Hearing Loss Overview

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Questions and Answers

What is the primary cause of conductive hearing loss?

Age-related changes

Neural component dysfunction

Dysfunction of the cochlea

Dysfunction of the external auditory canal or ossicles (correct)

In the Rinne Test for hearing loss, what result indicates a conductive hearing loss?

AC > BC

AC = BC or BC > AC (correct)

AC < BC

BC > AC and SNHL is present

Which treatment option is recommended for a patient with sudden sensory-neural hearing loss?

Monitoring for 6 months

Antihistamines

Immediate surgical intervention

High dose oral steroids (correct)

What is the primary symptom of presbycusis?

Age-related sensory-neural hearing loss Signup and view all the answers

What can indicate the presence of otosclerosis in a patient?

Progressive bilateral conductive hearing loss Signup and view all the answers

Which condition is most commonly associated with seborrheic dermatitis of the ear?

Cellulitis Signup and view all the answers

What is the most common cause of acoustic noise trauma?

Prolonged exposure to loud noises Signup and view all the answers

What condition is characterized by a 'cookie bite' hearing loss pattern?

Hereditary SNHL, non-syndromic Signup and view all the answers

Which of the following is a risk factor for acoustic neuroma?

Neurofibromatosis Signup and view all the answers

What is the proper treatment for hyperacusis?

Amplification and antidepressants Signup and view all the answers

What is the first line treatment for oral pain?

NSAIDs Signup and view all the answers

Which of the following medications can cause gingival hyperplasia?

Methotrexate Signup and view all the answers

What is a common symptom of adenoiditis?

Nasal congestion Signup and view all the answers

Which condition requires airway management and epinephrine due to rapid onset swelling?

Angioedema Signup and view all the answers

Which of the following is a condition for tonsillectomy?

Bad breath Signup and view all the answers

What condition is characterized by the presence of fluid in the middle ear space?

Otitis Media Effusion Signup and view all the answers

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

Amoxicillin high dose Signup and view all the answers

What condition is characterized by abnormal bone growth within the ear canal, commonly referred to as ‘surfers ear’?

Exostoses Signup and view all the answers

Which medication is often associated with causing dizziness and is used to treat vestibular conditions?

Meclizine Signup and view all the answers

Which condition is characterized by a sense of fullness in the ear and may require treatment with nasal steroids?

Eustachian Tube Dysfunction Signup and view all the answers

Which of the following is a classic symptom of Meniere's disease?

Fluctuant hearing loss Signup and view all the answers

The accumulation of squamous cells in the middle ear is known as what?

Cholesteatoma Signup and view all the answers

What is the primary treatment for a hordeolum (stye)?

Warm compress Signup and view all the answers

In the case of tympanic membrane perforation, how long should one expect the membrane to heal?

3 months Signup and view all the answers

Which type of conjunctivitis is more common in younger individuals?

Bacterial conjunctivitis Signup and view all the answers

What is the primary cause of dacryoadenitis?

Viral infection Signup and view all the answers

Which condition is characterized by 'S' shaped lid deformity?

Dacryoadenitis Signup and view all the answers

What is the treatment for chronic glaucoma?

Medications to lower intraocular pressure Signup and view all the answers

Which of the following describes the symptoms of acute angle closure glaucoma?

Rapid onset, extreme pain, and nausea Signup and view all the answers

What is the common treatment for dacryostenosis in newborns?

Gently massage downward Signup and view all the answers

Which of the following is NOT true about strabismus?

Pseudostabismus is considered abnormal in kids. Signup and view all the answers

What is the main characteristic of amblyopia?

Suppression of one eye's image by the brain Signup and view all the answers

What is the treatment commonly recommended for fungal keratitis?

Long term intensive topical antifungals Signup and view all the answers

Which of the following is NOT a component of the Center Criteria for diagnosing strep throat?

Presence of cough Signup and view all the answers

What is the most common type of salivary gland tumor?

Parotid tumors Signup and view all the answers

What is the characteristic symptom of perennial allergic rhinitis?

Persistent nasal congestion Signup and view all the answers

Which of the following is a risk factor that can increase the occurrence of allergic rhinitis?

