Patho- Exam 3

gbalsam quizlets

characteristics of cerumen

• hydrophobic

• acidic

• sticky

• protective

• antibacterial

migratory of pattern of epithelium sloughing

medial to lateral cleansing of the ear cerumen and debris

patho of cerumen accumulation

• obstruction due to ear canal disease

• narrowing of the canal

• failure of epithelial migration

• overproduction

cerumen impaction can cause

• conductive hearing loss

• earache/fullness

• itching

• reflex cough

• dizziness

• tinnitus

otitis externa

inflammation of the external auditory canal; "swimmer's ear"

most common cause of otitis externa

acute infection of P. aeruginosa

risk factors of otitis externa

swimming, trauma (Q-tips), devices, allergic contact dermatitis, dermatologic conditions (i.e., atopic dermatitis, psoriasis)

symptoms of otitis externa

otalgia, itching, fullness, discharge, pain with touch to the tragus/pulling the pinna

malignant otitis externa

rare, life threatening osteomyelitis of the temporal bone

who would you see malignant otitis externa in?

diabetics and immunocompromised

hematoma of the external ear

blunt force trauma to the auricle

cauliflower ear

deformity of the ear caused by destruction/bleeding of the underlying cartilage of the outer ear

barotrauma

pressure-related ear discomfort that can be caused by pressure changes when flying, driving in the mountains, scuba diving, or when the Eustachian tube is blocked

how is the pressure in the middle ear replaced?

yawning, swallowing, chewing gum

causes of barotrauma

flying, diving, blast injury

symptoms of barotrauma

pressure in ear, pain from stretching of TM, hearing loss

eustachian tube

a narrow tube between the middle ear and the throat that serves to equalize pressure on both sides of the eardrum

eustachian tube in children

shorter, wider, and more horizontal

eustachian tube in adults

angled downward and drains easier

when does the eustachian tube reach adult length?

by age 8

eustachian tube dysfunction

occurs when either:

• one is unable to equalize pressure across the eardrum

• one is unable to protect the middle ear from nasopharynx fluid

• one is unable to clear out mucus secretions

acoustic neuroma

benign tumor on the 8th cranial nerve stemming from Schwann cells

other name for acoustic neuroma

vestibular scwhannoma

risk factor for an acoustic neuroma

NF2 related schwannomatosis (mutation of neurofibrin type 2 and inactivation of the Merlin protein)

symptoms of acoustic neuroma

unilateral hearing loss, tinnitus, balance problems, compression of facial nerves leading to facial weakness/paralysis

labrynthitis

inflammation of the inner ear

cause of labrynthitis

bacterial or viral infections

symptoms of labrynthitis

spontaneous vertigo, nausea, vomiting, gait impairment

vertigo

a symptom of illusory movement; can be spinning, swaying, or tilting

vertigo is

a symptom, not a diagnosis

peripheral etiologies of vertigo

• BPPV

• labrynthitis

• herpes zoster oticus

• Meniere disease

• acoustic neuroma

• otitis media

central etiologies of vertigo

• vestibular membrane

• brainstem ischemia

• transient ischemic attack

• cerebrovascular accident

• multiple sclerosis

BPPV

benign paroxysmal positional vertigo

cause of BPPV

displacement of the otoliths (calcium carbonate crystals) in the semicircular canal

characteristics of BPPV

• provoked by specific head movements

• patients may have nausea/vomiting

• no hearing loss present

• can recur periodically

Meniere disease

disorder of the labyrinth that leads to progressive loss of hearing

classic triad of Meniere disease

episodic vertigo, tinnitus, and hearing loss

patho of Meniere disease

an abnormal fluid accumulation and ion homeostasis in inner ear; endolymphatic hydrops

cholesteatoma

overgrowth of squamous epithelium that is trapped in the skull base

hallmark symptoms of cholesteatoma

• painless otorrhea

• perforated TM

• granulation tissue in ear canal/middle ear

type of hearing loss seen with a cholesteatoma

conductive hearing loss

primary acquired cholesteatoma

occurs from eustachian tube dysfunction leading to prolonged exposure to negative ear pressure that then retracts the TM medially

secondary acquired cholesteatoma

sequel to chronic TM perforation that causes hearing loss to occur earlier in its course

otitis media

inflammation of the middle ear

acute otitis media

marked by the presence of middle ear fluid and inflammation of the mucosa that lines the middle ear space

cause of acute otitis media

obstruction of the eustachian tube resulting in fluid retention and suppuration of retained secretions

what is purulent otorrhea indicative of?

