Meniere's Disease Treatment
- Correct Answer - Usually, self-limiting. Treat acute attacks
Antihistamines for vertigo
Meclizine, dimenhydrinate
Antiemetics for nausea/vomiting o Promethazine, prochlorperazine
Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX
- Correct Answer - Symptoms: Ages 30-60
Gradual onset, one-sided
Sensorineural hearing loss, tinnitus that is insidious; CN 8
Facial numbness and pain if it compresses CN 5
,Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing
loss and tinnitus.
If it compresses on CN 5 will have facial numbness and pain
Treatment: Surgery
Cholesteatoma symptoms and treatment
- Correct Answer - Symptoms:
Cauliflower
Foul-smell
Hearing loss (typically conductive unless it's way inner than can have
sensorineural)
If erodes bones in face affects CN VII
Treatment: SURGERY
Battle Sign (Basilar Skull Fracture):
- Correct Answer - Bruising behind the ear (mastoid area) appear within
1-3 days after trauma
Parietal bone is most fractured. Linear fracture most common
leaking of clear fluid from nose and eyes, raccoon eyes
Look for clear, golden serous discharge from the ear or nose
treat immediately-Refer to ER
,Benign Paroxysmal Positional Vertigo (BPPV): Symptoms & DX &
Treatment
- Correct Answer - Symptoms: Vertigo lasting <1 minute caused by
sudden head movements and position changes
May lose balance and fall
Due to calcium carbonate crystals (otoconia) being trapped in the
semicircular canals
Dx: Gold Standard: Dix-Hallpike
Epley Maneuver in clinic or at home by pt
Test won't ask how to conduct treatment just be able to associated Epley
with BPPV
Acute Otitis Media (AOM)(Think of Media for Middle Ear): Strain &
symptoms & treatment
, - Correct Answer - Bacteria: Streptococcus pneumonia (others:
Haemophilus influenza, Moraxella catarrhalis)
High rate of beta-lactamase resistance
Symptoms: Unilateral ear pain (otalgia)
Popping noises, and muffled hearing, Either afebrile or low-grade fever,
The tympanic membrane can rupture. Blood and pus can be seen on the
pillow upon awakening with relief of ear pain ,TM will be red. Bulging and
the cone of light will be abnormal or displaced ,Most objective finding:
Decreased mobility per the tympanogram which will be a flat line
Treatment: NO antibiotic use in the prior month: o Amoxicillin high dose
(first line): 1000 mg TID x 5-7 days
Next antibiotic choices are: 23
Augmentin x 5-7 days o Omnicef or cefpodoxime BID x 5-7 days
Penicillin Allergy: Type 1 Allergy (anaphylaxis, angioedema):
Levofloxacin 750 mg QD x 5-7 days OR Doxycycline BID x 5-7 days •
Type 2 Allergy (skin rash): Omnicef, cefpodoxime, Ceftin BID x 5-7 days
Hearing Tests: Conductive Hearing Loss
Weber- Lateralization to bad ear
Rinne- BC>AC
Otitis Media with Effusion: Symptoms/TX/Hearing tests
- Correct Answer - Symptoms: Usually, painless
May follow AOM but can also be caused with chronic allergic rhinitis
Sterile CLEAR serious fluid is trapped in the middle ear. May see air
bubbles, Ear pressure along with mild hearing loss and ear popping
sounds,
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