Family history Signup and view all the answers

What is the primary treatment recommended for rhinitis medicamentosa?

Stop the nasal spray Signup and view all the answers

Which allergic condition is characterized by an itchy mouth or throat after consuming raw fruits or vegetables?

Oral allergy syndrome Signup and view all the answers

How are eosinophils typically assessed in the diagnosis of allergic rhinitis?

CBC blood test Signup and view all the answers

Which of the following correctly defines hyposmia?

Reduced ability to detect odors Signup and view all the answers

What is the primary recommended treatment for allergic rhinitis?

Nasal corticosteroids Signup and view all the answers

Which form of allergic rhinitis is primarily triggered by dust and indoor molds?

Perennial allergic rhinitis Signup and view all the answers

What is the primary treatment for infectious keratitis?

High concentration topical antibiotic drops Signup and view all the answers

Which type of conjunctivitis is associated with cobblestone papillae?

Allergic Conjunctivitis Signup and view all the answers

Which condition is most commonly linked to vision impairment due to infectious causes?

Bacterial Chlamydia Signup and view all the answers

Which symptom is NOT typically associated with keratoconjunctivitis sicca?

Copious discharge Signup and view all the answers

What indicates the need for emergency treatment in cases of conjunctivitis?

Copious discharge due to bacterial gonococcus Signup and view all the answers

What is the primary characteristic of nonproliferative diabetic retinopathy?

Retinal capillary closure and microaneurysms Signup and view all the answers

Which symptom is NOT typically associated with optic neuritis?

Lateral movement impairment Signup and view all the answers

What is the most common type of malignant nasopharyngeal tumor?

Nasopharyngeal carcinoma Signup and view all the answers

What is the recommended treatment for hypertensive retinopathy?

Aggressive blood pressure control Signup and view all the answers

Which risk factor is associated with a higher incidence of adenocarcinoma in sinonasal tumors?

Leather dust exposure Signup and view all the answers

What is the typical treatment approach for malignant tumors in the nasopharynx?

Chemotherapy and radiation Signup and view all the answers

Which of the following conditions is characterized by symptoms of rapid eye movements and sensitivity to light?

Nystagmus Signup and view all the answers

Which sign is indicative of proliferative diabetic retinopathy?

Cotton wool spots and dot and blot hemorrhages Signup and view all the answers

What is a common symptom associated with advanced paranasal sinus malignancies?

Proptosis Signup and view all the answers

Which condition is characterized by a slow-growing tumor primarily in young boys in the posterior nasal cavity?

Juvenile Angiofibroma Signup and view all the answers

What is the main characteristic that differentiates acute angle closure glaucoma from chronic glaucoma?

Rapid onset of symptoms Signup and view all the answers

In which type of keratitis are perineural and ring infiltrates commonly associated?

Acanthamoeba Keratitis Signup and view all the answers

Which condition is primarily treated with systemic antibiotics?

Dacryocystitis Signup and view all the answers

What type of therapy is recommended for the management of amblyopia?

Patching of the dominant eye Signup and view all the answers

What signs or symptoms are indicative of chronic glaucoma?

Loss of peripheral vision Signup and view all the answers

Which demographic is most commonly affected by dacryoadenitis?

Children Signup and view all the answers

What characteristic feature is associated with dacryostenosis in newborns?

Lack of signs of infection Signup and view all the answers

What is a common risk factor for development of chronic glaucoma?

Diabetes Signup and view all the answers

Which of the following symptoms is NOT part of the typical presentation of perennial allergic rhinitis?

Puffy eyelids Signup and view all the answers

What distinguishes submandibular and sublingual salivary gland tumors from parotid gland tumors in terms of malignancy risk?

Submandibular and sublingual tumors are more likely to be malignant. Signup and view all the answers

Which treatment is generally recommended for managing rhinitis medicamentosa?

Stop nasal spray and use nasal steroids. Signup and view all the answers

For which condition would you expect a patient to present with a gradual onset of painless swelling?

Salivary gland tumors Signup and view all the answers

Which physiological process initiates the clinical signs associated with allergic rhinitis?

