ear

Question 1

place tuning fork in midline skull
do you hear anything? yes which ear?
both (midline)
if one ear (abnormal -lateralizes to L/R)

Answer 1

Weber test

Question 2

conductive hearing loss: lateralizes to affected ear (louder in affected ear)
sensorinueral hearing loss: lateralizes to good ear (no sensation of sound in affected ear)

Answer 2

abnormal Weber test

Question 3

plugged ear canal causes louder sound heard in affected ear with Weber test. example of:

Answer 3

conductive hearing loss

Question 4

place tuning form on mastoid process
do you hear anything? yes
tell me when sound stops - then move it perpendicular to ear and ask if still here it.
normal: air conduction > bone conduction
conductive hearing loss: BC>AC (don’t hear it in front of hear)

Answer 4

Rinne test

Question 5

bone conduction > air conduction (rinne test) is a feature of

Answer 5

conductive hearing loss

Question 6

inflammation/infection of ear canal (superficial)

pain with manipulation of ear (pinna) or instrumentation of canal (otoscope)

Answer 6

acute otitis externa (swimmer’s ear)

Question 7

ear infection caused by P. aeruginosa (most common) or S. aureus

Answer 7

acute otitis externa (swimmer’s ear - wet ear after gone swimming)

Question 8

treatment of acute otitis externa (swimmer’s ear)

Answer 8

irrigation

topical antibiotics

Question 9

infection of middle ear space - usually bacterial

Answer 9

acute otitis media (AOM)

Question 10

diagnosis of acute otitis media

Answer 10

inspect tympanic membrane:
bulging
middle ear effusion (opaque, air-fluid level, pus)
erythema (nonspecific)
TM immobility under positive pressure with pnuematic otoscope

Question 11

ear infection caused by P. pneumoniae (most common), nontypable H. influenzae (not type B), M. catarrhalis

Answer 11

acute otitis media

Question 12

treatment of acute otitis media

Answer 12

antibiotics: amoxicillin, amoxicillin + clavulonic acid, cephalosporin
tympanostomy tubes (recurrent infections, equalize pressure)

Question 13

complication of acute otitis media

Answer 13

acute mastoiditis (AOM symptoms + post-auricular swelling, redness, mastoid tenderness)

Question 14

connects middle ear to phayrnx

Answer 14

eustachian tube

Question 15

difficulty maintaining equilibrium between middle ear pressure and atmospheric pressure
associated with allergic rhinitis
treat with intranasal steroids

Answer 15

eustachian tube dysfunction

Question 16

overgrowth of desquamated keratin debris in middle ear space that may erode the ossicular chain (ossicles) and mastoid air cells → form cystic lesion lined by keratnizing squamous epithelium (can be metaplastic)
associated with chronic middle ear infections

Answer 16

cholesteatoma

Question 17

“pearly” grayish-white lesion behind or involving TM or involving TM
conductive hearing loss
vertigo

Answer 17

cholesteatoma

Question 18

treatment of cholesteatoma

Answer 18

surgical removal involving tymapnomastoidectomy and reconstruction of ossicular chain

Question 19

negative ear pressure from eustachian tube dysfunction (pulls on TM and creates chronic retraction pocket) or direct growth of epithelium through a TM perforation, can cause:

Answer 19

cholesteatoma

Question 20

displaced otoliths (stones) in SCC in vestibular apparatus
diagnosed by dix-hallpike maneuver
treated by epley maneuvar

Answer 20

benign paroxysmal positional vertigo (BPPV) - most common cause of vertigo

Question 21

inflammation of vestibular nerve

Answer 21

vestibular neuritis

Question 22

brainstem + cerebellar lesions damaging vestibular nuclei or posterior fossa tumor

Answer 22

central vertigo

Question 23

imbalances of fluid + electrolyte composition of endolymph in vestibular apparatus causing this triad:
intermittent vertigo
tinnitis
hearing loss

Answer 23

Meniere disease (endolymphatic hydrops)

Question 24

sensation of spinning, objects moving

Answer 24

vertigo

Question 25

intermittent vertigo
tinnitis
hearing loss

Answer 25

Meinere disease

r/o schwannoma with MRI (usually no vertigo though)