Ear Anatomy and Conditions Overview

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Questions and Answers

What condition often leads to conductive hearing loss due to the absence of the ear canal?

Microtia

Atresia (correct)

Exostoses

Otitis Externa

Which medication is commonly used to treat Meniere's disease?

Benzodiazepines

Antibiotics

Meclizine

Lipoflavonoid (correct)

What is the recommended treatment for acute otitis media diagnosed with purulence?

Warm compress

Tympanostomy tubes

Amoxicillin high dose (correct)

Nasal decongestants

Which condition is characterized by painless drainage and hearing loss in the middle ear?

Cholesteatoma Signup and view all the answers

What does excessive cerumen require for removal?

Plastic curette or warm water Signup and view all the answers

What is a common presentation of benign paroxysmal positional vertigo (BPPV)?

Transient episodic vertigo Signup and view all the answers

What is the typical treatment for a hordeolum?

Warm compress for over 48 hours Signup and view all the answers

Which condition requires strict water precautions to allow healing?

Tympanic membrane perforation Signup and view all the answers

What is the most common cancer of nasopharyngeal malignancies?

Squamous cell carcinoma Signup and view all the answers

Which growth pattern is associated with juvenile angiofibroma?

Slow growing in young boys Signup and view all the answers

What is a significant risk factor associated with nasopharyngeal carcinoma?

Ethnicity, specifically among Asians Signup and view all the answers

Which symptom is NOT typically associated with paranasal sinus and nasal malignancies?

Severe abdominal pain Signup and view all the answers

What is the recommended treatment for malignant nasal tumors?

Chemotherapy or radiation depending on tumor type Signup and view all the answers

Which symptom is NOT associated with allergic rhinitis?

Epistaxis Signup and view all the answers

What is the preferred treatment for allergic rhinitis?

Corticosteroid nasal sprays Signup and view all the answers

Which is a common sign of salivary gland tumors?

Painless swelling Signup and view all the answers

Which test can help diagnose allergic rhinitis?

Skin testing Signup and view all the answers

In which condition does the body create more blood vessels as a compensation?

Rhinitis medicamentosa Signup and view all the answers

What characterizes anosmia?

Inability to detect odors Signup and view all the answers

Which statement about vasomotor rhinitis is correct?

It involves vascular changes in the nasal mucosa. Signup and view all the answers

What is the main treatment for Dacryocystitis?

Systemic antibiotics Signup and view all the answers

What is a common risk factor for developing allergic rhinitis?

Family history Signup and view all the answers

What should be avoided when preventing allergic rhinitis?

Irritants in the environment Signup and view all the answers

Which type of glaucoma is characterized by irreversible cupping of the optic disc?

Chronic open angle glaucoma Signup and view all the answers

What characterizes hyperosmia?

Increased sensitivity to odors Signup and view all the answers

What is the primary cause of Dacryostenosis in patients?

Nasolacrimal duct obstruction Signup and view all the answers

Which symptom is NOT associated with acute angle closure glaucoma?

Tunnel vision Signup and view all the answers

What characterizes Acanthamoeba Keratitis?

Freshwater and hot tubs Signup and view all the answers

What symptom is commonly associated with iritis (anterior uveitis)?

Unilateral eye pain Signup and view all the answers

Which age group is most commonly affected by Dacryoadenitis?

Children Signup and view all the answers

What is the primary treatment for uveitis posterior?

Systemic corticosteroids Signup and view all the answers

What treatment is preferred for chronic glaucoma to lower intraocular pressure?

Prostaglandins Signup and view all the answers

Which condition is characterized by a sudden onset of unilateral flashes of light followed by a shower of floaters?

Retinal detachment Signup and view all the answers

Which condition is characterized by misalignment of the eyes with constant misalignment known as tropia?

Strabismus Signup and view all the answers

Which vision loss condition is considered a medical emergency?

Central retinal artery occlusion Signup and view all the answers

What is a common sign of Dacryoadenitis?

