EENT Test 2 Flashcards
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
Why is the organ of corti and vestibular apparatus sensitive to anoxia and nutrient deprivation?
They have a very increased metabolic rate
Otosclerosis is what kind of hearing loss?
Conductive
Otosclerosis demographics
Onset in 20’s, familial tendency, more women than men, more whites
Otosclerosis general hx
Progressive hearing loss that preserves speech. Pt often soft spoken, may hear better in loud environment?
Otosclerosis PE/ Dx
Ct shows fused stapes/malleus
Otosclerosis audiology
Dip in bone conduction at 2000hz.
Tm may be pink and blue
Play audio for this term
Traumatic hearing loss is what kind of hearing loss? Conductive
Traumatic hearing loss hx
Rupture of Tm from increased pressure
Trauma hearing loss PE
On otoscopic exam, Tm is floppy.
Trauma tympanogram
Type ad (disrupted)
Inflammatory hearing loss is what kind of hearing loss?
Conductive
Inflammatory hearing loss PMHX
Om, pus and effusion, cholesteotoma
Inflammatory tympanogram type
Stiff- low impedence
Congenital hearing loss is what kind of hearing loss?
Sensorineural
Cause of congenital hearing loss
Genetic: usu fhx
Non genetic mbdt injury, disease (rubella)
Waadenburg syndrome sxs
Genetic hearing loss + white patch of hair.
Congenital hearing screen audiology:
Loud volumes resonate at 4k hz
Traumatic sensorineural hearing loss causes:
Head injury or noisy occupations such as farmers, construction, machinists, military, musician
Traumatic sensorineural hearing loss causes:
Head injury or noisy occupations such as farmers, construction, machinists, military, musician
Traumatic sensorineural hearing loss initial complaint:
Tinnitus. This is reversible until hairs on organ of corti are damaged beyond repair.
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
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.
