EENT TEST1 Flashcards
1
Q
The ossicles convert ___ energy into mechanical energy and amplify it, transferring it to the __ window of the cochlea
A
Sound energy
to the oval window
2
Q
The eustachian tube is opened by which muscle?
A
Tensor Veli Palatini
3
Q
Endolymph is found in the membranous labyrinth and has a high concentration of _____ and a lower concentration of ______.
A
Potassium
Sodium
Only place in body where this is found
4
Q
Which cranial nerve innervates the cochlea?
A
CN VIII
5
Q
Track the structures that convert sound energy into a nerve impulse.
A
Outer ear-Ear canal-TM-Ossicles-Cochlea-Endolymph- Organ of Corti-CN VIII- Temporal Lobe
6
Q
What is the name of the vascularization system that supplies blood to the inner ear?
A
stria vascularis
7
Q
The organ of corti is stimulated by the flow of _____ ions.
A
Potassium
8
Q
What is a Osteoma and what is it MC dt?
A
Exostoses the external auditory meatus Gradual narrowing of bony canal by bone that arises from canal walls (temporal bone),
Repeated cold water to the ear
9
Q
Homeopathic: Osteoma
A
Hekla Lava
10
Q
When is AOM worse?
A
Evening
11
Q
What is a sign in children, especially infants, that they might have AOM?
A
Anorexia and Insomnia
12
Q
A retracted TM with a yellow to amber color and fluid would suggest _____ rather than _____.
A
Otitis Media w/ Effusion rather than Acute Otitis Media
13
Q
What is a highly specific finding upon otoscopy with AOM?
A
Bulging TM
14
Q
What is a highly sensitive finding upon otoscopy with AOM?
A
Immobile TM
15
Q
An TM that is retracted with a history of allergies suggests…
A
OME
16
Q
In otitis media with effusion weber lateralizes to the _____ ear and Rinne with be _____>_____. What type of hearing loss is this?
A
Bad
BC>AC
conductive
17
Q
Complications: AOM (4)
A
Mastoiditis
Meningitis
Perforated TM
Cholesteatoma
18
Q
Which bacteria are associated with supperative complications?
A
P. aeruginosa
S. aureus
19
Q
S/sxs: Mostoiditis (5)
A
bulging in the canal protusion of the auricle red behind the ear TTP mastoid high fever
20
Q
Use ______, ____, or _____ to soften cerumen.
A
Debrox
calendula oil
olive oil
21
Q
Why should you not irrigate beans and grains to remove them from the ear canal?
A
They can swell
22
Q
Name some risk factors for OM. There are a lot.
A
cranial facial bone structure allergies dairy prone sleeping second hand smoke Race: eskimo, native american vit D deficiency < 18 months season weaning from breast milk beginning school or day care
23
Q
Supine bottle feeding with snuffles that causes aspiration in to the eustachian tubes is called…
A
Toynbee phenomena
24
Q
Tx failure in otitis externa correlates most with…
A
poor aural toilet
failing to fully clean the ear canal
25
Benefits of Abx in OM:
decrease mastoiditis
decrease meningitis
good tx for < 2yo with bilateral OM
26
The NNT to reduce pain with Abx.
20 pts (7%)
27
Risk of Abx use in OM.
increased rate of recurrence
| increased bacterial resistance
28
Infectious chondritis ____ the lobe and is usually unilateral, while relapsing polychondritis _____ the lobe and is usually bilateral
includes
| spares
29
Risk factors: otitis externa
change in pH from acid to alkaline
increased temp and humidity
mild trauma, frequent cleaning
30
Hx: otitis externa
swimming
trauma
dermatitis
q-tip abuse
31
Malignant otitis externa affects immunocompromised patients particularly...
those with DM, alcoholism, sever malnourishment
32
What may you see in the ear canal of Malignant OE?
granulation tissue
33
Complications: Malignant OE
osteopmyelitis, hearing loss, facial nerve paralysis, death.
34
Next steps: Suspected malignant OE in office.