Lid deformity Signup and view all the answers

What is a risk factor commonly associated with corneal ulcers?

Contact lens wear Signup and view all the answers

What is the treatment approach for Amblyopia?

Patching and glasses Signup and view all the answers

Which type of age-related macular degeneration starts as dry and is progressive?

Atrophic Signup and view all the answers

What is the leading cause of world blindness?

Cataracts Signup and view all the answers

What symptom differentiates scleritis from other eye conditions?

Deep boring pain Signup and view all the answers

What type of vision loss is associated with amaurosis fugax?

Transient monocular loss Signup and view all the answers

In age-related macular degeneration wet type, what is a common symptom?

Visual distortion of straight lines Signup and view all the answers

Study Notes

Ear (External)

Antonia: Absence of the external ear.
Microtia: Small external ear.
Atresia: Absence of the ear canal leading to conductive hearing loss.
Ear canal: Excessive cerumen can be removed with a plastic curette or warm water.
Foreign bodies: Do not flush organic material. Insects require lidocaine first.
Otitis Externa: Inflammation of the external ear canal ("swimmer's ear").
- Symptoms include ear pain, itching, and sometimes drainage.
- Treatment involves clearing the external ear canal and using antibiotics as needed.
Exostoses: Abnormal bone growths within the ear canal ("surfer's ear").
- Refer to rule out cholesteatoma.

Ear (Middle)

Eustachian tube dysfunction: May cause negative pressure in the middle ear.
- Symptoms include a sense of fullness in the ear, "popping," and "cracking."
- Treatment may include nasal steroids and decongestants.
- Rule out sudden hearing loss.
Barotrauma: A consequence of poor Eustachian tube function.
- Occurs during airplane descents, rapid altitude changes, and diving.
- Treatment involves prophylactic topical decongestants.
Acute Otitis Media: Infection of the middle ear space.
- Most common in young children.
- Viral causes include RSV, influenza, and adenovirus.
- Bacterial causes include Streptococcus pneumoniae.
- Must have purulence to make the diagnosis.
- Treatment involves high-dose amoxicillin.
- Complications include perforation (increased pressure in the middle ear) and mastoiditis (infection spreading from the middle ear to the mastoid).
Otitis Media Effusion: Fluid in the middle ear space.
- Up to 3 months is considered normal.
- Tubes may be needed.
- Treatment options for different durations:
  - Acute: Tympanocentesis (relief of pressure, seldom used)
  - Chronic: Tympanostomy tubes (spontaneously extrude; ear drainage is good; ear pain without drainage indicates blockage).
Tympanic membrane perforation: Observe, should heal in 3 months.
- Strict water precautions are necessary.
Cholesteatoma: Accumulation of squamous cells in the middle ear.
- Symptoms include painless drainage and hearing loss.
- Treat by referral and hearing test.

Ear (Vestibular)

Meclizine is a medication often causing dizziness.
Vertigo: Abnormal sensation of movement when none exists.
- Vestibular neuronitis: Not associated with sensorineural hearing loss (SNHL).
- Labyrinthitis: Associated with SNHL.
- Treatment involves benzodiazepines and anticholinergics for two weeks.
Meniere's disease:
- Symptoms include vertigo, ear pressure/fullness, tinnitus, and fluctuating hearing loss.
- Treatment involves lipoflavonoid and diuretics.
Benign Paroxysmal Positional Vertigo (BPPV): Transient episodic vertigo.
- Caused by canalithiasis (most commonly involving the posterior semicircular canal).
- Treatment involves canalith repositioning maneuvers.
Nystagmus: Involuntary rhythmic eye movement.
Oscillopsia: Illusion of subtle movement or shimmering.
Cupulolithiasis: Otolithic debris adheres to the cupula.
- Vertigo is persistent and episodic.
Canalithiasis: Clumping of otolithic debris in the endolymph.
- Vertigo is transient and episodic.
Superior semicircular canal dehiscence: Avoid loud noises.

