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EENT exam I with pictures plus cases, EENT Exam I
Terms in this set (81)
TM position (retracted or bulging)
Immobility of the TM
Otoscopic exams of case P and Case O depict two different types of OM. Pneumatic otoscopy reveals.
Which two TM features do most strongly support the diagnosis of OM?
A 10 year old female with untreated congenital cleft palate develops an extracranial bacterial complication after a 6-day episode of severe AOM. Inspection finding during physical examination of the patient. Based on the information above, what is the name of this complication?
A patient presents with otitis media. What is the position of the tympanic membrane?
Transparent effusion with air bubbles
Describe the ME effusion depicted in picture T
A 4 year old male presents with high fever preceded by a two history of URTI. Otoscopy findings see picture Z.
Otoscopy of the opposite side is unremarkable. What is the position (orientation) of the TM?
Peripheral facial nerve palsy affecting the right side
The patient below suffers from a complication of AOM. What is the correct assessment?
Otoscopic finding is a loudly screaming and febrile 19 month old male. What is the diagnosis based on the patient's presentation and the appearance of the TM in the picture?
What are the two forms of otitis media?
What type of otitis media is caused by bacterial infection?
What type of otitis media is caused by non-bacterial inflammation?
What are the bones of the middle ear?
What is the first bone of the middle ear?
What is the second bone of the middle ear?
What is the third bone of the middle ear?
Redness (erythema) alone is not a reliable sign of ETD and OM (T/F)
Handle of malleus
Cone of light
How long does OME need to be present until considered COME (chronic otitis media w/ effusion)?
What is the complication with OME?
What are the different types of OME?
What are some complications with AOM?
Spontaneous tympanic membrane perfusion
What are some complications with chronic form of bacterial OM?
Chronic suppurative otitis media (CSOM)
Define risk factor
Contributes to (promotes) development of disease
Statistically associated with condition
Direct cause of disease
In itself a direct causality
What are the etiology of all OM types?
Inflammation of nasopharynx
Eustachian tube dysfunction (ETD)
What is the major risk factor associated with OM?
The most common cause of acquired hearing loss in childhood (conductive hearing loss) is OM (T/F)
What is the most common age for acquired hearing loss (conductive hearing loss)?
6 months - 2 years
What percentage of children will have had at least one episode of OME before school age?
What type of OM is the most common condition in children <5 years that calls for medical drug therapy (antibiotics & analgescis)?
What type of OM occurs more in the winter than summer months, as it is usually associated with URTI?
What type of OM may lead to very dangerous complications if left untreated/
What causes OME?
OME may develop into AOM (T/F)
What anatomical sites does the Eustachian tube connect?
Middle ear and the pharynx
Which of the following is / are risk factors for development of otitis externa (OE)?
Repeated exposure of the EAM to water
Insufficient amount of cerumen in the EAM
Increased amounts of cerum in the EAM in conjunction with water exposure
Inflammation of the EAM
Inflammation of the EAM plus exposure to Pseudomonas spp.
(not low pH in the EAM) (All of the above)
What pathogen causes most causes of AOM? This organism can be isolated from the ME effusion in >50% of AOM patients?
What nerve is responsible for referred pain from the cervical spine to the ear?
2nd and 3rd cervical spinal nerves
A boxer is hit over his ear by an opponent. This affected auricle swells up rapidly. What management is necessary in order to prevent development of cauliflower ear?
Surgical drainage of the hematoma
A 4 year old boy presents at the chiropractic clinic with a 4 day history of low-grade fever, stuffy nose, nasal drainage, and sneezing. During the evening prior to the office visit, the boy developed a high fever and severe right sided earache.
Vital findings: HR 95 bpm; BP 110/65 mmHg; RR 25/min; Temp 102.8 degrees F.
ENT exam: Pneumatic otoscopy left side: EAM unremarkable. TM mobile and free from erythema. Normal TM position. No visible middle ear fluid. Pneumatic otoscopy right side: See picture Z below; EAM unremarkable; TM immobile.
Based on history and findings above, including picture Z, what is the most common likely diagnosis?
______ is defined as the accumulation of middle-ear effusion behind an intact TM without signs and symptoms of acute infection and is one of the most common causes of conductive hearing loss among children in the US, potentially leading to learning disabilities
OME is defined as the accumulation of middle-ear effusion behind an intact TM without signs and symptoms of acute infection and is one of the most common causes of _________ among children in the US, potentially leading to learning disabilities
Conductive hearing loss
OME is defined as the accumulation of middle-ear effusion behind an intact TM without signs and symptoms of acute infection and is one of the most common causes of conductive hearing loss among children in the US, potentially leading to _______ disabilities
Which of the following is LEAST likely associated with severely red tympanic membrane/
What is the most common cause of Eustachian tube dysfunction in children and adults?
Sophia a 16-month old female, is brought to the chiropractic clinic by her mother.
History of present illness: Sophia has had a cold for three days, with a runny nose and cough, and last night she developed a fever and incrased fussiness. The girl refuses to eat and only wants her bottle. According to her mother, last night Sophia woke up crying and was inconsolable until she was given ibuprofen for fever and finally was able to go back to sleep. Mother says Sophia acted like this three months ago when she had an ear infection, and she is worried that her daughter might have one again.