Refer to ENT for MRI or CT
35
DDx: pain with NML otoscopic exam and no loss of hearing.
```
Referred Pain from:
MC-TMJ
molar
cervical spine pain
malignancies
```
36
Red flag pts with referred ear pain include
smokers
alcohol abuse
>50 yo
DM
37
Which Abx ear drop is indicated in tx of OE and perforated TM? Why?
Fluoroquinolone due to excellent coverage for Pseudomonas and lack of ototoxicity
38
Homeopathy: OE
Hepar sulph:
39
Most common bacteria found in AOM...
S. pneumonia
40
What do you look at when deciding if AOM sxs are an exacerbation of a chronic state or a true acute?
physical gernals. If it is a new PG then give an acute
41
Are Abx effective for OME?
Nope
42
What is a helpful way to take the history of a pt with dizziness during the interview?
Ask the pt to describe their sxs without using the term dizziness.
43
ddx of outer ear pain
```
Lichen simplex chronicus,
Seborrheic dermatitis,
Contact dermatitis,
Atopic dermatitis,
Acute Cellulitis or Erysipelas,
Infectious Chondritis,
Relapsing Polychondritis,
Trauma-Auricular Hematoma
```
44
name that condition:
Itch/scratch cycle continues after initial insult such as bug bite. Most commonly found in outer canal and concha. Treatment: education, cut nails, soothing lotion
Lichen Simplex Chronicus
45
name that condition:
| Scaly Erythema & lesions on scalp and eyebrows
Seborrheic Dermatitis
46
name that condition
| Irritants to ear, such as perfume and earrings (nickel)
Contact Dermatitis
47
```
name that condition:
Atopic Patient (eczema, asthma, hayfever). Look for lesion on flexion folds, ear canal. Can be confused with otitis externa, but is sterile, no WBC, not infected
```
Atopic Dermatitis
48
name that condition:
Secondary to another dermatitis or trauma. is a more superficial infection - small area that is red, hot usually caused by Group A β hemolytic streptococci (GABHS) less commonly by Staphylococcus aureus;
Cellulitis: is a deeper infection that spreads along facial planes and will involve the whole auricle. Patient will be sicker- fever, chills.
Erysipelas
Acute Cellulitis
49
name that condition:
Deeper infection involving cartilage usually follows erysipelas. Entire ear red, hot, including lobe. Also systemic symptoms: fever, nausea, chills.
infectious chondritis
50
What structures are in the labryinth
Vestibule
Cochlea
Stria Vascularis
51
Vestibule does what
Semi-circular canals: primarily for proprioception and balance
52
What structure is primarily for the conversion of sound energy into electrical energy. The vibrations from the ossicles set the endolymph into motion, which causes a flow of positive ions (K+), across the negatively charged hairs on the organ of Corti, causing a synapse to fire. This information is conveyed by the 8th cranial nerve to the auditory area of the temporal lobe where it is interpreted as sound.
Cochlea
53
Facts about Stria Vascularis
the inner ear has a unique vascular system. It is the only vascularized epithelium in the body. The cells of the stria vascularis are high in mitochondria. Function: acts as a back up "battery for the organ of Corti, helps to maintain endolymph. Its vascular supply provides nutrients to the organ of Corti while keeping the vessels at a distance minimizing the distraction of noise from blood flow
54
What is the Labyrinth?
The inner ear has a convoluted shape that is referred to as the Labyrinth. The bony labyrinth, which has a protective/structural function, covers the membranous labyrinth. The bony Labyrinth is filled with perilymph that is essentially extra cellular fluid (high in sodium and low in potassium). The membranous labyrinth is filled with endolymph, the only extra cellular fluid in the body high in potassium and low in sodium.
55
What is the eustachian tube? What is its function?
a tube lined with respiratory mucosa that communicates between the middle ear and the nasopharynx. Function: permits adjustments of pressure between the middle ear and the external environment, allows for drainage and protects the middle ear from nasopharyngeal secretions and pathogenic bacteria. Being normally closed, it is opened by active contraction of the tensor veli palantini during swallowing or yawning.
