain was sharp and worsened with touching or pulling on the ear.
Associated pruritus and fullness.
Reported mild discharge.
History of swimming during recent beach vacation.
Physical exam showed EAC edema and erythema, with purulent discharge.
Pain with manipulation of the tragus and auricle.
TM difficult to visualize.

Malignant External Otitis

A 72-year-old male with poorly controlled diabetes presented with three weeks of severe right ear pain and drainage.
Pain was deep, throbbing, and radiated to jaw and neck.
Difficulty chewing, intermittent fevers, and night sweats reported.
No dizziness or hearing loss.
Prior episodes of swimmer's ear, but current presentation was worse.
Physical exam showed edema and tenderness to the right preauricular area, trismus, erythema, and granulation tissue in the external auditory canal (EAC).
Purulent discharge noted.
TM not visualized.
Treatment involved culture of drainage, biopsy of granulations, and CT/MRI/bone scan to determine severity.
1-6 months of oral/IV antibiotics.

Foreign Body in External Auditory Canal (FB in EAC)

A 6-year-old boy presented with a small bead lodged in his right external auditory canal (EAC) following a recent activity.
Complained of initial mild discomfort, gradually increasing irritability and foul-smelling discharge.
Denies dizziness or fever.
The physical exam revealed a shiny, round object in the EAC.
EAC erythematous and edematous, with purulent discharge.
No visible TM perforation.
Removal of the object was discussed, noting consideration for T-tubes, perforated TM, and veggie matter.
Referral to ENT for button batteries, insects, and penetrating foreign objects.

Acute Otitis Media (AOM)

A 4-year-old girl presented with right ear pain for two days.
Symptoms started following nasal congestion and low-grade fever.
No significant vomiting or diarrhea.
Physical exam showed a bulging and erythematous tympanic membrane (TM).
Treatment involves observation and/or antibiotics.
If no prior antibiotic use in the month, amoxicillin is first-line treatment.
If previous antibiotic use, use amoxicillin-clavulanate.
If penicillin allergy, consider cephalosporins or clindamycin.
Acute otitis media is commonly caused by Streptococcus pneumoniae.
Observation and/or antibiotics recommended for children with bulging and erythematous TM.

Chronic Otitis Media

A 35-year-old male presented with six months of intermittent purulent, foul-smelling discharge from his left ear.
Decreased hearing in affected ear, but no ear pain, vertigo, or fever.
History of recurrent childhood ear infections and T-tube placement.
Construction work with frequent exposure to dust.
Purulent debris in EAC with central TM perforation.
Reduced mobility of the TM with insufflation.
Granulation tissue noted around perforation.
Treatment involved removal of infected debris (if necessary), counseling on ear protection, and topical antibiotics.

Otitis Media with Effusion (OME)

A 5-year-old male presented due to concerns about reduced hearing.
No ear pain, discharge, or fever.
History of nasal congestion and upper respiratory infection.
Physical exam showed a dull and retracted tympanic membrane (TM) with loss of light reflex.

Acoustic Neuroma

A 45-year-old female with six-month history of gradual hearing loss on her right ear presents with difficulty in understanding conversations with others in noisy environments or when multiple people are talking.
She reports mild dizziness and unsteadiness.
No signs of ear pain, discharge, vertigo, or tinnitus.

Benign Paroxysmal Positional Vertigo (BPPV)

A 62-year-old female with two-week history of brief episodes of dizziness.
Dizziness triggered by positional changes (rolling, looking up, bending down).
Nausea but no vomiting.
Episodes less than a minute, multiple times per day.
No associated headache, hearing loss, or fullness.

Labyrinthitis

A 38-year-old male presents with a sudden onset of severe vertigo.
Vertigo was constant and worsened with head movements.
Associated nausea and vomiting, but no hearing loss, tinnitus, or ear pain.
Mild upper respiratory symptoms (nasal congestion and sore throat) prior to vertigo onset.
Difficulty walking due to unsteadiness.

### Barotrauma

A 35-year-old male presented with right ear pain and hearing difficulty.
Symptoms began during flight descent.
Sudden "popping" sensation in ear and sharp pain.
Muffled hearing.
No prior history of ear problems or ear infections associated with flying.
Recent cold and congestion before flying were reported.

Ramsay Hunt Syndrome

A 58-year-old male presented with facial weakness and a painful rash around his ear.
Rash described as itchy and burning, with fluid-filled blisters, accompanied by difficulty closing his right eye and drooling.
Decreased hearing and "ringing" sensation in the right ear.
Mild dizziness and imbalance.

Mastoiditis

A 7-year-old female presented with worsening right ear pain, fever, and irritability.
Symptoms began two weeks prior and included acute otitis media, followed by swelling, redness, and tenderness behind the right ear.
History of recurrent AOM.
Symptoms worsened with reluctance to turn the head due to pain.
Physical exam showed a bulging, erythematous, and immobile TM.
Treatment involved CT scan, culture of blood, CSF, or abscesses, referral to ENT.

Meniere's Disease

A 45-year-old female with recurring vertigo episodes lasting 1-4 hours.
Associated symptoms include room spinning, nausea, vomiting, a feeling of fullness in the affected ear, and tinnitus.
Intermittent hearing loss, worse during or after episodes.
No headache, vision changes, or recent upper respiratory infections.

Conductive Hearing Loss

A 32-year-old male with three-week history of decreased hearing in his left ear.
Described as a "muffled sound" sensation, similar to listening through a wall.
No pain, drainage, tinnitus.
Occasional itching in affected ear.
No trauma, recent upper respiratory infections, or exposure to loud noises.
No improvement with over-the-counter ear drops.

Sensorineural Hearing Loss (Presbycusis)

A 72-year-old male with two-year history of progressive hearing loss.
Difficulty understanding speech, especially in noisy environments.
Increasing volume on TV and phone helps.
No ear pain, drainage, vertigo, or tinnitus.
No history of ear infections, trauma, or exposure to loud noises.

External Ear Neoplasms (Malignant and Benign)

Malignant: Squamous cell carcinoma (SCC).
Benign: adenomatous tumor from ceruminous gland.
Middle ear neoplasms: rare, potentially benign or malignant, associated with pulsatile tinnitus, hearing loss, and mass behind the tympanic membrane.
Inner ear neoplasms: acoustic neuroma (vestibular schwannoma), characterized by hearing loss, tinnitus, and possible CN neuropathies.
Imaging like MRI is frequently useful in diagnosis.

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Description

This quiz covers key concepts in audiology focusing on cerumen impaction and otitis externa, including patient presentation, examination findings, and treatment options. Test your knowledge of ear conditions in both adults and children, and learn best practices for ear care and hygiene.