IgE production and sensitization Signup and view all the answers

What characterizes olfactory dysfunction related to sensorineural loss?

There is no effective treatment for this condition. Signup and view all the answers

Which condition could lead to the sensation of odor when none is present?

Phantosmia Signup and view all the answers

Which of the following is a key risk factor associated with perennial allergic rhinitis?

Family history of allergies Signup and view all the answers

Which type of imaging is typically used for evaluating salivary gland tumors?

MRI Signup and view all the answers

What is a crucial consideration when performing saline irrigation for allergic rhinitis?

Boil the tap water before use. Signup and view all the answers

Study Notes

Hearing Loss

Conductive Hearing Loss: Dysfunction in the external ear, ossicles, or tympanic membrane.
Sensory-Neural Hearing Loss: Dysfunction in the cochlea or neural components.
Mixed Hearing Loss: Combination of conductive and sensory-neural hearing loss.
Weber Test: Tuning fork placed on the center of the forehead.
- Normal: Sound is heard equally in both ears.
- Conductive Hearing Loss: Sound is louder in the affected ear.
- Sensory-Neural Hearing Loss: Sound is louder in the unaffected ear.
Rinne Test: Tuning fork placed against the mastoid bone then held near the ear.
- Normal: Air conduction (AC) is louder than bone conduction (BC).
- Conductive Hearing Loss: AC and BC are equal or BC is louder than AC.
- Sensory-Neural Hearing Loss: AC is louder than BC.
Middle Ear Effusions and Conductive Hearing Loss:
- Characterized by a non-mobile tympanic membrane.
- Treatment is observation for up to 3 months.
- Antihistamines and oral steroids are ineffective.
Otosclerosis: Stapes loses mobility due to excessive bony growth at the oval window.
- Increased osteoblastic and osteoclastic activity and vascular proliferation.
- Most commonly affects the anterior stapes footplate.
- Presents with progressive bilateral conductive hearing loss.
- Treatment: Referral to ENT.
  - Medications: Sodium fluoride and bisphosphonates.
Sudden Sensory-Neural Hearing Loss: Rapid onset within 72 hours, usually affecting one ear.
- Potential risk factors: Viral infection and environmental allergies.
- Treatment: Immediate referral to ENT and high-dose oral steroids.
Acoustic Neuroma: Schwann cell derived tumors affecting the vestibular portion of CN VIII.
- Risk factors: Neurofibromatosis.
- Signs: Unilateral sensory-neural hearing loss, tinnitus, and balance problems.
- Exam: Asymmetry of CN VII in large tumors.
- Treatment: Observation, high-dose oral steroids, surgical resection.
Hereditary Sensory-Neural Hearing Loss: Unknown origin.
- Syndromic findings: Symmetrical hearing loss.
- Non-syndromic findings: Cookie-bite or U-shaped configuration on audiogram.
- Treatment: Amplification.
Autoimmune Sensory-Neural Hearing Loss: Associated with conditions like rheumatoid arthritis and SLE.
- Typically bilateral and progressive.
- Treatment: Referral to ENT and corticosteroids.
Presbycusis: Age-related sensory-neural hearing loss.
- Loss of hair cells at the basal turn of the cochlea.
- Treatment: Amplification.
Acoustic Noise Trauma: Second most common cause of hearing loss.
- Loss typically begins in high frequencies.
- Treatment: Noise and hearing protection.
Tinnitus: Ringing, buzzing, or roaring noises.
Hyperacusis: Excessive sound sensitivity.
- Symptoms worsen with stress, anxiety, fatigue, caffeine, aspirin, and ibuprofen.
- Treatment: Amplification and antidepressants.