56
What are the three bony ossicles?
malleus, incus, stapes
57
what are the basic structures of the middle ear?
ossicles
58
what are the basic structures of the TM?
Pars flaccida, Lateral process of the Malleus, Vascular Strip, Pars tensa, Promentory, Umbo, Light Reflex.
59
What are the basic structures of the external ear
```
Helix
Anti-Helix
Concha
Lobe
Tragus
Anti Tragus
```
60
What is the function of the Bony labyrinth
protective/structural fxn, covers the membranous labyrinth & filled w/perilymph like ECF (↑Na & ↓K).
61
Membranous labyrinth
filled w/endolymph only ECF in body (↑K, ↓Na)
| Fxns
62
ASOM: Etiology+ Physical Exam findings
Bacterial "ear ache" 2⁰ to VRI
Allergy, ET dysfxn, etc
Middle ear fluid, TM red, loss of N landmarks, light reflex is smaller/distorted. mb fever, cervical LAD
otalgia, otorrhea, non-specific findings (fever, lethargy, irritability, anorexia, vomiting)
TM yellow, amber, Red,Buldging, Impaired Mobility
63
EOM Etiology + Physical Exam findings
no bacterial infx
m/c dt Allergies or VRI
Conductive hearing loss (Weber lateralizes to bad ear, Rinne BC > AC)
Usu painless, popping or gurgling sounds, plugged feeling; aural fullness
opaque; Retracted- tenting over short handle of malleus; little or no movement
flat
Abx don’t work
64
How does insufflation help you to diagnose acute and serous otitis media?
little or no movement of TM if Effusion or suppuration
65
How does Acoustic reflexometry help you to diagnose acute and serous otitis media?
acoustic reflex = contraction of stapedius mm elicited by an acoustically loud sound.
66
How does tympanometry help you to diagnose acute and serous otitis media?
measurement of reflected pressure on TM-> middle ear fxn. Impedance (sound) vs. pressure (-200 to +200)
67
Advantages of breast-feeding in preventing OM?
Gives baby Abs, PGs, & other immune stimulating cpds
Good feeding position for reducing ET blockage
Suckling develops face/nasophar mm
No dairy/soy formulas ↓allergens
68
A TM that is yellow, amber, Red,Buldging, Impaired Mobility is indicative of what?
AOM
69
Are Abx effective for OME?
NO only use them for ASOM
70
What is a helpful way to take the history of a pt with dizziness during the interview?
Ask patient to describe sx without the term dizziness
71
An internal sense of spinning could be called...
Vertigo
72
Most common cause of vertigo can be found in the _____ ____.
peripheral labyrinth
73
syncope or pre-syncope is usually due to
orthostasis or hypoglycemia
74
a pt with syncope or pre-syncope may complain of
dimming of the visual field and roaring in the ears, incoordination, confusion, pallor, and diaphoresis
75
With disequilibrium pts may describe their sxs as
"in their legs not their heads"
76
Lightheadedness is a waste basket term when no other dizziness sxs are present.
Yep
77
Important points on history for dizziness include...
Define the problem precisely, timing & frequency, medication history, provoking factors, which positions, movement, modalities, Recent or current URI. Problems with hearing or tinnitus, severity, and associated symptoms. ROS: Pay particular attention to cardiac, neurologic and otologic symptoms.
78
T/F: Lab testing is an effective way to dx the cause of vertigo.
False
79
Peripheral vertigo refers to dysfunction somewhere in the _____ or ____ ear.
Middle
| Inner
80
Peripheral vertigo: nystagmus is ______ and _____. ****
unidirectional
| horizontal
81
Central vertigo refers to dysfunction of the ____ ___ or _____
Where does it come from?
changeable, bi-directional, or vertical
Brainstem or cerebellum
82
In central vertigo you would expect N/V to be
less severe.
| Ask about neurologic symptoms
83
Favored sxs of central vertigo include...
weakness, dysarthria, vision changes, paresthesia, altered mental status, ataxia or other motor/sensory. Neurological Symptoms
84
Can you name the 16 provocatives tests for dizziness?
