Degenerative Flashcards
What is the rate of recurrence?
30-50% eventually have a recurrence; 10-20% within 1-2 weeks of the maneuver.
What percent of patients have scutum erosion associated with cholesteatoma?
42%.
What is the success rate of the Epley maneuver after only one manipulation?
50-77%.
What percent of cholesteatomas are complicated by a labyrinthine fistula?
5-10%.
What percent of cases of otosclerosis are bilateral?
85%.
What is the success rate after two manipulations?
95-97%.
What is a laryngocele?
Abnormal dilatation of the laryngeal saccule.
What are the most common manifestations of vertebrobasilar insufficiency (VBI)?
Abrupt, transient attacks of vertigo associated with bilaterally reduced caloric responses.
What are the two parts of a cholesteatoma?
Amorphous center surrounded by keratinized squamous epithelium.
What is the most commonly involved site of otosclerosis in the temporal bone?
Anterior to the oval window at the fissula ante fenestrum.
What is the treatment for vertigo secondary to vertebro-basilar insufficiency?
Aspirin or ticlid if aspirin sensitive.
What is the most common cause of pulsatile tinnitus in patients older than 50?
Atherosclerotic carotid artery disease.
What is the inheritance pattern of otosclerosis?
Autosomal dominant with incomplete penetrance (only 25-40% of carriers express the phenotype).
What does the “Blue Mantles of Manasse” refer to?
Basophilic appearance on hematoxylin and eosin staining of bone in the active stage of otosclerosis.
Where are internallaryngoceles located?
Beneath the mucosa of the false vocal cord and aryepiglottic folds.
Where do pharyngoesophageal/Zenker’s diverticula occur?
Between the oblique and transverse fibers of the inferior constrictor (Killian’s dehiscence), most commonly on the left, and between the cricopharyngeus and the esophagus (Killian-Jamieson area).
What are the deposits thought to consist of!
Calcium carbonate crystals, possibly resulting from microfractures of the temporal bone near the round window niche (also near the ampulla of the posterior SCC).
When do most laryngoceles present?
Can present at any time, but most commonly arise in the sixth decade of life.
Which theory is currently more favored?
Canalolithiasis.
What are the two types of tympanic membrane perforations?
Central and marginal.
What are the two types of cholesteatomas?
Congenital and acquired.
What are the two main theories of the pathophysiology of BPPV?
Cupulolithiasis theory: deposits gravitate, attach to, and stimulate the cupula. Canalolithiasis theory: deposits float freely within the SCCs under the influence of gravity.
How does this theory account for the latency of onset of nystagmus?
Delay is due to the adherence of deposits to the membranous wall of the labyrinth.
What is the typical route of spread of cholesteatomas originating in anterior mesotympanum?
Descend to the pouch of von Troeltch, and may involve the stapes, sinus tympani, or facial recess.
In a patient with a cholesteatoma, what factors make the presence of a fistula highly unlikely?
Disease
What is Eagle’s syndrome?
Elongation of the styloid process or ossification of the stylohyoid ligament resulting in nonspecific throat pain, foreign body sensation, and increased salivation.
What problem results from rupture of the middle meningeal artery?
Epidural hematoma.
What therapeutic maneuver is based on the canalolithiasis theory?
Epley.
What toxin is the most common cause of cerebellar degeneration?
Ethanol.
What is the significance of pain in a patient with cholesteatoma or chronic otitis media?
Expanding mass or empyema in the antrum.
What are mixed laryngoceles?
External laryngoceles with a dilated internal component.
What features on history distinguish far-advanced-otosclerosis from profound SNHL?
Family history of otosclerosis; progressive hearing loss usually of long duration; history of hearing aid use that is no longer beneficial or present use of a hearing aid with benefit beyond that which would be expected for the severity of the hearing loss; paracusis; and previous audiograms indicating an air-bone gap.
What are the terms used to describe involvement of the oval window and cochlea?
Fenestral otosclerosis and retrofenestral otosclerosis, respectively.
Which ossicle is most commonly involved in patients withcholesteatoma?
Incus.
What are the three types of laryngoceles?
Internal, external, and combined.
What are the histopathologic findings of patients with far-advanced-otosclerosis?
Invasion of otosclerotic foci into the cochlear endosteum and the stapes footplate.
Where does cholesteatomas are complicated by a labyrinthine fistula most often occur?
Lateral semicircular canal (75%).
Which of these is associated with cholesteatoma?
Marginal.
What virus is thought to play a role in the etiology of otosclerosis?
Measles.
Which layer of the otic capsule does otosclerosis involve?
Middle endochondral layer.
What condition is characterized by generalized tension in all laryngeal muscles?
Muscular tension dysphonia.
What genetic mutation has been implicated as a possible cause of otosclerosis?
Mutation of the CO-1 gene on chromosome 17q.
How is far-advanced otosclerosis (FAO) defined?
Otosclerosis with an air conduction threshold greater than 85 dB and a bone conduction threshold not measurable.
What are the three layers of the otic capsule?
Outer periosteal layer, inner periosteal layer (endosteum), and the middle endochondral layer.
What are the four etiologies of vocal cord immobility?
Paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar.
What features on physical exam distinguish FAO from profound SNHL?
Patients with FAO more likely will have a soft voice with better quality than expected for the degree of hearing loss and the ability to hear a 512 Hz tuning fork placed on the teeth, dentures, or gums.
How do laryngoceles become external?
Penetrate the thyrohyoid membrane at the site of entry of the superior laryngeal artery and nerve.
What percent of cases occur in the posterior SCC? Horizontal SCC?
Posterior (80-95%); horizontal (5-20%).
What are the most common sites of origin of primary acquired cholesteatomas?
Posterior epitympanum, posterior mesotympanum, and anterior epitympanum (in descending order of frequency).
What conditions accelerate hearing loss in patients with otosclerosis?
Pregnancy, estrogen replacement.
What are the two types of acquired cholesteatomas?
Primary and secondary.
What is the difference between a primary and a secondary cholesteatoma?
Primary usually occurs in the attic at Shrapnell’s membrane and starts as a retraction pocket; secondary is associated with chronic middle ear infection and TM perforations.
What are the two types of esophageal diverticula?
Pulsion and traction.
Which of these is associated with high intraluminal pressure?
Pulsion.
Which of these is Zenker’s diverticulum?
Pulsion.
What therapeutic maneuver is based on the cupulolithiasis theory?
Semont.
What is the typical route of spread of cholesteatomas originating in the posterior epitympanum?
Starting from Prussak’s space, penetrate posteriorly to the superior incudal space lateral to the body of the incus, and progress to the aditus and the antrum.
At what age does otosclerosis peak in incidence?
Third decade.
In which patients is Muscular tension dysphonia most commonly seen?
Untrained occupational and professional voice users.