External Ear

Seborrheic Dermatitis: Scaling and erythema affecting the auricular fold.
- Can predispose to cellulitis.
Psoriasis: Presents with scaly silver plaques.
Atopic Dermatitis: Prominent excoriation.
Contact Dermatitis: Caused by irritations, commonly due to nickel in earrings.
Skin Cancer: Squamous cell cancer is most common.
- Lack of subcutaneous tissue requires careful consideration during treatment.
Cellulitis: Infection of the pinna, with Staphylococcus being the most common organism.
Perichondritis: Pseudomonas is the most common causative organism.
Relapsing Polychondritis: Rheumatological disorder affecting the tracheobronchial tree.
- Treatment: Steroids.
Epidermoid Cyst: Benign proliferation of epidermal cells.
External Ear Trauma: Common in wrestlers.
- Prompt drainage of hematomas is crucial to avoid cauliflower ear.
  - Needle drainage within 6 hours.
  - Incision up to 7 days.
Congenital Malformations: Treatment involves early referral to ENT.
- Anotia: Absence of the external ear.
- Microtia: Small external ear.
- Atresia: Agenesis of the ear canal leading to conductive hearing loss.
Ear Canal:
- Excessive Cerumen: Removal with a plastic curette or warm water.
- Foreign Bodies: Avoid flushing organic material.
  - Treat insect foreign bodies with lidocaine first.
Otitis Externa: Swimmer's ear.
- Presents with ear pain, itching, and sometimes drainage.
- Treatment: Clean the external ear canal and antibiotics as needed.
Exostoses: Abnormal growth of bone within the ear canal, commonly referred to as "surfer's ear."
- Referral to rule out cholesteatoma.

Middle Ear

Eustachian Tube Dysfunction: Can lead to negative pressure in the middle ear.
- Symptoms include a sense of fullness, popping, and cracking in the ear.
- Treatment: Consider nasal steroids and decongestants.
- Rule out sudden hearing loss.
Barotrauma: Consequence of poor Eustachian tube function.
- Occurs during airplane descent, rapid altitude change, or diving.
- Treatment: Prophylactic topical decongestants.
Acute Otitis Media: Infection of the middle ear space.
- Most common in young children.
  - Viruses: RSV, influenza, adenovirus.
  - Bacteria: Streptococcus pneumoniae.
- Purulence is required for diagnosis.
- Treatment: High-dose amoxicillin.
- Complications:
  - Perforation: Increased pressure in the middle ear.
  - Mastoiditis: Infection spreads from the middle ear to the mastoid bone.
Otitis Media Effusion: Fluid in the middle ear space.
- Normal for up to 3 months.
- Tympanostomy tubes may be necessary.
- Treatment:
  - Acute: Tympanocentesis for pressure relief, rarely used.
  - Chronic: Tympanostomy tubes.
    - Ear drainage is favorable.
    - Ear pain without drainage indicates blockage.
Tympanic Membrane Perforation: Observation, typically heals within 3 months.
- Strict water precautions.
Cholesteatoma: Accumulation of squamous cells in the middle ear.
- Presents with painless drainage and hearing loss.
- Treatment: Referral for evaluation and hearing test.