Eye

Hordeolum (Stye): Localized infection/inflammation of the eyelid or eyelash (external hordeolum) or meibomian gland (internal hordeolum).
- Most commonly caused by Staphylococcus aureus.
- Symptoms include eyelid redness, pain, and swelling.
- Treat with warm compress (if greater than 48 hours, incision and drainage).
Chalazion: Noninfectious obstruction of the meibomian gland.
- Painless, small nodule, deep cyst inside the eyelid.
- Treat with warm compress.
Blepharitis: Inflammation of the eyelid margins.
- Associated with rosacea or seborrheic dermatitis.
- Staph-associated blepharitis: Red rimmed with dry scales and pain.
- Seborrhea-associated blepharitis: Greasy scales and pruritus.
- Treatment involves warm compresses.
Entropion: Inward turning of the lower eyelid, causing corneal excoriation.
- Treat with lubricants and botulinum toxin (Botox).
Ectropion: Outward turning of the lower eyelid.
- Etiology: Cranial nerve VII palsy, age-related tissue relaxation.
- Treat symptomatically.
Lid tumors: Mostly benign. Basal cell is the most common malignant type.
Conjunctivitis: Most common eye disease.
- Viral conjunctivitis is more common than bacterial.
  - Younger patients: More likely bacterial.
  - Older patients: More likely viral.
- Viral conjunctivitis: Caused by adenoviruses, bilateral, watery discharge. Treat symptomatically. Consider herpes simplex virus (HSV) if unilateral with eyelid vesicles; treat with antivirals.
- Bacterial conjunctivitis: Most commonly caused by Staphylococcus aureus, purulent discharge; starts unilateral and then becomes bilateral. Treat with oral antibiotics.
Fungal Keratitis: Caused by contact with plants.
- Characterized by satellite lesions.
Acanthamoeba Keratitis: Caused by exposure to fresh water or hot tubs.
- Characterized by perineural and ring infiltrates.
- Treat with long-term intensive topical use of biguanide and diamidine.
Dacryoadenitis: Inflammation of the lacrimal gland.
- Usually occurs in children due to viral infection.
- Characterized by an "S" shaped eyelid deformity.
- Treat symptomatically.
Dacryostenosis: Nasolacrimal duct obstruction.
- Common in newborns and infants.
- Lack signs of infection.
- Treat with gentle downward massage.
Dacryocystitis: Inflammation of the lacrimal sac.
- Usually due to obstruction.
- Most commonly caused by Streptococcus or Staphylococcus.
- Treat with systemic antibiotics.
- Common in postmenopausal women.
Glaucoma: Damage to the optic nerve due to high intraocular pressure.
- Acute angle closure glaucoma: Physically obstructed anterior chamber.
  - Primary: Preexisting condition.
  - Secondary: No preexisting condition.
  - Symptoms: Rapid onset, extreme pain, halos around lights, nausea, vomiting.
  - Exam: Hard eye, dilated and nonreactive pupil.
  - Treatment: Immediate ophthalmology referral to reduce intraocular pressure (IOP).
    - IV acetazolamide is used.
- Chronic glaucoma: Irreversible cupping of the optic disc.
  - Risk factors: Black race, older age, myopia, diabetes.
    - Chronic open angle glaucoma: Most common.
    - Chronic angle closure glaucoma: Flow of fluid into the anterior chamber is restricted.
  - Symptoms: Tunnel vision.
  - Treatment: Medications to lower IOP (prostaglandins are preferred).
Strabismus: Misalignment of the eyes ("cross eyes").
- Tropia: Constant misalignment.
