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PANCE 2.0 > EENT #6 (Ears) > Flashcards

EENT #6 (Ears) Flashcards

1
Q

Tympanic membrane rupture MC occurs due to ________ and MC occurs at what location?

A

Penetrating or noise trauma

Pars tensa

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2
Q

Symptoms of TM perforation

A
  • Acute ear pain, hearing loss
  • Sudden pain relief with bloody otorrhea
  • Tinnitus and vertigo
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3
Q

Although most TM perforations heal spontaneously, what should always be remembered if prescribing antibiotics for the ear?

A

Do not give aminoglycosides or water. They are ototoxic

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4
Q

What is a cholesteatoma

A

-Abnormal keratinized collection of desquamated squamous epithelium in the middle ear that can lead to bony erosion of the mastoid

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5
Q

What is a cholesteatoma MC from?

A

Chronic middle ear disease or Eustachian tube dysfunction

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6
Q

Symptoms of a cholesteatoma

A
  • Painless otorrhea (brown or yellow discharge with a strong odor)
  • May develop peripheral vertigo, tinnitus, dizziness, or cranial nerve palsies
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7
Q

What is seen on otoscopy of a patient with a cholesteatoma?

A

-Granulation tissue (cellular debris) and may have TM perforation

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8
Q

True or False: A patient with a cholesteatoma will have conductive hearing loss?

A

True

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9
Q

Management of a cholesteatoma

A

-Surgical excision of debris and cholesteatoma with reconstruction of the ossicles

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10
Q

What is otosclerosis?

A

Abnormal bony overgrowth of the footplate of the stapes leading to conductive hearing loss

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11
Q

Otosclerosis is what type of genetic inheritance pattern?

A

Autosomal dominant (may have family history of conductive hearing loss)

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12
Q

Symptoms of otosclerosis

A
  • Slowly progressive conductive hearing loss (especially low frequencies)
  • Tinnitus
  • Vertigo is UNCOMMON
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13
Q

Although conductive hearing loss is one way to diagnose otosclerosis, what is the most USEFUL?

A

Tone audiometry

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14
Q

Management for otosclerosis

A
  • Stapedectomy with prosthesis or hearing amplification (hearing aid)
  • Cochlear implantation if severe
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15
Q

What is the difference in nystagmus with peripheral vertigo vs central vertigo?

A

Peripheral: Horizontal nystagmus (beats away from affected side, fatiguable)
Central: Vertical nystagmus (nonfatiguable and continuous)

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16
Q

What are some causes of peripheral vertigo?

A 
BPPV (MC)
Meniere
Vestibular Neuritis
Labyrinthitis
Cholesteatoma
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17
Q

Nausea and vomiting is caused by sensory conflict mediated by which neurotransmitters (5)

A 
GABA
Acetylcholine
Histamine
Dopamine
Serotonin
18
Q

What is the first line medication for vertigo?

A

Meclizine
Scopolamine
Dimenhydrinate
Diphenhydramine

19
Q

Contraindications for antihistamines/anticholinergics such as Meclizine and Scopolamine?

A

Acute narrow angle glaucoma, BPH with urinary retention

20
Q

What is the mechanism of action of ondansetron and granisetron?

A

Blocks serotonin receptors both centrally and peripherally in the medulla (suppressing the vomiting center)

21
Q

Benign Paroxysmal Positional Vertigo is a type of peripheral vertigo that most commonly is due to _______

A

displaced otolith particles (calcium crystals) within the semicircular canals of the inner ear (Canalithiasis)

22
Q

MCC of peripheral vertigo

A

BPPV

23
Q

Symptoms of BPPV

A
  • Recurrent episodes of sudden, episodic peripheral vertigo (lasting 60 seconds or less) and provoked with specific head movements
  • Nausea, vomiting
  • NO HEARING LOSS, TINNITUS, or ATAXIA
24
Q

How do you diagnose BPPV?

A

Dix Hallpike (Nylen Barany) Test: produces fatiguable nystagmus

25
Q

How do you manage a patient with BPPV?

A

-Canalith repositioning treatment of choice (Epley Maneuver) or Semont Maneuver

26
Q

What is vestibular neuritis?

A

Inflammation of the vestibular portion of Cranial Nerve VIII (8)

27
Q

On the contrary, what is labyrinthitis?

A

Inflammation of the vestibular and cochlear portion of CNVIII (8)

28
Q

Although the etiologies of vestibular neuritis and labyrinthitis are idiopathic, what may it be associated with?

A

Viral or postviral inflammation

29
Q

Symptoms of both vestibular neuritis and labyrinthitis

A

Continuous peripheral vertigo
Dizziness, nausea, vomiting, gait disturbances
Horizontal and rotary nystagmus (away from affected side in fast phase)

30
Q

What does labyrinthitis only have?

A

Unilateral hearing loss, tinnitus

31
Q

Management of vestibular neuritis and labyrinthitis

A
  • Glucocorticoids are first line
  • Antihistamines (Meclisine) or anticholinergics for symptoms
  • Both are self-limited and resolve within weeks
32
Q

What is Meniere’s Disease?

A

Idiopathic distention of the endolymphatic compartment of the inner ear due to excess fluid

33
Q

Meniere Disease is characterized by four findings. What are they?

A
  • Episodic peripheral vertigo (lasting minutes-hours)
  • Fluctuating sensorineural hearing loss
  • Tinnitus
  • Ear Fullness

-Other symptoms: Horizontal nystagmus, nausea, vomiting

34
Q

Management of Meniere Disease

A
  • Initial: Dietary modification: avoidance of salt, caffeine, nicotine, chocolate, and alcohol
  • Medical: antihistamines (Meclizine) and diuretics (Hydrochlorothiazide) to reduce pressure are options
35
Q

If the case of Meniere’s Disease is refractory, what treatments can be pursued

A 
Surgical decompression (T tube)
Labyrinthectomy
Intraaural Gentamicin
36
Q

What is an acoustic CNVII neuroma?

A

Vestibular schwannoma–benign tumor involving Schwann cells which produce myelin sheath

37
Q

Where does an acoustic neuroma arise?

A

Cerebellopontine angle and can compress structures (CNVIII, VII, and V)

38
Q

Symptoms of an acoustic neuroma

A
  • Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise
  • Tinnitus
  • Facial numbness
  • Facial paresis
  • Ataxia
  • Headache
39
Q

What is the imaging study of choice for an acoustic neuroma

A

MRI

40
Q

However, what is the laboratory study of choice for an acoustic neuroma?

A

-Audiometry

41
Q

Treatment for an acoustic neuroma

A

-Surgery or focused radiation therapy

PANCE 2.0 (62 decks)

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