a perforated TM

contributing factors of otitis media

• eustachian tube defect

• eustachian tube obstruction

• immune dysfunction

patho of acute otitis media

antecedent event (viral URI) leading to stagnant secretions accumulating and growing into the middle ear

bacterial pathogens of otitis media

S. pneumoniae, H. influenzae, M. catarrhalis

viral pathogens of otitis media

RSV, rhinovirus/enterovirus, coronavirus, adenovirus, influenza

otitis media with effusion

inflammation of the middle ear resulting in the collection of serous, mucoid, or purulent fluid

chronic suppurative otitis media

persistent non-healing perforation of the tympanic membrane; complication of acute otitis media

most common causes of TM perforation

• otitis media

• barotrauma

• trauma

symptoms of TM perforation

severe pain, pain that suddenly resolves, otorrhea, tinnitus, hearing loss

conductive hearing loss

change in the outer or middle ear that impairs sound from being conducted from the outer to the inner ear

causes of conductive hearing loss

cerumen impaction, foreign body, tumor, infection, etc.

sensioneural hearing loss

disability of the inner ear to transduce sound waves

causes of sensioneural hearing loss

congenital/hereditary factors, CNS, noise induce, presbycusis

mastoiditis

bacterial infection of the mastoid air cells secondary to acute otitis media

symptoms of mastoiditis

• postauricular tenderness, swelling, erythema

• protrusion of the auricle

• ear pain

stages of mastoiditis

• hyperemia of mucosal lining of mastoid air cells

• transudation/exudation of fluid or pus

• necrosis of bone by loss of vascularity in septa

• cell wall loss with coalescence into abscess cavities

• extension of inflammatory process to contiguous areas

tinnitus

a perception of sound in proximity to the head in absence of an external source; can be a buzzing, ringing, hissing

patho of tinnitus

most commonly a result of abnormalities within the auditory system

tinnitus may be associated with

• sensorineural hearing loss

• ototoxic medications

• infection

• vascular ischemia

• acoustic neuroma

external foreign bodies

embedded ear piercings within the auricle

epistaxis

nosebleed

causes of epistaxis

trauma, mucosal inflammation from a URI, septal abnormality, bleeding disorder

patients with an increased risk for epistaxis

• allergic rhinitis

• chronic sinusitis

• HTN

• coagulopathy

• older age/colder weather

anterior epistaxis

most common; originates from Kiesselbach's plexus

posterior epistaxis

bleeding from the posteriolateral branches of the sphenopalatine artery; can be a significant hemorrhage

allergic rhinitis

inflammation of the mucous membranes of the nose, eyes, eustachian tubes, middle ear, pharynx

increased risk of allergic rhinitis

presence of eczema and asthma (atopic triad)

signs and symptoms of allergic rhinitis

nasal itching, watery rhinorrhea, nasal congestions, sneezing

release of histamine in allergic rhinitis

dilates capillaries of mucous membranes

clinical findings in allergic rhinitis

allergic shiners, allergic salute (transverse nasal crease), pale or edematous nasal mucosa

sinusitis

inflammation resulting from infection of one or more paranasal sinuses

most common cause of sinusitis

viral URI (rhinovirus, influenza, parainfluenza)

when does viral sinusitis typically resolve?

within 7-10 days

bacterial sinusitis

failure to improve of acute sinusitis

most common causes of bacterial sinusitis

S. pneumoniae, H. influenzae, M. catarrhalis

patho of sinusitis

mechanical obstruction of the sinus drainage due to mucosal edema

fungal rhinosinusitis

mostly benign or noninvasive except when they occur in individuals who are immunocompromised

chronic rhinosinusitis

inflammatory process that involves the paranasal sinsuses that persists longer than 12 weeks

three major clinical syndromes of chronic rhinosinusitis

• CRS with/without polyps

• allergic rhinosinusitis

• fungal rhinosinusitis

symptoms of chronic rhinosinusitis

nasal stuffiness, postnasal drip, facial fullness, malaise

nasal polyps

abnormal, benign lesions that originate from any portion of the nasal mucosa or paranasal sinuses

polyp development has been linked to

chronic inflammation, autonomic nervous system dysfunction, and genetic predisposition

intranasal foreign bodies is characterized by

unilateral purulent and foul-smelling nasal discharge

oropharyngeal candidiasis

"thrush;" overgrowth of yeast causing desquamation of epithelial cells

cause of oral thrush

Candida albicans

risk factors for oral thrush

corticosteroid use, asthma, rhinitis

pseudomembranous candidiasis

white plaque on buccal mucosa, palate, tongue, and/or oropharynx that is easily scraped off

atrophic candidiasis

"denture stomatitis;" erythematous skin without plaques

epiglottitis

inflammation of the epiglottis and adjacent supraglottic structures

infectious epiglottitis is a

cellulitis

most common cause of epiglottitis

H. influenzae

patho of epiglottits

swelling results from edema and accumulation of inflammatory cells

what would you find on a lateral neck x-ray that would be indicative of epiglottitis?

the "thumb sign"

pharyngitis

inflammation of the throat