- Phoria: Intermittent misalignment.
- Pseudostrabismus is normal in children.
- Treatment: Patching, contact lenses, or eyeglasses.
Amblyopia: Lazy eye.
- Preventable if treated early.
- The eye does not match the brain, so the brain suppresses the image from one eye to prevent double vision.
Presbyopia: Loss of accommodation due to aging.
Myopia: Nearsightedness, focuses in front of the retina.
Hyperopia: Farsightedness, focuses behind the retina.
Astigmatism: Multiple focal points.
Iritis (anterior uveitis): Inflammation of the iris.
- Symptoms: Unilateral eye pain, redness.
- May have hypopyon (layering of leukocytes) and ciliary flush.
- Treat by ophthalmology referral.
Uveitis, Intermediate: Inflammation of the vitreous cavity.
- Bilateral, with floaters and blurred vision.
- Characterized by "snowballs."
- Treat with systemic corticosteroids.
Uveitis, Posterior: Inflammation of the choroid, retina, and vitreous.
- Symptoms: Floaters, cells in the vitreous humor.
- Treat with systemic corticosteroids.
Scleritis: Inflammation of the sclera.
- Symptoms: Deep boring pain, worse at night, photophobia, increased pain with ocular movements.
- Treatment varies.
Cataracts: Leading cause of blindness worldwide.
- Most common type is age-related.
- Risk factors: Aging, smoking.
- Symptoms: Blurry or ghosting images, problems seeing at night.
  - Congenital cataracts: Asymptomatic; leukocoria needs investigation for tumor.
- Treatment: Surgery.
Corneal Ulcers: Most commonly caused by infection.
- Risk factor: Extended contact lens wearers.
- Symptoms: Pain, photophobia, tearing.
- Treatment varies with the cause; consider it an emergency!
Retinal Detachment:
- Symptoms: Unilateral sudden flashes of light; shower of floaters; shadow or curtain coming down; no pain or redness.
- Treat with urgent referral to ophthalmologist.
Vitreous Hemorrhage: Leakage of blood into the vitreous humor.
- Symptoms: Sudden vision loss, bleeding within the eye.
- Eye is NOT red or painful, unilateral is more common. Red reflex is diminished or absent.
- Treat with referral to ophthalmologist.
Age-Related Macular Degeneration (AMD): Leading cause of permanent vision loss in the elderly.
- Non-reversible, bilateral.
  - Dry AMD: Atrophic/geographic (all AMD starts as dry).
    - Progressive, bilateral atrophy.
    - Drusen are present.
    - Treat with oral antioxidants.
  - Wet AMD: Neovascular/exudative.
    - New, leaky vessel growth.
    - Visual distortion (straight lines appear crooked).
    - Gray or green discoloration.
    - Treat with laser photocoagulation.
Central and Branch Retinal Vein Occlusions:
- Symptoms: Painless vision loss, first noticed upon waking, unilateral.
- Characterized by "blood and thunder" appearance, cotton wool spots, and optic disc swelling.
- Treat by referral.
- Complication: Neovascularization.
Central and Branch Retinal Artery Occlusions: MEDICAL EMERGENCY.
- Symptoms: Sudden, painless, profound monocular vision loss.
- Characterized by a red fovea (cherry red spot), box-car segmentation, and relative afferent pupillary defect (RAPD).
- Perform Doppler ultrasonography.
- Treat by referral to assess for a stroke.
Amaurosis fugax: Transient ischemic attack.
- Symptoms: Sudden onset, monocular loss of vision, usually lasting a few minutes with complete recovery.

