A6320 Medical Aspects Infection Control and Disorders of the External Ear Study Guide.pdf

Topic:_________Infection Name: _____________Melissa Nunez______________________ Control and Disorders of the External Ear___________ Class: ______AUD 6320___________ Date: __________September 21, 2024__________________ ____________...

Topic:_________Infection Name: _____________Melissa Nunez______________________ Control and Disorders of the External Ear___________ Class: ______AUD 6320___________ Date: __________September 21, 2024__________________ _________________________ Essential Question: What is audiology infection control and what are disorders of the external ear? Notes: Questions/Main Ideas: What are infections? Germs enter the body, multiply, and result in an adverse reaction within the body What are the five major 1) Viruses categories of infectious 2) bacteria agents? 3) fungi 4) protozoa 5) helminths What are viruses? -Viruses contain nucleic acid and can be surrounded by a protein shell and lipids -20-40 nanometers in diameter -it can only reproduce when entering a host cell What are some examples -common cold of viruses? -measles -chicken pox -influenza -AIDS What is bacteria? -Single cell organisms 10-100 times larger than viruses -reproduce by dividing cells and can mutate allowing them to change in the environment What are some examples -strep throat of bacteria? -tuberculosis -staph skin infections -blood stream infections What are other infections -fungi agents? -protozoa -helminths What are some examples -ringworm of fungi? -histoplsamosis What are some examples -malaria of protozoa? -dysentery What are some examples -hookworm of helminths? What is otomycosis? Fungal infection of the year Where does otomycosis -typically occurs in warm or tropical areas typically occur? What are signs and -pain symptoms of -itching otomycosis? -swelling -drainage How do infections 1) Source spread? -infectious agent or germ -surfaces (dry or wet), indwelling medical devices, dust, decaying debris 2) Susceptible Person -Person who is at risk to exposure to the source -At risk if they are not vaccinated, are not otherwise immune, have a weakened immune system, have a way for germs to enter the body 3) Transmission -germs are moved to the susceptible person -touch, sprays, splashes, inhalation, and sharp injuries What are modes of -Contact transmission? -vehicle -airborne -vectorborne What is contact -transfer of a microorganism through touching or coming transmission? in contact with contaminated objects What are the three types 1) direct of contact transmission? 2) indirect 3) droplet What is direct contact -physical transfer of a microorganism to a susceptible transmission? host in the absence of an intervening object barrier or condition What is an example of -the audiologist touched the patient’s ear with an direct contact? unwashed hand What is indirect contact -microorganism is transferred from its temporary resting transmission? place to a susceptible host via a secondary surface -when an individual is exposed to a contaminated surface or object What is an example of -picking up a tympanometry tip that has dropped on the indirect contact? floor and using it for a patient tympanogram What is droplet contact? A microorganism expelled from an individual comes into contact with the mucosal lining of the eyelids, nose, or mouth of a susceptible individual. What is an example of -pediatric patient coughs towards your face during droplet contact? otoscopy What is vehicle Transfer of a microorganism to a susceptible host through transmission? contaminated food or water What is airborne -the microorganism is disseminated through the air by transmission? either droplet nuclei or dust particles How does airborne -airborne transmission encompasses 3 feet of airspace transmission differ from and is a much larger area of transmission droplet transmission? What is vectorborne Transfer of a microorganism via animal or insect transmission? What is route of -the place where the microorganism gains access to the transmission? human body -this can typically occur through the nose, eyes, ears, and mouth -this can also occur if there’s a change in the epithelial layer of the skin if there is a cut, scrape, or nick -once the microorganism has entered the body it is outside of the audiologist scope of practice to influence disease process What is the predominant -Staphylococcus organism found on custom HAs? What is Staphylococcus? -bacteria that typically form grape-like clusters and can be found on the skin and mucous membranes, with some species capable of causing infections ranging from mild skin conditions to severe illnesses like pneumonia Why is the ear canal -it retains moisture conducive to bacterial -neutral/alkaline pH levels and fungal growth? What are opportunistic