1. Gait Test
2. Orthostatic BP and pulses
3. Hyperventilation
4. Valsalva: Don't perform this test if Pt has CAD or other risk factors for stroke
6. Gaze Nystagmus:
7. Vestibular-ocular reflex (VOR) Head-Impulse (or head thrust) test -
8. Dix-Hallpike, Nylan-Barany maneuvers, or George's test:
9. Romberg Tests:
10. Past Pointing: (+ )
11. Fistula Test:
12. Hennebert’s sign:
13. Caloric Testing:
14. Neuro PE:
15. General exam:
85
What are the three bony ossicles?
malleus, incus, stapes
86
What is the eustachian tube? What is its function?
a tube lined with respiratory mucosa that communicates between the middle ear and the nasopharynx. Function: permits adjustments of pressure between the middle ear and the external environment, allows for drainage and protects the middle ear from nasopharyngeal secretions and pathogenic bacteria. Being normally closed, it is opened by active contraction of the tensor veli palantini during swallowing or yawning.
87
What is the Labyrinth?
The inner ear has a convoluted shape that is referred to as the Labyrinth. The bony labyrinth, which has a protective/structural function, covers the membranous labyrinth. The bony Labyrinth is filled with perilymph that is essentially extra cellular fluid (high in sodium and low in potassium). The membranous labyrinth is filled with endolymph, the only extra cellular fluid in the body high in potassium and low in sodium.
88
what structures are present in the labyrinth and what are their functions?
Vestibule - Semi-circular canals: primarily for proprioception and balance
• Cochlea - primarily for the conversion of sound energy into electrical energy. The vibrations from the ossicles set the endolymph into motion, which causes a flow of positive ions (K+), across the negatively charged hairs on the organ of Corti, causing a synapse to fire. This information is conveyed by the 8th cranial nerve to the auditory area of the temporal lobe where it is interpreted as sound.
• Stria vascularis - the inner ear has a unique vascular system. It is the only vascularized epithelium in the body. The cells of the stria vascularis are high in mitochondria. Function: acts as a back up "battery for the organ of Corti, helps to maintain endolymph. Its vascular supply provides nutrients to the organ of Corti while keeping the vessels at a distance minimizing the distraction of noise from blood flow
89
ddx of outer ear pain
```
Lichen simplex chronicus,
Seborrheic dermatitis,
Contact dermatitis,
Atopic dermatitis,
Acute Cellulitis or Erysipelas,
Infectious Chondritis,
Relapsing Polychondritis,
Trauma-Auricular Hematoma
```
90
Gait Test-
Observe gait, have pt turn corners; shuffling gait, w/ bradykinesia & wide based ataxic turns suggest Parkinson’s
91
Hyperventilation
ask pt to do deep & rapid breathing for 1-3 min. ask the pt what they felt. (+) = anxiety
92
Valsalva
expire forcefully for 10-15 sec. ↓venous return;
if czs pre-syncope = dizziness likely CVS not vestibular. Potentiated Valsalva starts w/ squatting for 30 sec. Don't perform this test if Pt has CAD or other risk factors for stroke
93
With Spontaneous Nystagmus what do you use to magnify and prevent visual fixation
Frenzel Lens (+ 20 diopters)
94
Gaze Nystagmus
Hold eccentric gaze (pt looking off to side at your finger) for 20 sec in horiz& vertical planes.
Jerk nystagmus in the direction of gaze or downbeat nystagmus suggest a Central vertigo.