Vestibular System

Vertigo: Abnormal sensation of movement when none exists.
- Vestibular Neuronitis: Not associated with sensory-neural hearing loss.
- Labyrinthitis: Associated with sensory-neural hearing loss.
- Treatment: Benzodiazepines and anticholinergics for 2 weeks.
Meniere's Disease: Characterized by vertigo, ear pressure/fullness, tinnitus, and fluctuating hearing loss.
- Treatment: Lipoflavonoids and diuretics.
Benign Paroxysmal Positional Vertigo (BPPV): Transient episodes of vertigo.
- Caused by canalithiasis.
  - Posterior semicircular canal is most commonly affected.
- Treatment: 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.
- External: Eyelid/eyelashes.
- Internal: Meibomian gland.
- Most commonly caused by Staphylococcus aureus.
- Presentation: Eyelid redness, pain, and swelling.
- Treatment: Warm compress.
  - I&D if symptoms persist for more than 48 hours.
Chalazion: Non-infectious obstruction of the Meibomian gland.
- Painless, small nodule, deep cyst inside the lid.
- Treatment: Warm compress.
Blepharitis: Inflammation of the eyelid margins.
- Associated with rosacea or seborrheic dermatitis.
- Staphylococcal Blepharitis: Red rimmed, dry scales, painful.
- Seborrheic Blepharitis: Greasy scales, pruritic.
- Treatment: Warm compress.
Entropion: Inward turning of the lower lid.
- Can lead to corneal excoriation.
- Treatment: Lubricants and Botox.
Ectropion: Outward turning of the lower lid.
- Etiology: Cranial nerve VII palsy or age-related tissue relaxation.
- Treatment: Symptomatic.
Lid Tumors: Most are benign.
- Basal cell carcinoma is the most common malignant tumor.
Conjunctivitis: Most common eye disease.
- Viral causes are more prevalent than bacterial.
  - Younger patients: Bacterial more common.
  - Older patients: Viral more common.
- Viral Conjunctivitis: Adenovirus, bilateral disease, watery discharge.
  - Treatment: Symptomatic.
    - Consider HSV if unilateral with lid vesicles, treat with antivirals.
- Bacterial Conjunctivitis: Staphylococcus most common, purulent discharge, starts unilateral then bilateral.
  - Treatment: Oral antibiotics.
Fungal Keratitis: Contact with plants.
- Presents with satellite lesions.
Acanthamoeba Keratitis: Fresh water and hot tubs.
- Perineural and ring infiltrates.
- Treatment: Long-term intensive topical biguanide/diamidine.
Dacryoadenitis: Inflammation of the lacrimal gland.
- Typically occurs in children due to viral infection.
  - "S" shaped lid deformity.
- Treatment: Symptomatic.
Dacryostenosis: Nasolacrimal duct obstruction.
- Common in newborns and infants.
  - Lack of signs of infection.
- Treatment: Gentle downward massage.
Dacryocystitis: Inflammation of the lacrimal sac.
- Commonly due to obstruction.
- Usually caused by Streptococcus or Staphylococcus.
- Treatment: Systemic antibiotics.
- Adults: Most commonly affects 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 IOP.
    - IV acetazolamide.
- Chronic Glaucoma: Irreversible cupping of the optic disc.
  - Risk factors: Black race, older age, nearsightedness, diabetes.
    - Chronic Open Angle Glaucoma: Most common type.
    - Chronic Angle Closure Glaucoma: Impaired flow of fluid into the anterior chamber.
  - Signs: Tunnel vision.
  - Treatment: Medications to lower IOP.
    - Prostaglandins are preferred.
Strabismus: Misalignment of the eyes ("cross eyes").
- Tropia: Constant misalignment.
- Phoria: Intermittent misalignment.
- Pseudostrabismus: Normal finding in infants.
- Treatment: Patching, contact lenses, or eyeglasses.
Amblyopia: Lazy eye.
- Preventable if treated.
- The eye does not match the brain, suppressing the image from one eye to prevent double vision.
Avulsion of Permanent Teeth: DO NOT touch the root of the tooth.
- This is a TRUE DENTAL EMERGENCY.

Medications and Dental Effects

Gingival Hyperplasia: Anticonvulsants, methotrexate, cyclosporine.
Dental Erosion: Progesterone, nitrates.
Osteonecrosis: Bisphosphonates.
Dental Caries: Sugar preparations.

Oral Health

Antibiotic Prophylaxis: Most patients do not require antibiotic prophylaxis.
Oral Pain: NSAIDs are the first-line treatment option.
Angioedema: Hypersensitivity reaction presenting as soft, non-itchy swelling of the mouth, lips, tongue, or cheeks.
- Rapid onset.
- Treatment: Airway management with epinephrine.

Throat

Tonsillitis: Congestion with bacteria in the tonsils.
- Tonsillectomy indications: Recurrent infections, sleep apnea, gagging, one tonsil larger than the other, bad breath, 7 episodes/year.
Adenoiditis: "Junky nose" - persistent feeling of stuffiness.
- Unable to breathe through the nose, ill-appearing, cervical lymphadenopathy.
  - Other signs: Long face, gummy smile, dry lower lip, mouth breathing.
- Adenoidectomy indications: Recurrent adenoiditis, sinusitis, persistent middle ear fluid, sleep apnea.
Pharyngitis: Viral > Bacterial, more prevalent in winter months, ages 4-7.
- Pathogens: Streptococcal, herpes/coxsackievirus, oral candida, GABHS.
  - Treat GABHS to prevent sequelae.
- Streptococcal types: Non-hemolytic, hemolytic.
- Symptoms: Sore throat, dysphagia, fever, malaise, headache, vomiting (in children), absence of other upper respiratory infection symptoms.
- Screening: Rapid strep antigen test (RST).
  - Center Criteria:
    - Fever or elevated temperature.
    - Absence of cough.
    - Tender anterior cervical lymph nodes.
    - Tonsillar swelling or exudates.
    - Age 2 years or younger, or symptoms persisting for 2 weeks.
Salivary Gland Tumors: Often benign, but require evaluation.
- Parotid Gland: Most likely to be benign and most common location.
- Submandibular and Sublingual Glands: Less common and more prone to malignancy.
- Signs: Painless swelling of gradual onset.
- Imaging: MRI.
- Treatment: Referral to ENT.

