Ear Conditions

Keloid

firm/nodular/hypertrophic mass of scar tissue

form after minor trauma (ear piercing)

m/c→dark skin

Chondrodermatitis Nodularis Helicis

painful+tender papule

chronic inflammatory lesion

affects cartilaginous portion of ear

may turn red

most common: helix
antihelix

biopsy→rule out carcinoma

Tophi

hx of gout

deposit of uric acid crystals

characteristic of chronic gout

hard nodule in the helix/antihelix

may discharge chalky white crystals through the skin

Rheumatoid Nodules

chronic rheumatoid arthritis

may be present before arhtritis

small lumps on helix/antihelix+hands

repeated injuries→ulcerations

Cutaneous Cyst

aka: sebaceous cyst

forms at 9-o’clock on posterior ear

closed firm sac attached to the epidermidis

Otitis Externa

initial sx: itching in ear canal
typically occurs after swimming

pain: movement of pinna/chewing→intense

discharge: watery→purulent+thick
musty
foul-smelling

hearing: exudate+swelling of ear canal→conductive hearing loss

inspection: erythematous+edematous ear canal
tympanic membrane obscured

Bullous Myringitis

PP: painful+hemorrhagic vesicles on TM±ear canal

CM: earache
blood-tinged discharge
conductive hearing loss

Meneire’s Disease

onset→sudden

druation/course
several hours to 1+ day
recurrent

hearing loss
sensorineural
flucutates/recurs/progresses

tinnitus→±

associated sxs
fullness in ear
nausea
vomiting
nystagmus

Vertigo (General)

perception of movement

peripheral or central

cardinal sx of vestibular dx

spinning/tumbling/falling sensation

exaggerated sense of motion in response to movement

Vertigo vs Dizziness vs Disequilibrium vs Syncope

vertigo: specific term for sx of “dizziness”

dizziness: non-specific term

disequilibrium: unsteadiness
imbalance
sensation of floating

syncope: transient loss of conscious+loss of tone

Peripheral vs Central Vertigo

peripheral vertigo:

not generating/transmitting accurate signals

-vestibular apparatus dysfunction
-CN 8 dysfunction

central vertigo:

CNS not interpreting signals properly

-vestibular nuclei dysfunction
-cerebellum dysfunction
-vestibular migraine

Benign Paroxysmal Positional Vertigo

onset→sudden

duration/course
few seconds to <1 min
lasts a few weeks

hearing loss→none

tinnitus→absent

associated sxs
±nausea
±vomiting
nystagmus

Central Vertigo

onset→often sudden

duration/course
varies
rarely continuous

hearing loss→none

tinnitus→absent

associated sxs

other brainstem sxs:
-dysarthria
-ataxia
-sensory+motor deficits

Acute Vestibular Neuronitis

onset→sudden

duration/course
hours to 2 weeks
may recur x 12-18 months

hearing loss
UL
sensorineural

tinnitus→absent

associated symptoms
nausea
vomiting
nystagmus

Acute Labyrinthitis

onset→sudden

duration/course
hours to 2 weeks
may recur x 12-18 months

hearing loss
UL
sensorineural

tinnitus→±

associated sxs
fullness in ear
nausea
vomiting
nystagmus

Acoustic Neuroma

onset
compression of vestibular branch of CN8→insidious

duration/course→varies

hearing loss→impaired on affected side

tinintus→present

associated sxs
CN5 involvement
CN7 involvement

Sinusitis

PP: bacterial infection of sinuses

RF: URI worsening/more than 7-10 days

CM: frontal headache
facial pain/pressure
pain in maxillary tooth
nasal congestion

PE: purulent nasal discarge
tenderness over frontal/maxillary sinuses
swelling over involved sinus

Basal Cell Carcinoma

raised nodule

lusturous surface+telangiectasia

TM Perforation

P: hole in TM

E: ME infection

Tympanosclerosis

PP: scarring in middle ear

E: AOM

C: conductive hearing loss

Serous Effusion

E: viral URI
sudden atmospheric changes

CM: fullness
popping sensation
±pain (common)

Acute Otitis Medial With Purulent Effusion

PP: bx infxn of ME

E: H influenzae
s pneumoniae

CM: earache
fever
hearing loss

DX: bulging TM
loss of landmarks