EENT Test 2 Flashcards by Melanie Stein

Endocrine conditions Ddx for inner ear conditions (broad list)

B12, vit a, vit d, fe, zn, mg, b6, folate;

Hyperlipidemia, hypercholesterolemia, dm, hypothyroidism, celiac, hypoglycemia, electrolyte imblance

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Why is the organ of corti and vestibular apparatus sensitive to anoxia and nutrient deprivation?

They have a very increased metabolic rate

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Otosclerosis is what kind of hearing loss?

Conductive

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Otosclerosis demographics

Onset in 20’s, familial tendency, more women than men, more whites

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Otosclerosis general hx

Progressive hearing loss that preserves speech. Pt often soft spoken, may hear better in loud environment?

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Otosclerosis PE/ Dx

Ct shows fused stapes/malleus

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Otosclerosis audiology

Dip in bone conduction at 2000hz.

Tm may be pink and blue

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Play audio for this term

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Traumatic hearing loss is what kind of hearing loss? Conductive

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Traumatic hearing loss hx

Rupture of Tm from increased pressure

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Trauma hearing loss PE

On otoscopic exam, Tm is floppy.

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Trauma tympanogram

Type ad (disrupted)

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Inflammatory hearing loss is what kind of hearing loss?

Conductive

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Inflammatory hearing loss PMHX

Om, pus and effusion, cholesteotoma

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Inflammatory tympanogram type

Stiff- low impedence

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Congenital hearing loss is what kind of hearing loss?

Sensorineural

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Cause of congenital hearing loss

Genetic: usu fhx

Non genetic mbdt injury, disease (rubella)

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Waadenburg syndrome sxs

Genetic hearing loss + white patch of hair.

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Congenital hearing screen audiology:

Loud volumes resonate at 4k hz

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Traumatic sensorineural hearing loss causes:

Head injury or noisy occupations such as farmers, construction, machinists, military, musician

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Traumatic sensorineural hearing loss causes:

Head injury or noisy occupations such as farmers, construction, machinists, military, musician

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Traumatic sensorineural hearing loss initial complaint:

Tinnitus. This is reversible until hairs on organ of corti are damaged beyond repair.
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Traumatic sensorineural hearing loss audiology

Drop off in higher frequencies

Inflammatory sensorineural hearing loss causes:

Infections. Strep endotoxins pass through oval window . Measles, syphilis damage nerves

Neoplastic sensorineural hearing loss causes

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Granulomas, meningiomas, acoustic neuroma.

Suspect neoplastic hearing loss when?

Unilateral hearing loss

How to rule out neoplastic hearing loss

Mri

Acoustic neuroma hearing loss

Localized in high frequencies, retrocochlear pattern with deep v wave 

Speech audiometry measures

Threshold that speech is accurately heard at. Increased cochlear hearing loss correlates to decreased word recognition

Tympanometry measures

Tm mobility

Electrocholeography measures

Records electrical potential of cochlea, diagnosis menieres | 

Auditory brain stem response measures what?

Nerve conduction. Prolonged with acoustic neuroma. Objective test in young children, delayed test positive for prolonged time.

Minerals helpful for presbycussis?

Zinc, vit c, e, alpha lipoic acid

What is presbycusis?

Hearing loss of old age

Ototoxic substances ti

Aminoglycosides (gentamicin, streptomycin,neomycin), phenytoin, anti htn diuretic, nitroglycerin,quinine, salicylate,sedatives and hypno

Improve circulation to middle ear:

Bilberry, vinpocetine,ginkgo, pycnogenol, Vinco minor,capsicum, ginger,acupunture

Tinnitus causes Infx, | 

Antibiotics, head/neck trauma, menieres, noise, earwax, bp changes, metabolic changes, presbycusis, otosclerosis, autoimmune disease, neoplasms, genetics.

Vestibular neuritis and labyrinthitis both have peripheral vertigo characteristics. What makes them different?

VN: viral infection precedes. L: Infx is current, also has hearing loss. 

What PE is appropriate for perilymphatic fistula?

Insufflation and pressing on the tragus make sxs worse

PE for benign positional vertigo?

Dix hall pike induces brief upbeat nystagmus which fatigues | Suspect central if downbeat nystagmus that doesn't fatigue.

How specific is rinnes for conductive hearing loss?

Not. Very specific though

Red flags for stroke:

Older age, hx of cvd, sudden onset, asymmetrical smile or other neuro deficit, ataxia, downbeat or vertical nystagmus, worst headache ever

Vertigo definition:

Pt says room spins or that they have an internal sense of spinning 

Vestibular neuritis features:

- onset often viral Infx. - sudden severe vertigo/ imbalance with nausea and vomiting. Worse movement. Vertigo near constant - no hearing issues, no tinnitus. - resolves days to weeks

Labyrinthitis features:

- inflammatory disorder of inner ear. Disturbs balance AND hearing. Can be one or both sides - usually resolves in days to weeks, but may have bppv for months - nystagmus towards unaffected side, caloric test absent, head impulse pos, hearing loss of higher freq.

Cns/ stroke red flags

Hyper acute onset vertigo, occipital headache, gait ataxia | 

Benign Paroxysmal positional vertigo features:

- most common cz of recurrent vertigo. - brief episodes which mbdt head trauma/ dental surgery / etc - Dix hallpike causes upbeat nystagmus towards affected side - no hearing change. Triggered by change in position

Red flags for central positional vertigo

Hyper acute onset, stroke red flags, negative head impulse, focal neuro deficits, new onset headache, valsalva worsens

Menieres features

Episodic vertigo attacks with 1-3 hours in between. - sense of aural fullness - tinnitus and sensorineural hearing loss. - hypersensitive to loud noises - fhx, usu middle aged women.

How to dx menieres

Auditory brainstem response

What differentiates menieres from Tia

Tia has faster onset,episodes get worse, focal neuro deficit,stroke risk factors

What usually causes bilateral vestibular failure?

Aminoglycoside toxicity.