Nose

Allergic Rhinitis: Typically presents at younger ages.
- Risk factors: Familial history.
- Perennial allergic rhinitis increases the risk of sleep disorders.
- IgE-mediated type I hypersensitivity.
- Sensitization -> IgE production -> mast cells -> mediators -> clinical signs.
- Perennial Allergic Rhinitis: Dust, mites, indoor molds, animal dander.
- Seasonal Allergic Rhinitis: Tree, grass, weed pollens.
- Occupational Allergic Rhinitis: Latex, chemicals, farm animals.
- Symptoms: Nasal congestion, rhinorrhea (clear/watery), pruritus, sneezing.
- Exam Findings:
  - Eyes: Conjunctivitis, tearing, shiny appearance.
  - Nose: Boggy turbinates, wet, swollen nasal mucosa, itching.
- Increased occurrence during pregnancy.
- Diagnosis: Skin testing, CBC shows increased eosinophils.
  - Nasal swab for eosinophils.
- Prevention: Avoid irritants.
- Treatment:
  - Corticosteroid nasal sprays.
  - Avoid first-generation antihistamines (sedating).
  - Second-generation antihistamines are preferred.
  - Mast cell stabilizers need to be started prior to symptom onset and take weeks to be effective.
  - Leukotriene antagonists: Add-on therapy with potential mental health side effects.
  - Saline irrigation: NEVER use unboiled tap water.
Oral Allergy Syndrome: Raw fruits, vegetables, and tree nuts.
- Itchy mouth/throat or swollen lips, tongue, or throat.
  - Example: "I can eat blueberry muffins but NOT blueberries raw."
Rhinitis Medicamentosa: Rebound effect with continued use of topical decongestants.
- Use of Afrin for longer than 3 days can lead to the body compensating by creating more blood vessels.
  - This can lead to atrophy of the nasal mucosa.
- Treatment: Discontinue the nasal spray and use nasal steroids, oral steroids, or IM steroids.
Vasomotor and Gustatory Rhinitis: Difficult to treat.
Olfactory Dysfunction: Altered sense of smell.
- CN I (through the cribriform plate)
- Smell and taste are closely related.
- Sense of smell declines 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: Address the underlying cause.
- Treatment for Sensorineural Loss: No effective treatment.
  - Safety counseling: Smoke detectors.
- Hyperosmia: Smell more than usual (pregnancy).
- Normosmia: Normal sense of smell.
- Complications: Increased risk of food poisoning, environmental exposure, diminished satisfaction, social isolation.

Eye Conditions

Eyelid Inflammation
- Often self-limiting
- Gonococcal infection: Copious discharge, usually from genital secretions
  - Treat: IM Ceftriaxone (emergency)
- Chlamydial infection: Most common infectious cause of blindness
  - Treat: Oral antibiotics
- Allergic conjunctivitis: Itchiness
  - Vernal conjunctivitis presents with cobblestone papillae
  - Treat: Topical antihistamines
Dry eyes (Keratoconjunctivitis sicca)
- Inadequate tear production or accelerated tear evaporation
- Symptoms: Blurred vision, dryness, gritty/sandy sensation, eye strain
- Treat: Artificial tears
Pinguecula: Raised yellowish white mass on the conjunctiva, rarely needs to be removed.
Pterygium: Fleshy triangular growth on the conjunctiva, removal is often indicated.
Infectious Keratitis
- Infection of the cornea
- Signs: Eye pain, discharge, eye redness
- Treat: High concentration topical antibiotic drops, ER referral
- Herpes Simplex Keratitis: Corneal ulceration, dendritic branching pattern
  - Treat: Antivirals
- Herpes Zoster Ophthalmicus: Affects the trigeminal nerve
  - Symptoms: Malaise, fever, Hutchinson's sign (vesicles on the tip of the nose)
  - Treat: Oral antivirals
- Fungal Keratitis: Associated with contact with plants
  - Presents with satellite lesions
- Acanthamoeba Keratitis: Associated with fresh water and hot tubs
  - Presents with perineural and ring infiltrates
  - Treat: Long term intensive topical biguanide/diamidine
Dacryoadenitis: Inflammation of the lacrimal gland
- Commonly occurs in children due to viral infection
- Presents with an "S" shaped eyelid deformity
- Treat: Symptomatic
Dacryostenosis: Nasolacrimal duct obstruction
- Common in newborns/infants
- Lack signs of infection
- Treat: Gentle downward massage
Dacryocystitis: Inflammation of the lacrimal sac
- Commonly due to obstruction
- Usually caused by Strep or Staph
- Treat: Systemic antibiotics
- Most common in postmenopausal women

Eye Conditions: Glaucoma

Glaucoma: Damage to the optic nerve due to high intraocular pressure
- Acute angle closure glaucoma:
  - Physically obstructed anterior chamber
  - Symptoms: Rapid onset, extreme pain, halos and lights, nausea, vomiting
  - Exam: Hard eye, dilated and nonreactive pupil
  - Treat: Immediate ophthalmology referral to reduce IOP
    - IV acetazolamide
- Chronic Glaucoma: Irreversible cupping of the optic disc
  - Risk factors: Black race, older age, nearsightedness, diabetes
  - Chronic Open Angle Glaucoma: Most common type
  - Chronic Angle Closure Glaucoma: Flow of fluid into the anterior chamber is obstructed
  - Signs: Tunnel vision
  - Treat: Medications to lower IOP
    - Prostaglandins are preferred

Eye Conditions: Strabismus, Amblyopia

Strabismus: Misalignment of the eyes ("cross eyes")
- Tropia: Constant misalignment
- Phoria: Intermittent misalignment
- Pseudostrabismus: Normal in children
- Treat: Patching, contact lenses, 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
- Treat: Eye patching, vision therapy, surgery
Diabetic Retinopathy: Noninflammatory retinal disorder characterized by retinal capillary closure and microaneurysms
- Type 1 diabetes is most common
- Pregnancy can worsen retinopathy
- Nonproliferative diabetic retinopathy: Develops first
  - Signs: Vision loss, blurriness
  - Treat: Optimize disease control
- Proliferative diabetic retinopathy: More severe vision loss, neovascularization
  - Signs: Black spots/floaters, dot and blot hemorrhages, cotton wool spots
  - Treat: Optimize disease control

Eye Conditions: Other

Hypertensive Retinopathy/Choroidopathy:
- Arteriovenous nicking (copper/silver wiring), blurry vision, visual field defects, superficial flame-shaped hemorrhages, yellow hard exudates, optic disc edema
- Risk factors: Smoking, diabetes
- Treat: Aggressive blood pressure control
- Optic neuritis: Inflammation of the optic nerve
  - Strongly associated with demyelinating diseases like MS
  - Signs: Abrupt vision loss, periorbital pain, brow ache
  - Treat: Corticosteroids
- Optic disc swelling: Drusen (small, white deposits) associated with farsightedness
- Papilledema: Swelling of the optic disc due to raised intracranial pressure, usually bilateral
- Oculomotor Palsies: Affect cranial nerves III, IV, and VI, which innervate extraocular muscles
  - Symptoms: Double vision, pain on eye movement
  - Exam: Ptosis (drooping eyelid), pupil abnormalities
    - 3rd nerve palsy: Eye is down and out
    - 4th nerve palsy: Vertical hypertropia (eye deviates upward)
    - 6th nerve palsy: Difficulty with lateral movement
- Nystagmus: Involuntary rapid eye movements, can cause limited vision
  - Congenital nystagmus: Presents between 6 weeks and 6 months
  - Acquired nystagmus: Associated with medical conditions
  - Symptoms: Rapid eye movements, sensitivity to light

