208 ENT

Question 1

Which part of the ear is affected in conducive hearing loss?

Answer 1

Outer/middle ear

Question 2

Which part of the ear is affected in senrorineural hearing loss?

Answer 2

Inner ear/cochlear/auditory nerve

Question 3

What is a positive Rinne’s test?

Answer 3

When air conduction is greater than bone conduction

Question 4

Which ear does the pt hear the sound in in a Weber’s test in a unilateral conductive hearing loss?

Answer 4

In the affected ear

Question 5

Which ear does the pt hear the sound louder in a Weber’s test in a unilateral sensorineural hearing loss?

Answer 5

Away from the affected ear

Question 6

What is myringosclerosis?

Answer 6

Chalky white patches on the eardrum which are benign and a result of previous damage

Question 7

How many dB amplification does the pinna provide at 4kHz?

Answer 7

3dB

Question 8

How many dB of amplification does the concha provide at 4-5kHz?

Answer 8

10dB

Question 9

How many dB of amplification does the ear canal provide at 2.5kHz?

Answer 9

10dB

Question 10

What is the net gain of amplification at 2.5kHz as the sound waves travel through the ear to the auditory nerves?

Answer 10

20dB

Question 11

Name a cause of congenital conductive hearing loss

Answer 11

Atresia

Question 12

What is the most common cause for sensorineural hearing loss?

Answer 12

Increasing age

Question 13

Name 2 drugs which can cause sensorineural hearing loss

Answer 13

Gentamycin

Furosemide

Question 14

Name 3 inflammatory conditions which can cause lesions of CN VIII and therefore a sensorineural hearing loss
(4 listed)

Answer 14

TB
Sarcoidosis
Neurosyphilis
Carcinomatous meningitis

Question 15

What is otosclerosis?

Answer 15

Inherited disease where a small focus of spongy bone developing at fissula ante finestrum which maintly causes conductive hearing loss

Question 16

What is the treatment of otosclerosis?

Answer 16

Surgery - fixation of the stapes with a prosthesis

Hearing aid

Question 17

What is another name for secretory otitis media with effusion?

Answer 17

Glue ear

Question 18

What condition can reoccur in pt’s with glue ear?

Answer 18

Otitis media

Question 19

What are the treatment options for glue ear?

4 listed

Answer 19

Watch and wait
Grommets
Grommets + adenoidectomy
Hearing aid

Question 20

Which cells deteriorate in presbyacusis?

Answer 20

Hair cells / ganglion cells

Question 21

What causes an acoustic neuroma?

Answer 21

Slow overgrowth of Schwann cells which cover the vestibular/cochlear nerves

Question 22

Where do acoustic neuromas tend to reside once they have reached around 2-3cm?

Answer 22

Cerebellopontine angle

Question 23

What type of hearing loss does acoustic neuromas cause?

Answer 23

Unilateral sensorineural hearing loss

Question 24

What is the outcome of an untreated acoustic neuroma?

Answer 24

Hydrocephalus - the tumour grows into the cerebellopontine angle and occludes the cerebral aqueduct and 4th ventricle

Question 25

What are the 2 factors thought to contribute to the formation of a cholesteatoma?

Answer 25

Epithelial migration coupled with negative middle ear pressure

Question 26

Which direction do cholesteatomas tend to grow/migrate?

Answer 26

Superomedially

Question 27

In which trimester of pregnancy can a congenital cholesteatoma start forming?

Answer 27

1st trimester

Question 28

What are the possible complications of an untreated cholesteatoma?
(4 listed)

Answer 28

Facial nerve paralysis
Meningitis
Mastoid abscess
Brain abscess

Question 29

What are the 3 red flags of vertigo?

Answer 29

1. Any cranial nerve symptoms
2. Weakess/ numbness in limbs
3. Gaze evoked nystagmus

Question 30

What is the most common cause of isolated vertigo?

Answer 30

BPPV - benign paroxysmal positional vertigo

Question 31

Which manoeuvre is performed to diagnose BPPV?

Answer 31

Dix-Hallpike

Question 32

Which manoeuvre is curative in most pt’s with BPPV?

Answer 32

Epley

Question 33

What is the cause of BPPV?

Answer 33

Otoconia felling off the macula to create a mass behind the cupula

Question 34

What causes Meniere’s disease?

Answer 34

Build up of endolymphatic fluid in the inner ear due to restricted flow which causes distension and disruption to normal neuroepithelia. Also known as endolymphatic hydrops

Question 35

What is the progression of symptoms in Meniere’s disease?

Answer 35

Hearing loss and tinnitus followed by vertigo

Question 36

What causes the ionic disequilibrium in Meniere’s disease? What is the outcome of this?

Answer 36

Endolymph and perilymph mixing together which causes stimulation and damage of the neuroepithelium

Question 37

What is betahistidine used to treat?

Answer 37

Prophylaxis of vertigo in Meniere’s disease

Question 38

What are the surgical options for Meniere’s disease?

4 listed

Answer 38

1. Grommets + gentamycin into the middle ear
2. Saccus decompression (opening of the endolymphatic sac)
3. Chemical labyrinthectomy
4. Bony labyrinthectomy

Question 39

What causes vestibular neuritis?

Answer 39

Inflammation of the vestibular nerve by a virus or arterial occlusion

Question 40

What are the symptoms of vestibular neuritis?

Answer 40

Severe vertigo

N&V

Question 41

What distinguishes vestibular neuritis from labyrinthitis?

Answer 41

Vestibular neuritis has preserved auditory function

Question 42

What is prochloperazine used in the treatment of?

Answer 42

Vestibular neuritis - vestibular sedation

Question 43

What can be observed in an examination of a patient with vestibular neuritis/labyrinthitis?

Answer 43

Nystagmus in all directions,

Question 44

Name 3 introcerebral diseases which can cause vertigo

Answer 44

MS
Migraine
Posterior circulation stroke

Question 45

Which ear is effected in a left beating nystagmus?

Answer 45

Right - the fast phase defines the nystagmus but the slow phase moves towards the affected side due to the unopposed action of the extraocular muscles

Question 46

Where in the brainstem is the vestibular nucleus found?

Answer 46

Pons