👂 The Ear · Screening · Diagnosis · Treatment · Mnemonics

🔍 SCREENING
➤ Universal newborn hearing screen (OAE + ABR) by 1 month.
➤ High-risk registries (CMV, meningitis, family history).
➤ Periodic monitoring for delayed-onset SNHL (CMV, genetic).

🩺 DIAGNOSTIC TESTS
➤ Diagnostic ABR (threshold estimation).
➤ Behavioral audiometry (VRA 6-30mo, play 2.5-5yr).
➤ Tympanometry + acoustic reflexes.
➤ CT temporal bone (EVA, Mondini).
➤ Genetic testing (GJB2, SLC26A4, mtDNA).
➤ CMV PCR (saliva/urine, dried blood spot).

💊 ACCURATE TREATMENT
➤ Conductive: treat OME, surgical repair of ossicles.
➤ SNHL: hearing aids (by 1 month post-dx).
➤ Cochlear implant (severe-profound, FDA >9 mo).
➤ Valganciclovir for congenital CMV with SNHL.
➤ Genetic counseling.

🔍 SCREENING
➤ No routine screening; clinical awareness.
➤ Urgent audiometry for any sudden hearing loss (<72h).

🩺 DIAGNOSTIC TESTS
➤ Audiometry (≥30 dB over 3 contiguous frequencies).
➤ MRI with gadolinium (IAC/brain) – exclude schwannoma, labyrinthitis, stroke.
➤ Labs: CBC, ESR, ANA, Lyme (endemic), FTA-ABS, HIV.
➤ CT if EVA or trauma suspected.

💊 ACCURATE TREATMENT
➤ Oral prednisone 1 mg/kg/day (max 60 mg) x 7-14 days + taper.
➤ Intratympanic dexamethasone (salvage or primary severe).
➤ Combination oral + IT may improve outcomes.
➤ Ramsay Hunt → acyclovir + steroids.

🔍 SCREENING
➤ Newborn hearing screen (all infants with microtia/atresia/pits).
➤ Renal ultrasound (associated anomalies).
➤ Ophthalmology exam if syndromic.

🩺 DIAGNOSTIC TESTS
➤ High-resolution CT temporal bone (ossicles, canal, facial nerve).
➤ MRI inner ear (cochlear malformations, EVA).
➤ Audiometry (CHL, SNHL, mixed).
➤ Genetic testing (EYA1, SLC26A4, CHD7).

💊 ACCURATE TREATMENT
➤ BAHA soft band (infant) → BAHA abutment ≥5 yr.
➤ Atresiaplasty after age 5 (selected cases).
➤ Congenital cholesteatoma: surgical excision + second look (6-9 mo).
➤ Preauricular pit excision only if recurrent infection.

🔍 SCREENING
➤ Clinical diagnosis, no lab screen.
➤ Recurrent cases: check for diabetes, immunocompromise.

🩺 DIAGNOSTIC TESTS
➤ Otoscopy: edema, erythema, debris, pain on tragal/pinna manipulation.
➤ Culture if severe, recurrent, or necrotizing OE suspected.
➤ CT/MRI (necrotizing OE → skull base osteomyelitis).

💊 ACCURATE TREATMENT
➤ Topical ciprofloxacin/dexamethasone (non-ototoxic) for 7 days.
➤ Severe edema → ENT wick placement.
➤ Oral analgesics (ibuprofen).
➤ Necrotizing OE: IV antipseudomonal (ceftazidime, cipro) + ENT debridement.
➤ Prevention: acidifying drops after swimming.

🔍 SCREENING
➤ Pneumatic otoscopy + tympanometry if uncertain.
➤ No universal OME screen; evaluate at-risk children.

🩺 DIAGNOSTIC TESTS
➤ Pneumatic otoscopy: bulging/decreased mobility = AOM.
➤ Tympanometry (type B = effusion).
➤ Tympanocentesis (severe, immunocompromised, failed therapy).

💊 ACCURATE TREATMENT
➤ AOM: amoxicillin 80-90 mg/kg/day x 10d (<2y) or 5-7d (>2y mild).
➤ Watchful waiting (6m-2y nonsevere unilateral, >2y).
➤ Treatment failure → amoxicillin-clavulanate or ceftriaxone.
➤ OME: observe 3 months; tubes if persistent hearing loss/speech delay.
➤ Tympanostomy tubes for recurrent AOM (≥3 in 6mo or ≥4 in 12mo).

🔍 SCREENING
➤ Clinical suspicion: persistent OM + postauricular swelling/pinna protrusion.

🩺 DIAGNOSTIC TESTS
➤ Contrast-enhanced CT temporal bone (coalescence, abscess).
➤ MRI/MRV for sigmoid sinus thrombosis.
➤ Blood culture, middle ear culture (myringotomy).

💊 ACCURATE TREATMENT
➤ IV antibiotics (ceftriaxone + vancomycin if toxic).
➤ Myringotomy + tube drainage.
➤ Mastoidectomy: coalescence, subperiosteal abscess, intracranial complications, or failure of 48h IV.
➤ Total duration 4 weeks (IV then oral).

🔍 SCREENING
➤ Vestibular testing for chronic disequilibrium.
➤ Audiometry for suspected Meniere, otosclerosis.

🩺 DIAGNOSTIC TESTS
➤ Audiometry + tympanometry (rule out middle ear).
➤ MRI IAC (vestibular schwannoma, labyrinthitis).
➤ Dix-Hallpike (BPPV).
➤ Electrocochleography (Meniere).
➤ VEMP, caloric testing.

💊 ACCURATE TREATMENT
➤ Benign paroxysmal vertigo: reassurance, migraine prophylaxis if needed.
➤ Vestibular neuritis: prednisone + vestibular rehab; suppressants ≤3d.
➤ BPPV: Epley maneuver.
➤ Otosclerosis: stapedectomy or hearing aid.
➤ Perilymphatic fistula: middle ear exploration + repair.

🔍 SCREENING
➤ Head trauma → examine pinna, ear canal, TM, Battle sign, facial nerve.

🩺 DIAGNOSTIC TESTS
➤ CT temporal bone (fracture type, ossicles, facial canal).
➤ Audiometry (conductive, SNHL).
➤ Beta-2 transferrin (CSF leak).
➤ ENoG for facial paralysis.

💊 ACCURATE TREATMENT
➤ Auricular hematoma: drainage + pressure dressing.
➤ TM perforation: keep dry, observe 4-6 weeks; tympanoplasty if persistent.
➤ Longitudinal fracture: conservative; delayed facial palsy may recover.
➤ Transverse fracture: SNHL, immediate facial palsy → possible decompression.
➤ CSF leak: head elevation, observe; repair if persistent.
➤ Perilymphatic fistula: exploration + repair.

🔍 SCREENING
➤ Suspect tumor: aural polyp, bloody otorrhea, facial paralysis, lytic lesion.

🩺 DIAGNOSTIC TESTS
➤ CT temporal bone with contrast (bone destruction, soft tissue).
➤ MRI (intracranial extension, vascularity).
➤ Biopsy (histopathology, immunohistochemistry).
➤ Systemic imaging/staging (PET, skeletal survey for LCH).

💊 ACCURATE TREATMENT
➤ Rhabdomyosarcoma: multiagent chemo (VAC) + radiation ± surgery.
➤ Langerhans cell histiocytosis: isolated → curettage/steroids; multisystem → chemo.
➤ Glomus tumor: pre-op embolization + surgical excision.
➤ Osteoma/exostoses: remove only if symptomatic.
➤ Leukemic infiltration: treat underlying leukemia.