PANCE Blueprint EENT (7%)

Dysfunction of the eustachian tube

VIDEO-CASE-PRESENTATION-REEL-DX

Eustachean Tube Dysfunction

Patient will present as → a 9-year-old female with right otalgia and a nonproductive cough for one day. The patient complains of constant popping in her ears and a fluctuating conductive hearing loss with tinnitus. The patient has no significant past medical history, her immunizations are up to date, and both of her parents are non-smokers. On otoscopic examination, the tympanic membranes are grey with normal landmarks including visualization of the middle ear ossicles. There is no evidence of bulging pus or exudate suggestive of an acute inflammatory process.

Eustachian tube (ET) swelling inhibits ET's ability to auto insufflate leading to negative pressure

  • ETD usually follows the onset of an upper respiratory infection
  • Will present with ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, fluctuating conductive hearing loss, and tinnitus
  • Eustachian tube dysfunction is a primary cause of AOM and OME
  • All children < 7 years old have some ET dysfunction

An excellent otoscopic exam is key to making this diagnosis – otoscopic findings are usually normal. May see fluid behind TM if acute serous otitis media

  • Definitive diagnosis is with tympanogram

All children < 7 years old have some ET dysfunction (based on the angle of the eustachian tube) will resolve with age.

  • Ibuprofen as needed for pain
  • Nasal steroids can be prescribed in more severe cases
  • Systemic decongestants, such as pseudoephedrine or phenylephrine, may be helpful for nasal congestive symptoms
  • Surgery is generally indicated when medical management fails

Note that the tympanic membranes are grey with normal landmarks including visualization of the middle ear ossicles. There is no evidence of bulging pus or exudate suggestive of an acute inflammatory process.

Question 1
Conductive hearing loss noted in children may be caused by
A
Meningitis
Hint:
Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma.
B
Medications
Hint:
Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma.
C
Chronic eustachian tube dysfunction
D
Intracranial hemorrhage
Hint:
Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma.
E
Chronic exposure to loud noises
Hint:
Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma.
Question 1 Explanation: 
Signs of hearing loss may include delayed speech development, behavioral problems, and impaired comprehension. Hearing loss can be categorized as conductive or sensorineural. Conductive hearing loss is usually caused by otitis media with effusion. Other causes include foreign bodies in the ear, allergies, or chronic eustachian tube dysfunction. Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma. Although hearing screening has been mandated in 34 states for all children, absolute indications for audiologic evaluation include premature birth (birth weight < 2,500 g or birth weight > 2,500 g with complications including asphyxia, seizures, intracranial hemorrhage, hyperbilirubinemia, persistent fetal circulation, and assisted ventilation), intrauterine infection, bacterial meningitis, anomalies of the first or second branchial arch, anomalies of the neural crest or ectoderm, family history of hereditary or unexplained deafness, parental concern, and delayed speech or language development or other disabilities (including mental retardation, autism, cerebral palsy, and blindness). Infants are tested using either otoacoustic emissions (OAE) or auditory brain stem– evoked responses (ABR). The auditory brain stem– evoked response uses external scalp electrodes to detect waveforms that occur in predictable patterns after an auditory stimulus. The prompt recognition of hearing problems in children can help prevent delays in language development.
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