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Clinical Medicine > ENT I > Flashcards

ENT I Flashcards

1
Q

what occurs if there’s a mismatch of the bilateral labyrinth system?

A

vertigo

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2
Q

semicircular canals - what are they and types?

A

Organ for body movement

-posterior semicircular canal, lateral, superior

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3
Q

posterior semicircular canal detects what?

A

when head tilts down towards shoulder

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4
Q

lateral semicircular canal detects what?

A

when head shakes side to side, “no”

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5
Q

superior semicircular canal detects what?

A

when head nods up and down, “yes”

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6
Q

organ for hearing?

A

cochlea

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7
Q

what do otolith organs sense? names?

A

gravity and linear acceleration
-motion according to their orientation

names: utricle and saccule

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8
Q

utricle

A

otolith organ

  • horizontal in head
  • registers acceleration in horizontal plane
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9
Q

saccule

A

otolith organ

  • vertical in head
  • registers acceleration in vertical plane
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10
Q

what is CN VIII responsible for?

A

vestibulocochlear nerve

-responsible for balance and orientation in space and auditory function

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11
Q

where does the Eustachian tube run?

A

anterior wall of middle ear to open in nasopharynx

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12
Q

what ends are wider in Eustachian tube?

A

nasopharyngeal and tympanic ends are wider than middle of the tube

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13
Q

what is narrowest protein of ET tube?

A

bony isthmus

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14
Q

when is the ET tube open and closed?

A

normally closed

-only open during swallowing and yawning

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15
Q

what is ET tube most important normal function?

A

equalization of pressure across tympanic membrane

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16
Q

types of ET tube dysfunction (HINT: 2)

A

dilatory and patulous

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17
Q

what is dilatory ET tube dysfunction?

A

-cartilage portion of tube doesn’t dilate

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18
Q

causes of dilatory ET tube dysfunction?

A
  • inflammation
  • pressure dysregulation
  • acquired anatomic abnormalities
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19
Q

what is patulous ET tube dysfunction?

A

valve incompetency -> chronic patency

-STUCK OPEN

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20
Q

dilatory ET tube dysfunction HALLMARK presentation

A

accompanying symptoms of hearing loss and abnormalities of the tympanic membrane

  • retraction
  • middle ear effusion
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21
Q

what will you see on otoscope exam for dilatory ET tube dysfunction?

A
  • effusion
  • scarring
  • thickening of TM (if chronic)
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22
Q

what might TM have on dilatory ET tube dysfxn?

A
  • retractions
  • effusion
  • cholesteatomas
  • perforations
  • plaques
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23
Q

patulous ET tube dysfxn HALLMARK presentation

A

autophony (pt hears own voice amplified) & ear fullness

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24
Q

what is patulous ET tube dysfxn worsened by?

A

exercise and prolonged speaking

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25
Q

PE findings for patulous ET tube dysfxn?

A

breathing induced excursions (movements) of TM and sensorineural hearing loss

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26
Q

what will weber test reveal for dilatory ET tube dysfxn?

A

lateralization to affected ear -> conductive hearing loss

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27
Q

what are the differences in types of hearing loss for patulous and dilatory ET tube dysfxn?

A

patulous -> sensorineural

dilatory -> conductive

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28
Q

treatment of dilatory ET tube dysfunction?

A

treat underlying etiology

  • antihistamines
  • decongestants (Zyrtec)
  • nasal steroids
  • vaslsalva
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29
Q

treatment of patulous ET tube dysfxn?

A
  • treat if severe symptoms >6 weeks
  • ventilation tubes in severe cases (equalize pressure)
  • hydration and mucous thickening agent
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30
Q

what do you do for both patulous and dilatory ET tube dysfunction?

A

REFER TO ENT

  • nasal endoscopy
  • CT or MRI w/contrast if >3 months of unilateral sx’s or middle ear effusion
  • surgery if mass found
  • balloon dilation
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31
Q

is vertigo a symptom or diagnosis?

A

SYMPTOM

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32
Q

what are the key to diagnosis of vertigo?

A

duration of episodes and association with hearing loss

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33
Q

what is affected in peripheral vertigo?

A

semicircular canals, otolith organs

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34
Q

what is affected in central vertigo?

A

cerebellum, CN VIII, brainstem

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35
Q

what is the balance center of the brain?

A

cerebellum

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36
Q

why does vertigo occur?