Commonplace organisms that don’t produce infection in infections? individuals with intact immune systems but take the opportunity to infect the body with a disabled immune system What are appropriate -appropriately fitted gloves personal barriers? -safety glasses -masks -consider gowns in the vestibular evaluation if a patient is apt to become sick What are touch surfaces? An area that may come in direct or indirect contact with hands What are some examples -countertops of touch surfaces? -chairs -tables -workbench What are splash Area that may be hit with blood, bodily fluids, or other surfaces? secretions from a contaminated source What are some examples -cerumen removal space of splash surfaces? -where contaminated instruments are placed Clean vs. Disinfect Clean Disinfect Removes contamination Removes contamination without killing germs and kills germs Wipe off the counter with Audiologists should use a paper towel hospital-grade disinfectants What is sterilization? Process of killing 100% of vegetative microorganism What critical instruments -instruments that are invasive and directly contact the should be sterilized? blood bloodstream -noninvasive instruments that come in contact with mucous membranes and bodily substances -noninvasive instruments that penetrate skin surfaces from use or misuse How to dispose of -most waste with ear discharge or cerumen can be place infectious waste? in a regular waste receptable -materials containing significant amounts of blood should be labeled with a symbol for biohazard waste and disposed of appropriately -if a patient is to become ill (vomit) during a vestibular evaluation that byproduct is typically not determined to be infectious waste What is inflammation? -results from the activation of your immune system to an “offending agent” What cells respond to -inflammatory cells offending agents? -cytokines What are two types of 1) acute inflammation inflammation? 2) chronic inflammation What is acute Response to sudden body damage inflammation? What are symptoms of -flushed skin at the site of the injury acute inflammation? -pain -swelling -heat What is chronic Continued inflammatory response in the absence of the inflammation? offending agent What are symptoms of -abdominal pain chronic inflammation? -chest pain -fatigue -fever -joint pain What are signs? Objective, physically observable, and measurable conditions What are some examples -fever of signs? -swelling -discharge -rash What are symptoms? Changes and sensations that the person experiences; more subjective; not observable What are some examples -pain of symptoms? -headache -nausea -tinnitus What are systemic signs a) fever of inflammation? b) leukocytosis (increased white blood cells) which can lead to discharge from site (“pus”) c) synthesis of plasma proteins (liver) What are local signs of a) heat inflammation? b) redness (due to increased blood flow) c) swelling due to accumulation of exudate (fluid and  cellular) d) pain (secondary to swelling) – pain in ear = otalgia e) an inflammation may not have an active infectious agent involved (could have above signs but technically not have an infection) What is otorrhea? - discharge from the ear -Color, smell, persistence and consistency/viscosity are all important characteristics and provide localizing or specific disease info - The duration of occurrence can be significant: – Otorrhea for more than 20 years is the most common physical finding (sign) associated with Squamous cell cancer of the ear What is otalgia? -pain in the ear What is primary otalgia? The cause is from some part of the auditory system What is The cause is from outside the auditory system secondary/referred otalgia? Why is otalgia painful? Because the outer ear has redundant sensory innervation What is pain? -physical suffering or discomfort caused by illness or injury What are some examples -dull of describing pain? -penetrating -pulsating -sudden/stabbing -aching -pinching -burning What are some questions What are activities that make the pain worse? that explore the What are activities that make the pain better? characteristics of pain? Is pain constant or intermittent? V Trigeminal -tragus  -anterior half of pinna -anterior wall of external auditory canal -outer layer of anterior tympanic membrane VII Facial -posterior wall of external auditory canal -outer layer of anterior tympanic membrane IX Glossopharyngeal -posterior wall/floor of external auditory canal -middle and inner layers of TM (middle ear too) X Vagus -posterior pinna (concha) -posterior wall/floor of EAC -outer layers of TM -cervical spinal nerve C2 (Great Auricular Branch) -posterior half of pinna -skin covering mastoid What are the sources of -infection in the outer or middle ear (typically, in the primary otalgia? external ear canal) -blockage or swelling of external ear