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Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions > 26 Idiopathic > Flashcards

26 Idiopathic Flashcards

1
Q

What condition would cause a tense sounding voice, vocal fatigue, and a prolonged closed phase with reduced vibratory and mucosal wave amplitude during videostrobe?

A

Glottic hyperabduction dysphonia

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2
Q

What kind of dystonia is spasmodic dysphonia (SD)?

A

Focal

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3
Q

What are the characteristics of focal dystonias?

A

Inappropriate and excessive efferent activity of motor neurons in small areas

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4
Q

What are 2 types of SD

A

Adductor and Abductor

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5
Q

Which type of SD is more common

A

Adductor

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6
Q

What type of SD is characterized by a harsh, strained voice w/ inappropriate pitch breaks, breathiness, and glottal fry

A

Adductor SD

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7
Q

What are the typical features of abductor SD

A

Breathy, effortful hypnotic voice w/ abnl whispered segments of speech

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8
Q

The inability to sustain vowels during speech is suggestive of what d/o?

A

Adductor SD

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9
Q

Voiceless consonant is suggestive of what d/o?

A

Abductor SD

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10
Q

What percent of SD is familial

A

12%

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11
Q

Which muscles are responsible for adductor SD?

A

Thyroarytenoid and LCA

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12
Q

Which muscle is responsible for abductor SD?

A

PCA

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13
Q

What is preferred method of tx for SD?

A

Chemical denervation w/ botox

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14
Q

What are the 2 ways to deliver botox to PCA

A

Transcricoid and retrograde (rotating the larynx away from side of injxn)

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15
Q

How can one confirm placement of needle in PCA?

A

Using EMG guidance, have pt sniff

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16
Q

What can be done if SD sx persist after complete paralysis of PCA?

A

Inject the CONTRA PCA with very small increments of toxin or inject the cricothyroid muscle

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17
Q

How is injection into cricothyroid muscle accomplished and how is proper placement confirmed

A

Peroral route; confirm by having pt sing an ascending scale and observing the increase in EMG activity as pitch increases

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18
Q

What are the adverse effects of PCA injxn?

A

Stridor (particularly w/ exertion), airway compromise, dysphagia, aspiration

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19
Q

What is the adductor laryngeal breathing dystonia?

A

Paradoxical adduction of the VF during inspiration, causing inspiratory stridor that worsens with exertion and disappears during sleep

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20
Q

What effect does adductor laryngeal breathing dystonia have on the voice

A

None

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21
Q

What syndrome is a/w blepharospasm

A

Meige’s syndrome

22
Q

Which muscles are involved in blepharospasm

A

Orbicularis oculi, procerus, and corrugator supercilii

23
Q

What causes hemifacial spasm

A

A vascular loop, most commonly of the anterior or posterior inferior CBL art, impinging on root of CN VII

24
Q

What is initial tx for hemifacial spasm?

What is the procedure of choice for these pts?

A
  • baclofen

- microvascular decompression

25
Q

Which muscles are injected when using botox for hemifacial spasm

A

Zygomaticus major and minor, levator anguli oris, risorius

26
Q

What muscles are injected when using botox to tx oromandibular dystonia

A

masseter, temporalis, and medial and lateral pterygoids

27
Q

What percent of pts w/ unilateral tinnitus have retrocochlear pathology

A

11%

28
Q

What is the m/c cause of venous pulsatile tinnitus

A

Idiopathic intracranial hypertension syndrome (pseudotumor cerebri, benign intracranial HTN)

29
Q

What is m/c cause of pulsatile tinnitus in young female pts

A

IIH

30
Q

What are six etiologies of pulsatile tinnitus

A
  • IIH
  • Jugular bulb abnlities
  • Hydrocephalus a/w stenosis of sylvian aqueduct
  • Inc ICP a/w Arnold-chiari synd
  • Abnl condylar and mastoid emissary veins
  • Idiopathic or essential tinnitus
31
Q

What is the tx for IIH

A

Weight reduction and acetazolamide (250 mg TID) or lasix (20 mg BID)

Lumbar-peritoneal shunt for pts w/ visual deterioration, persistent HA, or disabling tinnitus

32
Q

What is the definition of sudden sensorineural hearing loss

A

> 20 dB HL over at least three contiguous frequencies occurring w/in 3 days

33
Q

In what percent of sudden SNHL can a definitive cause be determined?

A

10%

34
Q

What % of SSNHL will turn out to have a vestibular schwannoma

A

4%

35
Q

What are 2 common theories of etiology of idiopathic SSNHL

A

Circulatory disturbance and inflammatory reaction (usu viral)

36
Q

What is current standard of care for w/u and tx of idiopathic SSNHL

A

Otologic exam, audio, r/o retrocochlear pathology –tx w/ steroids, +/- antivirals (no), +/- diuretics

37
Q

What lab studies are useful in w/u of idiopathic SSNHL

A

Coag profile (CBC, PT, PTT), viral studies, ESR

38
Q

What is prognosis of idiopathic SSNHL

A

Overall recovery to functional hearing levels in 65-69%; no conclusive evidence that outcome is improved by medical tx

39
Q

When is spontaneous recovery of hearing in SSNHL more likely

A

If pt is w/o vestibular sx and suffers only partial HL, particularly low freq (better prog if apex of cochlea involved)

40
Q

What tx are used to try to optimize cochlear blood flow

A

Vasodilators (histamine, papaverine, verapamil, CO2) and blood thinners (defibrinogenation therapy, dextran, papaverine)

41
Q

What evidence supports use of CO2 for SSNHL

A

Fisch et al. (1983) compared carbogen (95% oxygen and 5% carbon dioxide) inhalation therapy daily for 5 days with papaverine and low-molecular-weight dextran for 5 days and found a statistically significant improvement in hearing levels with carbogen therapy. These findings have not been replicated.

42
Q

What evidence supports use of corticosteroids for SSNHL

A

Steroid therapy is among the few treatment methods in ISSNHL to have single modality, randomized, prospective studies demonstrating effectiveness.

43
Q

What evidence supports use of antivirals for SSNHL

A

No randomized prospective studies have demonstrated effectiveness

44
Q

What factors lead to best rate of recovery after SSNHL

A

Pts treated with steroids and vasodilators with worse initial PTA and SDS, younger age, and greater number of treatments are most likely to improve

45
Q

When is middle ear exploration indicated in SSNHL

A

If loss occurs in an only hearing ear – to r/o a fistula

46
Q

What type of bony EAC growth is usu attached to tympanosquamous suture line

A

Osteoma

47
Q

Indications for removal of EAC exostoses

A

Less than 1 mm aperture, recurrent otitis externa, and water trapping

48
Q

What are sx of patulous ET

A
  • Aural fullness
  • Autophony
  • Tympanophonia that improve when head is placed down b/w the legs
  • Onset occurs w/ wt loss or after RT to NP
49
Q

What is tympanophonia

A

Audition of one’s own breath sounds

50
Q

What are some tx for patulous ET

A
  • Reassurance
  • Wt gain
  • SSKI (10 gtt in juice po TID)
  • Premarin nasal spray (25 mg in 30 cc NS, 3 gtt per nose TID)
  • Occlusion of ET
  • Myringotomy and tympanostomy tube placement

Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions (14 decks)

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