A

damage to CNS integrate sensory input and asymmetrical signal is sent

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37
Q

causes of peripheral vertigo

A
  • Benign paroxysmal positional vertigo
  • Vestibular neuritis (AKA labrythitis)
  • Meniere’s Disease
  • Herpes zoster oticus
  • Acoustic neuroma
  • Aminoglycoside toxicity
  • Superior semicircular dehiscence syndrome
38
Q

causes of central vertigo

A
  • Migraines
  • Cerebral tumor on VIII
  • Chiari Malformation
  • Brain ischemia (cerebellar infarct) - Ie. Vertebrobasilar stroke
  • TIA
  • MS
39
Q

clinical presentation of peripheral vertigo

A
  • sudden onset
  • tinnitus & hearing loss
  • +/- nystagmus
40
Q

clinical presentation of central vertigo

A

gradual onset, no auditory symptoms like in peripheral vertigo

41
Q

what is the most common cause of vertigo?

A

benign paroxysmal positional vertigo (~50%)

42
Q

what is benign paroxysmal positional vertigo provoked by?

A

head movements like turning in bed, tilting head backward to look up

43
Q

what is benign paroxysmal positional vertigo caused by?

A

calcium debris in semicircular canal (posterior canal most common)
-aka Canalithiasis

44
Q

clinical presentation of benign paroxysmal positional vertigo

A
  • rapid onset of dizziness or spinning (vertigo) that lasts seconds to minutes
  • nystagmus (classic is clockwise)
  • sensation of motion with sudden head movements
  • NO ear pain, hearing loss, tinnitus
45
Q

dx of benign paroxysmal positional vertigo

A

Dix-hallpike positional testing

  • Clockwise, rotary nystagmus – fatigable with repetition
  • Latency of 5-15 seconds between supine position and onset of nystagmus
  • Induced the vertigo and nystagmus
46
Q

further testing for benign paroxysmal positional vertigo (if needed)

A
  • electronystagmogaphy (records eye movements)
  • MRI/CT to r/o CVA or bleed

MRI COMES BEFORE CT

47
Q

txt of benign paroxysmal positional vertigo

A

-txt is symptomatic b/c resolves w/in months

48
Q

what is first line txt for benign paroxysmal positional vertigo?

A

antihistamines

49
Q

after antihistamines, what do you use to treat benign paroxysmal positional vertigo?

A
  • antiemetics, Benno’s, scopolamine
  • vestibular rehab
  • surgery (only after 6 months)
50
Q

vestibular rehab for benign paroxysmal positional vertigo

A
  • epley maneuver to shift stone around - 3 different positions
  • also do gaze stimulation exercises
51
Q

vestibular neuritis (aka labrynthitis)

A

viral or post-viral inflammatory disorder affecting vestibular portion of CN VIII
-benign and self-limited

52
Q

vestibular neuritis vs labrynthitis

A

vestibular neuritis: vertigo w/out hearing loss

labrynthitis: vertigo w/unilateral hearing loss on affected side

53
Q

symptoms of vestibular neuritis (aka labrynthitis)

A
  • Rapid onset of severe, persistent vertigo
  • Gait instability
  • Decreased hearing in 1 ear for labrynthitis
  • Horizontal nystagmus
  • Positive head thrust
  • Nystagmus is suppressed with visual fixation
  • If patient falls it is toward the affected side
  • +/- unilateral hearing loss
54
Q

imaging for vestibular neuritis (aka labrynthitis)

A

MRI/MRA for infarct
-MRA looks at blood vessels

CT if MRI/MRA not available

55
Q

when would you do imaging for vestibular neuritis (aka labrynthitis)?

A

if concern for lesion or stroke in cerebellum causing symptoms

56
Q

txt of vestibular neuritis (aka labrynthitis)

A

-steroid therapy (may improve recovery)
-antihistamines, antiemetics
, vestibular rehab

57
Q

prognosis of vestibular neuritis (aka labrynthitis)

A
  • self-limiting
  • few days-week
  • may have nonspecific dizziness and imbalance for months
58
Q

when would you do vestibular rehab for vestibular neuritis (aka labrynthitis)?

A

After acute symptoms subside with aggressive proprioception and balance exercises

59
Q

Meniere’s disease

A
  • Peripheral vestibular disorder attributed to excess endolymphatic fluid pressure
  • Causes episodic inner ear dysfunction
60
Q

what is affected in Meniere’s disease?

A

Labyrinth/inner ear

  • Cochlea
  • Semicircular canals
  • Otolithic organs
61
Q

Risks of Meniere’s disease

A

allergy, stress, viral

62
Q

Meniere’s clinical presentation

A
  • vertigo
  • unilateral sensorineural hearing loss
  • unilateral tinnitus
  • ear fullness
  • disabling imbalance
  • horizontal-torsional nystagmus in acute attack
63
Q

unpredictable episodes of Meniere’s last how long and followed by what?