canal -trauma to outer ear -dry, itchy EACs, following excessive Q tip use What are sources of -dental referred otalgia? -temporomandibular joint (TMJ) disorders -cervical spine disorders -tumors of oral cavity (base of tongue) -neuralgias of CNs V, VII, IX, and X -idiopathic (unknown cause) Why are cervical spine Remember that the cervical spine nerve, C2, is sensory disorders a source of from pinna referred otalgia? What is neuralgia? -a stabbing, burning, and often severe pain due to an irritated or damaged nerve What is trigeminal -chronic conditions that results in episodes of shooting neuralgia? pain -can impact one side of the face or can spread across time -pain can be severe and frequent What are some -medication treatments for trigeminal -surgery neuralgia? -radiation therapy DISORDERS OF THE EXTERNAL EAR Development of Week 9 Mesenchyme surrounding Auditory Organs membranous labyrinth chondrifies Week 12-16 Capsule next to membranous labyrinth starts vacuolization to for a cavity around membranous labyrinth and fills with perilymph Week 18 Ectodermal plug of external auditory meatus breaks down Week 16-24 Endochondral ossification appears in remaining cartilage of otic capsule forming petrous portion of the temporal bone. Continues to form mastoid process of temporal bone Week 18-22 Organ of Corti structure develops 26 weeks Brainstem auditory pathway is formed 28 weeks AABR (Automated Auditory Brainstem Response) can be recorded 3rd Trimester Startle response of fetus recorded from vibration of abdominal wall What is the external  2.5 cm – 3.0 cm in length auditory meatus?  0.75 cm in diameter  Outer one-third cartilaginous and is responsible for the secretion of cerumen   Medial two-thirds is bony  Innervations: Trigeminal (V), facial (VII), and glossopharyngeal (IX) cranial nerves What are external ear -congenital ear abnormalities disorders of the pinna? -microtia -aural atresia -external otitis -perichondritis -neoplasms What are low set ears? -congenital ear abnormality -top of the ear is positioned below the inner canalith of the eyes -do not rely on subjective assessment What do low set ears look like? What is a preauricular -common congenital abnormality pit? -typically an indentation less than 3mm from the pinna -typically isolated and asymptomatic What is the clinical  15-20% of cases of congenital abnormality and significance of a syndromes associated with hearing loss have preauricular pit? preauricular pits  2.6% of patients with preauricular pits are associated with kidney concerns  5x more likely to have a permanent hearing loss  Preauricular pits can develop cysts that can become infected or develop into an abscess What is microtia? -the external ear fails to develop properly in the first trimester of pregnancy -can occur concomitant with atresia -absence of an ear or underdeveloped outer ear What are the microtia Grade 1: Smaller than normal, but the ear has mostly grades? normal anatomy Grade 2: Part of the ear looks normal, usually the lower half. The canal may be normal, small or completely closed Grade 3: just a small remnant of “peanut-shaped” skin and cartilage. There is no canal, which is called aural atresia. Grade 4: Complete absence of both the external and the ear canal, also called “anotia”. What do microtia grades look like? What is aural atresia? -the external auditory canal fails to develop properly, resulting in an abnormally closed or absent ear canal -congential (1/10,000-20,000 live births) -acquired: trauma or repeated ear infections What are symptoms or -absent external auditory canal or “blind pouch” in the aural atresia? canal -middle ear can also be involved: -TM can be absent - ossicles can be malformed or absent -the inner ear can be malformed but has a different embryologic development -typically, conductive hearing loss -“pinpoint ear canal” can collect epithelial cells and develop a external canal cholesteatoma -unilateral or bilateral involvement -ABR evaluation What is the etiology of -typically occurs with other craniofacial abnormalities aural atresia? What are some  Pierre Robin syndromes associated  CHARGE with aural atresia?  