Past medical history: AOM four months ago; resolved with treatment
Meds: Ibuprofen for fever
Allergies: No known allergies
In addition to AOM, what concomitant illness is most likely based on this child's current presentation?
What finding does the DC need to look for in Sophia's ear to confirm the diagnosis of AOM?
Bulging tympanic membrane
Otoscopy of Sophia's affected ear reveals central TM perforationa dn mucopurulent otorrhea. How should the DC manage this case?
Prompt referral to a board certified ENT specialist
What risk factor for otitis media in children is most common (i.e. has the highest prevelance)?
A 19 month old male has received chiropractic care for 6 months. The patient has had a history of B/L COME for the past 6 months. Current ear exam reveals B/L retracted, immobile TM and clear ME effusion with air bubbles B/L. Temp 98.8 degrees F. Current screening reveals delayed language development. The audiometry report reveals conductive hearing loss of 32 dB B/L.
How should the DC manage the case at this time?
Prompt referral to an ENT specialist
After properly implemented management by the DC, what subsequent treatment is indicated?
Surgical insertion of tympanostomy (PE) tubes
Which of the following signs and symptoms are features of the meningism triad?
Eustachian tube dysfunction (ETD) is initially associated with pressure change in the middle ear. Which of the following statements is correct regarding ETD?
Decreased ME pressure due to absorption of air (N2) via the subepithelial ME capillaries
A 4 year old male with a 2-day history of earache, fever, and fatigue. There is U/L yellow and thick ME effusion and increased ME pressure. The TM on the affected side is red, bulging, immobile, and ruptured. There is thick, yellow fluid draining via the outer ear canal. Diagnosis
AOM with serous effusion
What condition is characterized by all of the following features?
Long lasting ME inflammation (>3 months)
Persistant bacterial ME effusion
Chronic suppurative otitis media
What unique ear disease originates in the TM and develops from retraction pockets at the pars flaccida region leading to formation of a skin cyst. Erosion and destruction of the temporal bone are common, and distal spread within the skull may occur.
Select the matching OM complication from the list:
Headache, high fever, nuchal ridigity, photophobia, irritability, confusion, coma, bulging anterior fontanelle
Select the matching OM complication from the list: '
Severe sense of motion, nausea, emesis, complete loss of balance, nystagmus
Select the matching OM complication from the list:
Headache, high fever, nuchal ridigity, photophobia, irritability, confusion, coma, buldging anterior fontanelle, U/L neurological deficit findings, U/L increased DTRs, U/L Babinski sign
Select the matching OM complication from the list:
Epidermoid cyst that orginates in pars flaccida causing slow (months to years) development of progressive hearing loss, mastoiditis, facial palsy, and vertigo
What sign or symptom is unique to AOM?
What structures or compartments are seperated by the tympanic membrane?
External ear canal and middle ear
A 5 year old patient presents with a C/C of hearing loss on the left side for the past week while having a cold.
During Rinne testing, the following results are recorded:
Right ear = AC>BC 512 Hz
Left ear = BC>AC 512 Hz
Weber testing lateralizes to the left side
Conductive hearing loss on the left
What condition usually presents with sudden onset of severe otological otalgia and fever?
What finding below occurs most often in uncomplicated OME?
Mild hearing loss
Why are serious and difficult cases of AOM treated with antibiotics?
Antibiotics eliminate the bacteria that cause AOM
Which of the following symptoms / findings of acute meningitis is most common?
Which of the following symptoms / findings is most specific for acute meningitis?
What is the name of the acute, sterile inflammation of the middle ear?
A 65 year old women presents with mild left sided hearing loss and a 3 month history of 15 lbs weight loss. Physical examination reveals retracted TM with clear middle ear effusion on the left side and multiple enlarged, pain free, and firm cervical lymph nodes on the left. Based on the data presented, what is the best clinical assessment?
Chronic suppurative otitis media with lymphadenoaphy
A 5 year old male with right-sided AOM is treated with antibiotics by a pediatrician. The patient has severe otalgia and moderate fever. What additional treatment has shown to be INEFFECTIVE in AOM cases?
Why do chiropractic cervical spine adjustments most likely alleviate the symptoms and signs of otitis media?
Restoration of ME pressure via increased muscle tone of tensor veli palatini
All except of the following are risk factors of otitis media. Identify the least significant risk factor for otitis media.
What is an expression to the widely accepted conservative treatment recommendations for otitis media?
Intracranial AOM complication
In which of the following cases is insertion of ear tubes indicated?
B/L COME with >30 dB hearing loss
A DC is successfully managing a two year old female with OME. The treatment includes upper cervical adjustments. Which of the following treatments may be used by the DC to increase aeration of the Eustachian tube and to facillitate middle ear drainage?
Munice technique (pharyngeal sweep)
Select the INCORRECT statement
Antihistamines and nasal decongestant drugs are highly effective treatment of ETD (otitis media) and ostiomeatal obstruction (rhinosinusitis)