Medical and Surgical Treatment Flashcards

What is the first-line treatment for uncomplicated acute otitis externa in an adult with an intact tympanic membrane?

Answer: Topical antibiotic ear drops

Topical antimicrobial drops are first-line for uncomplicated AOE, and systemic antibiotics are reserved for spread beyond the canal or for immunocompromised patients.

A patient with idiopathic sudden sensorineural hearing loss gets no improvement after a course of oral steroids. What is the recommended salvage therapy?

Answer: Intratympanic corticosteroid injection

Intratympanic steroids are recommended as salvage therapy when initial treatment for sudden SNHL fails.

Which treatment for Meniere's disease ablates vestibular function while usually preserving hearing?

Answer: Intratympanic gentamicin

Low-dose intratympanic gentamicin selectively damages vestibular hair cells and carries a fairly low risk to hearing.

What is the definitive treatment for an acquired cholesteatoma?

Answer: Tympanomastoidectomy

Cholesteatoma keeps growing and eroding bone, so surgical removal by tympanomastoidectomy is the definitive treatment.

What is the preferred surgery for conductive hearing loss caused by otosclerosis with stapes fixation?

Answer: Stapedotomy with a prosthesis

Stapedotomy makes a small fenestration in the fixed footplate and places a piston prosthesis to restore sound transmission.

An elderly diabetic patient has severe otalgia, granulation tissue on the canal floor, and a high ESR. What is the cornerstone of treatment?

Answer: Prolonged antipseudomonal antibiotics

Necrotizing (malignant) otitis externa is usually caused by Pseudomonas and needs weeks of antipseudomonal therapy, such as a fluoroquinolone, plus glucose control.

What is the treatment of choice for posterior semicircular canal BPPV?

Answer: Epley canalith repositioning maneuver

The Epley maneuver moves otoconia out of the posterior canal and resolves symptoms in most patients.