Nose

Allergic Rhinitis:
- Typically presents at younger ages.
- Risk factors: Family history.
- Perennial allergic rhinitis increases the risk of sleep disorders.
- IgE-mediated type I hypersensitivity.
- Sensitization leads to IgE production, which triggers mast cells to release mediators, resulting in clinical symptoms.
- Perennial allergens: Dust, mites, indoor molds, animal dander.
- Seasonal allergens: Tree, grass, and weed pollens.
- Occupational allergens: Latex, chemicals, farm animals.
- Symptoms: Nasal congestion, rhinorrhea (clear/watery), pruritus, and sneezing.
- Exam:
  - Eyes: Conjunctivitis, watering, shiners.
  - Nose: Boggy turbinates, wet swollen nasal mucosa, itching.
- Increased occurrence in pregnancy.
- Diagnosis: Skin testing; complete blood count (CBC) shows increased eosinophils. Swab for eosinophils.
- Prevention: Avoid irritants.
- Treatment: Corticosteroid nasal sprays.
  - Avoid first-generation antihistamines (sedating).
  - Second-generation antihistamines are preferred.
  - Mast cell stabilizers must be started before symptom onset and take weeks to be effective.
  - Leukotriene antagonists: Add-on therapy, potential mental health effects.
  - Saline irrigation: NEVER use unboiled tap water.
Oral Allergy Syndrome: Reaction to raw fruits, vegetables, and tree nuts.
- Symptoms: Itchy mouth/throat or swollen lips/tongue/throat.
  - Example: "I can eat blueberry muffins, but not blueberries raw."
Rhinitis Medicamentosa: Rebound effect with continued use of topical decongestants.
- Example: Afrin use for longer than three days leads to the body compensating by producing more blood vessels, potentially causing atrophy of the nasal mucosa.
- Treat by stopping the nasal spray and using nasal steroids, oral steroids, or intramuscular steroids.
Vasomotor and gustatory rhinitis: Difficult to treat.
Olfactory Dysfunction: Altered sense of smell.
- CN I (through cribriform plate) responsible for smell.
- Smell and taste are closely related.
- Sense of smell naturally decreases with age.
  - Hyposmia: Reduced ability to detect odors.
  - Anosmia: Inability to detect odors.
  - Dysosmia: Change in normal odor perception.
  - Phantosmia: Sensation of odor when none is present.
- Treatment of transport loss: Treat the underlying issue.
- Treatment of sensorineural loss: No effective treatment.
- Safety counseling is important: Ensure working smoke detectors.
- Hyperosmia: Smell more than usual (pregnancy).
- Normosmia: Normal sense of smell.
- Complications: Increased risk of food poisoning, environmental exposure, diminished satisfaction, and social isolation.

Nasal Masses

Nasal Polyp: Benign mass, but 5-15% are squamous cell carcinoma.
- Symptoms: Unilateral nasal obstruction, facial pressure, headache. Similar to sinusitis.
- Treatment: Surgical excision (medial maxillectomy).
- High recurrence rates.
Juvenile Angiofibroma: Slow-growing tumor in young boys (uncommon!).
- Located in the posterior nasal cavity, extending into the nasopharynx.
- In girls, it is associated with gonadal dysgenesis.
- Treatment: Removal.

Malignant Tumors

Malignant tumors of the nose are very rare.
Symptoms: Chronic rhinitis or sinusitis, unilateral ear pain, and hearing loss.
Nasopharyngeal malignant tumors:
- Nasopharyngeal carcinoma (squamous cell): Most common nasopharyngeal cancer.
  - Risk factors: Adult age, Asian race, Epstein-Barr Virus (EBV) exposure.
- Adenocarcinoma/adenoid cystic carcinoma (less common):
  - Part of sinonasal tumors.
  - Risk factors: Wood dust, leather dust, asbestos.
  - Most commonly from ethmoid sinuses.
- Lymphoma ("lethal midline granuloma"):
  - Most commonly T-cell lymphoma.
  - Associated with significant bleeding and EBV.
- Overall high cure rates.
Paranasal sinuses and nasal malignancies:
- Squamous cell carcinoma: Maxillary antrum is the epicenter.
- Lymphoma:
- Symptoms (advanced): Proptosis, expansion of the cheek, ill-fitting maxillary dentures, severe pain, malar hypesthesia (infraorbital nerve involvement).
Risk Factor for Nasopharyngeal Carcinoma: Smoking.
- Treatment is more successful if the base of the skull is NOT involved.
- Lower cure rates for tumors involving the skull base.
Diagnostics: CT and MRI.
Treatments: Varies depending on the tumor type and extent; chemotherapy and/or radiation may be used.

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Description

This quiz covers various conditions affecting the external and middle ear, including microtia, atresia, otitis externa, and Eustachian tube dysfunction. It explores causes, symptoms, and treatment options for these ear-related issues. Perfect for students studying otolaryngology or related fields.