A

may last hours, recurring, followed by fatigue

64
Q

spontaneous episodes of Meniere’s disease last how long?

A

20min-24 hours

65
Q

imaging for Meniere’s

A

audiometry - positive low frequency sensorineural hearing loss

electronystagmography - pos unilateral reduced vestibular response

caloric testing - shows loss/impairment of thermally induced nystagmus on affected side

66
Q

is there a specific Meniere’s test?

A

NO!

67
Q

txt for Meniere’s does what/

A

relief of symptoms but doesn’t address underlying pathology

68
Q

goals of txt for Meniere’s?

A
  • Reduce frequency and severity of vertigo attacks
  • Reduce or eliminate hearing loss and tinnitus associated with attacks
  • Minimize disability
  • Prevent disease progression (mostly hearing loss and imbalance)
69
Q

txt for acute symptoms of Meniere’s

A
  • Antihistamines
  • Antiemetics
  • Benzodiazepines
  • Anticholinergics (Scolpolamine)
70
Q

long-term txt for Meniere’s

A
  • Lifestyle adjustments
  • Salt restriction
  • Limit caffeine and nicotine
  • Limit alcohol
  • If tinnitus, avoid excessive noise
71
Q

non-destructive txt procedures for Meniere’s

A

Surgical: On endolympathic sac and succolotomy
-Can cut a hole in the top and let excess fluid drain out

  • Intratympanic steroids
  • Positive pressure pulse generator
72
Q

destructive txt procedures for Meniere’s

A

Intratympanic gentamicin injection (Kills everything)

Surgical laburinthectomy
(Deafness in that ear results)

Vestibular nerve resection
(Cut vestibular portion of CN VIII)

73
Q

semicircular canal dehiscence syndrome

A

Thinning of the bone that separates the superior semicircular canal from middle cranial fossa
-Allows pressure to be transmitted into inner ear

74
Q

how is vertigo provoked in semicircular canal dehiscence syndrome?

A

coughing, sneezing, valsalva, loud sounds (Tullio phenomenon)

75
Q

what establishes dx for semicircular canal dehiscence syndrome?

A

high resolution Ct of the temporal bone

76
Q

tinnitus epidemiology

A
  • children
  • increases w/age
  • men>women
  • smokers
77
Q

will chronic tinnitus remit completely

A

no, but often becomes less bothersome over time

78
Q

types of tinnitus (HINT: 2)

A

pulsatile, non-pulsatile

79
Q

pulsatile tinnitus sounds like and seen it what disorders?

A
  • Like listening to own heartbeat
  • Vascular disorders
  • Arteriovenous shunts
  • Venous hums
  • Eustachian tube dysfunction
  • Arterial bruits (worse in quiet environment)
80
Q

non-pulsatile tinnitus

A
  • Clicking tinnitus (secondary to middle ear spasm)

- Unilateral

81
Q

causes of tinnitus

A
  • ototoxic meds
  • presbycusis
  • otosclerosis
  • chiari malformations
82
Q

how do ototoxic meds cause tinnitus?

A

Affects various components of the cochleovestibular end-organ

83
Q

presbycusis and tinnitus

A
  • Sensorineural hearing loss with aging

- Any acquired high frequency loss commonly associated with tinnitus

84
Q

otosclerosis and tinnitus

A

Condition of abnormal bone repair of the stapes footplate bone

85
Q

chiari malformations and tinnitus

A

Occurs when low lying cerebellar tonsils cause tension on the auditory nerve

86
Q

history for diagnosing tinnitus

A
  • get description of tinnitus
  • ask about previous ear disease, noise exposure, hearing status, head injury, symptoms suggestive of TMJ
  • review all meds and supplements
  • review medical conditions
  • ask if difficulty hearing or hearing loss
87
Q

medical conditions associated with tinnitus

A

HTN, atherosclerosis, neurologic illness, prior surgery

88
Q

physical exam for tinnitus

A
  • Complete HEENT
  • Cranial nerve exam
  • Evaluate tympanic membrane
  • Auscultate the neck, periauricular area, temple, orbit, mastoid
  • Effects of positioning on vascular compression of the neck on side involved should be noted
89
Q

what to avoid with tinnitus?

A

excessive noice and ototoxic and other drugs that damage cochlea

90
Q

txt for tinnitus

A

-Correct identified comorbidities and mitigate their effect of tinnitus
-Treat underlying depression and insomnia
-Cochlear implants in cases of severe sensorineural hearing loss
-Tinnitus retraining therapy
Bio-feedback cognitive therapy as adjunct

Clinical Medicine (11 decks)

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