95
Vestibular Ocular Reflex
1. Head-Impulse (or head thrust) test - highly sensitive/specific test of VOR. Thrust pts head 20-30 degrees while pt fixates on a pt. N = no loss of fixation. If peripheral vertigo pt has “catch-up” saccade to re-fixate on the target when thrust is in the direction of lesion. ** most useful test to DDX peripheral & central vertigo
96
Head Shake Test
Shake head for 20 sec at 2 shakes/sec w/ eyes closed. The inspect eyes for nystagmus. N= no nystagmus
U/L & horiz nystagmus = peripheral vertigo. Vertical nystagmus ~ central vertigo.
97
Dix-Hallpike, Nylan Barany maneuvers, or George's test:
Observe pt at rest, test extraocular motions, rotate & extend head, lay pt down & hold position for 30 sec or pt tolerance. Note intensity, latency & fatigue of nystagmus.
(+) = positional veritgos
98
Romberg
standing feet together eyes closed – can they maintain balance? (+) w/ eyes open = cerebellar d/o; (+)w/ eyes closed = peripheral neuropathy or vestibular d/o
99
Past Pointing
(+)) Dysmetria or dysdiadoochkinesia = cerebellar lesion.
If vestibular d/o, pt will veer toward affected side when eyes closed (Also do heel to shin test & check gait)
100
Fistula Test
Insufflation, if opening (perilymphatic fistula) btn TM & vestibular apparatus, Δ in aural pressure will cz sx & or nystagmus
101
Henneberts Sign
Vertigo after pushing on tragus & external auditory meatus on affected side. (+) = perilymphatic fistula.
102
Caloric Testing
1. Pt sitting back at 30º & ice cold water is instilled into ears. N = ↓ circulation czs dizziness & nystagmus unidirectional (fast component away from labyrinth being tested & slowly back) dt hypo fxning of vestibular apparatus
If peripheral lesion = ice water on damaged side does not cz nystagmus or effect spontaneous nystagmus
Also (-) for central vertigo
103
Neuro PE
Assess CNs, motor strength, speech & coordination. Look for focal neuro signs, particularly involving brainstem or cerebellum.
104
General Exam
Thorough otologic, hearing exams. Look for evidence if ASOM, OME, choleteatoma, Ramasay-hunt syndr. If stroke is considered, perform a careful CV exam (i.e. atrial fibrillation, bruits, HTN)
105
hypovolemia
Drop in systolic BP of 15-20 mm hg & increased pulse rate (10 bpm) =
106
autonomic dysfunction
Drop in systolic BP of 15-20 mm hg & low pulse rate =
107
Multiple Sensory Defect
in geriatric patients, due to decreased functioning of multiple systems such as: diminished eyesight, poor proprioception and muscle weakness.
Increased risk for falls
108
What direction is the Nystagmus in peripheral vertigo
Unidirectional
109
What direction is the Nystagmus in central vertigo
bidirectional
110
What plane is the nystagmus in, in central vertigo
Central = Down beat, torsional or true vertical nystagmus (vertical usu vestibular nuclei or cerebellar lesions)
111
What plane is the nystagmus in peripheral vertigo
Peripheral = usu horizontal w/ slow phase beating in direction of defunct labyrinth
Their eyes will move with the head and then “catch up to the other side”
112
What is a Key sign of peripheral vertigo
Nystagmus that can be suppressed by visual fixation is a key sign of peripheral vertigo
113
Jerk nystagmus in the direction of gaze or downbeat nystagmus suggest what?
a Central vertigo.
114
What finding in vestibular ocular reflex is indicative of peripheral vertigo
peripheral vertigo, you will perceive a “catch-up” saccade to re-fixate on the target (your nose) when thrust is in the direction of the lesion.
115
Headshake Test sign of peripheral vertigo
A unilateral nystagmus in the horizontal plane indicates a peripheral vertigo.
116
Headshake test sign of central vertigo
A vertical nystagmus suggests a central vertigo.
117
Romberg and Sharpened Rhomberg Tests: if positive with eyes open what would you suspect?
suspect cerebellar disorder.
118
Romberg and Sharpened Rhomberg Tests: if positive with eyes closed what would you suspect?
If positive with eyes closed, suspect peripheral neuropathy or vestibular disorder.