VATER  Goldenhar  Treacher Collins What are audiologic -unilateral or bilateral atresia management factors of -hearing sensitivity or nonatretic ear aural atresia? -extent of atresia -age of patient What are symptoms of -infection of the ear canal and pinna external otitis? -related to bacterial infections or fungal infections (less common) -Pseudomonas – most common bacteria -“Swimmer’s Ear” What is the audiometric -pain with movement of pinna evaluation of external -no expected changes with audiometric evaluation unless otitis? ear canal is swollen shut What are treatments for -antibacterial agents external otitis? -corticosteroids What is perichondritis? -perichondrium provides blood supply to cartilage -if the perichondrium is separated from both sides of the cartilage may lead to avascular necrosis -this results in a deformed pinna -“cauliflower ear” What are symptoms or -redness perichondritis? -pain -swelling What are treatments for -oral antibiotics perichondritis? -abscess, incision and drainage What is the etiology of -trauma perichondritis? -insect bites  -cartilage piercings -incision or infection of the pinna What is a neoplasm? An abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should. Neoplasms may be benign (not cancer) or malignant (cancer). What are benign -may grow large but do not spread into or invade nearby neoplasms? tissues or other parts of the body What are malignant -can spread into or invade nearby tissues neoplasms? -can also spread to other parts of they body through the blood and lymph systems -tumor What are neoplasms of  Skin Cancer the ear? -Actinic Karatosis (pre-cancerous) -Basal Cell Carcinoma -Melanoma -Squamous Cell Carcinoma  Adenoid Cystic Carcinoma (ACC)  Metastatic Carcinoma What is skin cancer of  “Simply put, if you have skin, you can get skin the ear? cancers.”- Skin Cancer Foundation  Depending on skin color skin cancer can be diagnosed too late resulting in more difficult treatment  New, changing or unusual skin symptoms should be evaluated by a dermatologist What is actinic -dry, scaley, or crusty patches of skin keratosis? -combination of colors: red, pink, flesh toned -easier to feel due to raised and scaley surface -precancerous lesions with 5-10% developing into skin cancer What does actinic keratosis look like? What is basal cell -open sores, red patches, shiny bumps, scars, elevated carcinoma? edges with indentation -can crust, itch or bleed -unique to each person -patient’s with darker skin tones may have pigment to appearance of lesion -MOST COMMON FORM OF SKIN CANCER What does basal cell carcinoma look like? What is melanoma?  A - Asymmetry  B - Border  C - Color  D - Diameter  E - Evolving Why is early detection -five year survival rate is 99% if detected early important? -if it spreads to the lymph nodes survival drops to 68% What does melanoma look like? What is squamous cell -dry, scaley, thickened or wart like patches of skin carcinoma? -if left untreated lesions can progress to deeper levels of the skin and spread to other parts of the body -2nd leading cause of skin cancer What does squamous cell carcinoma look like? What is adenoid cystic -rare form of cancer that develops in glandular tissue carcinoma (ACC)? -can develop in salivary glands or other regions of head and neck -rare cause of malignancies of the outer ear with only 5% of cases related to ACC What is an example of -36 year old female an ACC case study? -otoscopy reveals a 1x1 cm elevated lesion of the posterior wall of the external auditory canal -symptoms include: otalgia RE (dull, aching, constant), decreases hearing RE, denies tinnitus, denies discharge, denies bleeding from the ear, denies vertigo What is another example -incisional biopsy was performed of an ACC case study? -underwent wide and local incision with adjuvant radiotherapy -reoccurence is common even with intervention -lesion can metastasize to lymph nodes or distal structures (ex. Lungs) or nervous system What is metastatic -metastatic carcinoma of temporal bone is uncommon carcinoma? -involvement in late stages of the disease process -can also occur relative to hematogenesis (leukemia) -diagnosis is typically overshadowed by complications of metastatic disease process What are sites for -breast primary tumors? -lung -kidney -stomach -bronchus -prostate What are symptoms of -development of cochleovestibular loss metastatic carcinoma? -facial paralysis -discharge from ear often mistaken for chronic otitis externa/otitis media -severe headache/otalgia when lesion reaches the Dura CERUMEN MANAGEMENT What is the external  tubelike structure that’s 2.5 cm to 3.0 cm in length auditory meatus? (adult)   0.75 cm in diameter (adult)  Originates at the concha and ends at the TM  Curved like an elongated letter S  Outer 1/3 cartilaginous  Medial 2/3 is bony  Entire length of the ear canal is epidermal lining -Outer 1/3 o Hair follicles o Cerumen producing glands What is the purpose of -lubrication cerumen? -antimicrobial -hydrophobic -cleaning -physical barrier -protects against insects What are types of  Single gene with two alleles cerumen? -ABCC11  Dry -recessive -Northern China, Korean, Native American  Wet -dominant -Europe, Africa What is cerumen -the nonroutine removal of cerumen within the removal? cartilaginous ear canal necessary for access in performance of audiological procedures that shall occur under physician and surgeon supervision. Cerumen removal, as provided by this section, shall only be performed by a licensed