Nose and Sinuses Conditions

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
- Perennial allergens: Dust, mites, indoor molds, animal dander
- Seasonal allergens: Tree, grass, weed pollens
- Occupational allergens: Latex, chemicals, farm animals
- Symptoms: Nasal congestion, rhinorrhea (clear/watery), pruritus, sneezing
- Exam:
  - Eyes: Conjunctiva, watering, shiners
  - Nose: Boggy turbinates, wet, swollen nasal mucosa, itching
- Diagnosis: Skin testing, CBC shows increased eosinophils
- Prevention: Avoid irritants
- Treat: Corticosteroid nasal sprays
  - Avoid first generation antihistamines (sedating)
  - Second generation antihistamines are preferred
  - Mast cell stabilizers must be started before symptom onset, take weeks for effect
  - Leukotriene antagonists: Add on therapy, potential mental health effects
  - Saline irrigation: NEVER use unboiled tap water
Oral Allergy Syndrome: Reactions to raw fruits, vegetables, and tree nuts
- 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 used >3 days, body compensates by creating more blood vessels
- Can lead to atrophy of the nasal mucosa
- Treat: Stop nasal spray, use nasal steroids, oral steroids, or IM steroids
Vasomotor and Gustatory Rhinitis: Difficult to treat
Olfactory Dysfunction: Altered sense of smell (CN I)
- Smell and taste are closely related
- Sense of smell 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
- Treat transport loss: Treat the underlying issue
- Treat sensorineural loss: No effective treatment
- Safety counseling: Smoke detectors
- Hyperosmia: Smell more than usual (pregnancy)
- Normosmia: Normal sense of smell
- Complications: Increased risk of food poisoning, environmental exposure, diminished satisfaction, social isolation
Nasal Polyps: Benign growths in the nasal cavity
- Findings: Unilateral nasal obstruction, facial pressure, headache
- Most are benign, but 5-15% are squamous cell carcinoma
- Treat: Surgical excision (medial maxillectomy)
- Recurrence rates are high
Juvenile Angiofibroma: Slow-growing tumor in young boys, uncommon
- Posterior nasal cavity, growing into the nasopharynx
- Girls with this tumor may have gonadal dysgenesis
- Treatment: Removal

Nose and Sinuses Conditions: Malignant Tumors

Malignant Nasal and Sinus Tumors: VERY RARE
- Symptoms: Chronic rhinitis/sinusitis, unilateral ear pain, hearing loss
- Nasopharyngeal malignant tumors:
  - Nasopharyngeal carcinoma (squamous cell): Most common cancer of the nasopharynx
    - Risk factors: Adulthood, Asian race, EBV exposure
  - Adenocarcinoma/Adenoid cystic carcinoma: Less common
    - Sinonasal tumors
    - Risk factors: Wood dust, leather dust, asbestos
    - Most commonly arise from the ethmoid sinuses
  - Lymphoma (Lethal midline granuloma): Most commonly T-cell lymphoma
    - Associated with Epstein-Barr virus
    - Bleeds significantly
- Paranasal sinuses and nasal malignancies:
  - Squamous cell carcinoma: Most common, often originates in the maxillary antrum
  - Lymphoma:
  - Symptoms (advanced): Proptosis, expansion of the cheek, ill-fitting maxillary dentures, severe pain, malar hypesthesia (involvement of the infraorbital nerve)
- Risk factor: Smoking
- Treatment: Depends on the tumor type and extent (chemotherapy, radiation)
- Cure rates are higher if the base of the skull is NOT involved.
- Diagnostics: CT and MRI

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Description

This quiz covers the different types of hearing loss, including conductive, sensory-neural, and mixed hearing loss. It also explains the Weber and Rinne tests, their procedures, and how to interpret the results. Understanding these concepts is crucial for diagnosing and managing hearing impairments.