audiologist What are cerumen  Specula removal tools? -Hartman -Tonybee -Farrior -Gruber  Forceps -hinge -alligator   Curette -hooks -loops -bent (buck curette)  Clic  Water lavage When should you not -do not use on a complete impaction use a water lavage? -do not want wet ears for vestibular patients if you are doing air calorics because the water will have a cooling effect What can magnification -operating microscope include? -custom eye level magnification -adjustable eye level magnification -fixed eye level magnification What are case history -middle ear history questions to ask for -blood thinners cerumen removal? -diabetes -previous cerumen removal -active drainage -otalgia When to refer in relation -blood thinners to cerumen removal? -diabetic -active ear pathology -fungal infection -deformities of the ear -ear diseases (skin cancer) What are removal Hard & Dry Curette, forceps, suction, techniques for different ear irrigator types of cerumen? Flaky/desquamating skin Forceps Solid/malleable Suction/curette Soft/wet Suction Soft/wet/sticky Water lavage Very hard Softening agent with suction What is the proper -consider positioning yourself so that you are lower than positioning for cerumen the ear (1-2 inches) removal? -always work with your dominant hand and brace -non dominant hand, use/have a tissue or wet wipe ready What is the proper -always pull at cerumen from behind strategy for cerumen -consider positioning pointer finger on concha to pull up removal? and back or middle finger on right side -suction does not work with hard wax; consider use of a softening agent -patients can use home softening agent for 1-2 weeks prior to cerumen removal What are complications -need for referral related to cerumen -TM perforation removal? -Bleeding: need to stop bleeding before the patient leaves the office -if bleeding will not stop, pack with gauze and refer to ENT office What if they needed an -have them return in 2 weeks when the EAM is healed ear mold impression? What is documentation -entire case history required for cerumen -cerumen impaction info (ear, partial, & total) management? -documentation of removal method -incidents: What did the ear canal look like afterward? -follow up plan; if there was bleeding, how’d you stop it? Always be prepared for litigation EXOSTOSES AND OSTEOTOMAS What are exostoses? -multinodular bony masses developed due to prolonged irritation of the external auditory canal -typically associated with contact to cold water “Surfer’s ear” -typically, bilateral lesions (but can be unilateral) What can happen if the -trap debris in ear canal exostoses are large? -impinge on the TM -difficult to visualize TM  -cause conductive hearing loss What does exostoses look like? What are osteomas? -less common than exostoses -frequently confused with exostoses -typically a solitary, unilateral, and pedunculated bony growth -mix of bone and fibrous tissue What is a peduncle? -an elongated stalk of tissue What do osteomas look like? TYMPANIC MEMBRANE PERFORATIONS What is the tympanic 8-10 mm in diameter membrane (TM)? Three layers (0.1 mm in thickness) What are the three layers 1) Epidermal of the TM? 2) Fibrous 3) Membranous Where in the cone of 5:00 for right ear light typically located? 7:00 for left ear What does the TM look like? What is a perforation of  Common injury with a variety of causes: the TM? -infections from otitis media -direct trauma by foreign objects -flying objects -irrigation of EAC -concussive injury from blow to the EAC -barotrauma -temporal bone fractures -the TM rupture threshold is 184 dB SPL in human  Occur near the pars flaccida and pars tensa  Most will heal spontaneously yet, others may remain due to chronic infection  Related to trauma or chronic middle ear infections What does a TM perforation look like? What is -calcified plaques occur around circumference of TM tympanosclerosis? and/or head of the malleolus -only TM involvement (myringosclerosis) -hearing loss is typically related to tympanosclerosis  especially when the ossicular chain is involved What are the goals of 1) The prevention of disease and injury and the medicine? promotion and maintenance of health 2) The relief of pain and suffering caused by maladies 3) The care and cure of those with a malady and those who cannot be cured 4) The avoidance of premature death and the pursuit of a peaceful death How many people 1.5 billion people globally experience hearing loss? Who is at risk for 1 billion people aged 12-35 hearing loss related to noise exposure? What is the estimated 980 billion dollars globally annual cost of unaddressed hearing loss? What is the second Falls leading cause of unintentional injury deaths worldwide? How many individuals -each year an estimated 684,000 die from falls globally? -over 80% are in low- and middle-income countries Summary: