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Medical Audiology > Final Exam > Flashcards

Final Exam Flashcards

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USMLE® Step 1 flashcards
1
Q

Cholesteatoma

A

Abnormal skin growth behind TM. A cyst that arises from the pars flaccida. can expand into and beyond ME space

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2
Q

How does a cholesteatoma form?

A

in response to repeated infection or trauma, sometimes present at birth. Neg ME pressure causes a perforation or weak spot and skin grows in response which causes a pocket

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3
Q

Tx for cholesteatoma

A

course of antibiotics to reduce any current infection, surgery to remove is final Tx

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4
Q

Tuning Fork Difference Test

A
  • comparison of AC BTW ears
  • tells which ear is most sensitive to that Hz
  • TF held alternatively BTW ears
  • helpful to determine better ear
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5
Q

Weber Test

A

TF placed on center of forehead, midline of skull, nose, chin or upper teeth
- ask Pt where they hear the sound

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6
Q

Rinne Test

A

comparison of TF loudness on mastoid or next to ear

- ask which is louder?

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7
Q

Positive Rinne

A

AC > BC (NH or SNHL)

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8
Q

Negative Rinne

A

AC < BC (CHL)

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9
Q

Equivocal Rinne

A

AC = BC

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10
Q

Rinne Test Interpretation

A

negative rinne = 25 dB CHL

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11
Q

Problems with tuning fork tests

A 
experience:
- poor tech
- improper interpretation 
limitation of fork: 
- test at freq used only
- incorrect interpretation w/ limited results
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12
Q

Sites of possible ossicular discontinuity

A
  • incudo-stapedial joint- most common
  • separation of the incudo-malleal joint
  • dislocation of the incus
  • dislocation of the stapes from the oval window
  • fracture of the stapes
  • fracture of the malleus or incus- common
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13
Q

Etiology of ossicular discontinuity

A
  • blunt head trauma
  • longitudinal temporal bone fracture
  • barotrauma
  • penetrating trauma
  • chronic otitis media
  • chronic OM with cholesteatoma
  • congenital malformation
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14
Q

Effects of ossicular discontinuity on hearing

A
  • mild- mod severe CHL
  • depends on severity of disartic
  • if CHL > 40 dB, suspect disartic
  • large ABG @ high Hz, suspect disartic
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15
Q

Tx for ossicular discontinuity

A
  • partial or total ossicular replacement prostheses (PORP/TORP)
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16
Q

Causes of ossicular discontinuity surgery failure

A
  • on going ME abnormalities
  • recurrent cholesteatoma
  • recurrent OM
  • formation of granulation tissue or adhesions
  • extrusion or absorption of the presthesis and bony anklyosis of prosthesis
  • iatrogenic
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17
Q

Myringoplasty

A

reconstruction of a perforation of TM

- patching of perf that does not reach margin

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18
Q

tympanoplasty

A

reconstruction of the TM, also includes addressing ME pathology

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19
Q

Indications for tympanoplasty

A
  • CHL due to TM perf or ossicular dysfx
  • chronic or recurrent OM secondary to contamination
  • progressive HL due to chronic ME pathology
  • perf or HL persistent > 3 mos. due to trauma, infection, surgery
  • inability to bathe or participate in water sports safely
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20
Q

Goals of tympanoplasty

A
  • establish an intact TM
  • eradicate ME disease and create an air-containing ME space
  • restore hearing by building a secure connection BTW the eardrum and the cochlea
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21
Q

Tympanoplasty techniques

A
  • overlay technique- lateral grafting, post-aurical approach

- underlay technique- medial grafting, canal approach

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22
Q

Type I tympanoplasty

A

TM is grafted to an intact ossicular chain

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23
Q

Type II tympanoplasty

A
  • malleus is partially eroded

- TM +/- malleus remnant is grafted to incus

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24
Q

Type III tympanoplasty

A
  • malleus and incus are eroded

- TM is grafted to the stapes superstructure

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25
Q

Type IV tympanoplasty

A
  • stapes superstructure is eroded but food plate is mobile

- TM is grafted to a mobile foot plate

26
Q

Type V tympanoplasty

A

TM is grafted to a fenestration in the horizontal SCC

27
Q

tympanoplasty prognostic indicators

A
  • status of ME
  • presence of handle of malleus
  • perf > 50%
28
Q

Otosclerosis

A
  • bony changes that occur are usually a combination of resorption and remodeling of the otic capsule bone
  • abnormal new bone tissue is formed, starting soft and possibly becoming hardened or sclerotic
  • first stage of otosclerosis is also known as otospongiosis
  • later stage- bone growth hardens
  • can occur anywhere in the otic capsule but most commonly the stapes footplate
29
Q

symptoms of otosclerosis

A
  • gradually progressive HL
  • tinnitus in 50-60% of patients
  • often bilateral
  • sometimes vestibular involvement
  • schwartz sign- red blush hue behind the TM due to vascularity of otospongiosis
30
Q

Etiology of otosclerosis

A
  • not fully understood
  • hereditary
  • endocrine, biochemical, metabolic, vascular
  • pregnancy- hormonal
31
Q

clinical otosclerosis

A

involving fixation of stapes footplate

32
Q

histological otosclerosis

A
  • involving portion of otic capsule NOT stapes footplate- remains freely mobile
33
Q

Otosclerosis Audiogram

A
  • initially flat or rising CHL
  • mass component- high freq HL
  • max CHL- 60-65 dB
  • Carhart’s Notch
  • bilat, progressive CHL
  • word rec normal
  • can spread to cochlea and cause SNHL or mixed
34
Q

diagnosis of otosclerosis

A
  • audio
  • impedance mismatch
  • family Hx
  • tinnitus
  • imbalance/vertigo
  • CT scan
  • schwartz sign
35
Q

Tx for otosclerosis

A
  • monitoring
  • amplification
  • diet- reduce caffeine, alcohol, salt
  • medical- sodium fluoride, vit D
  • surgery- stapes mobilization, stapedectomy
36
Q

osteoma

A
  • small tumor of new bone growth that is unilateral and singular
  • commonly found at the junction of the cartilaginous and bony portion of the EAC
37
Q

Exostosis

A
  • new bone growth in multiple and bilateral
  • arises from periosteum
  • removed by grinding
  • common among cold water swimmers
38
Q

Usher Syndrome

A

genetic disorder characterized by HL, RP, vestibular probs

39
Q

Retinitis Pigmentosa

A
  • deterioration of the sensory cells of the retina
  • rods deteriorate first
  • pattern: night blindness, blind spots, tunnel vision
40
Q

Type I Usher Syndrome

A
  • profound HL from birth
  • RP progresses early
  • vestibular areflexia
41
Q

Usher Syndrome Type II

A
  • sloping high Hz HL present at birth that does not progress
  • RP onset in adolescence
  • normal vestib Fx
42
Q

Usher Syndrome Type III

A
  • NH and sight at birth
  • progressive HL
  • mod HL by teens, severe-prof by middle age
  • RP begins in teenage yrs
  • progressive loss of vestib Fx
43
Q

Genetics of Usher Syndrome

A
  • autosomal recessive pattern

- genes encode protein that make up cilia

44
Q

Management of Usher Syndrome

A
  • early Dx important
  • CI
  • mobility/balance training
  • Tx RP
  • genetic testing
45
Q

Acoustic Neuroma

A
  • benign slow growing tumors

- assoc. with neurofibromatosis

46
Q

Symptoms of AN

A
  • HL- most frequent initial symptom, asymmetric, high Hz, decreased speech discrim
  • vertigo
  • dysequilibrium
  • tinnitus
  • headache
  • nystagmus
47
Q

Diagnosis of AN

A
  • history and physical exam
  • audio
  • ABR
  • OAE
  • vestib testing
  • MRI
48
Q

AN Tx Options

A
  • observation
  • surgery
  • radiotherapy
  • conventional
  • stereotactic
49
Q

4 types of presbycusis

A
  • sensory
  • neural
  • strial
  • cochlear conductive
50
Q

Sensory presbycusis

A
  • affecting haircells and supporting cells

- bilat, precipitous HFSNHL w/ excellent SDQ

51
Q

Neural presbycusis

A
  • loss of afferent neurons in cochlea

- same audio as sensory but SDQ poor

52
Q

Strial

A
  • due to atrophy of lateral wall of stria vascularis

- fairly flat SNHL with good SDQ

53
Q

cochlear conductive

A
  • metabolic

- possibly due to thickening of BM

54
Q

NIPTS

A
  • NIHL
  • HL caused by chronic exposure to noise over a long period of time
  • characteristic high frequency loss
  • c/o HL and tinnitus
55
Q

Acoustic Trauma

A
  • HL caused by a single, short latency exposure
  • sudden HL- greatest in ear facing towards noise
  • unique audio config
56
Q

Blast trauma

A
  • HL secondary to sudden explosive force

- from change in pressure

57
Q

otologic effects of blast injuries

A
  • ME- TM perf most common, occasional ossicular chain disruption
  • inner ear- may be damaged at pressures insufficient to rupture TM, initial SNHL
58
Q

auditory symptoms of blast trauma

A
  • HL - SNHL, CHL, mixed, bilat or uni, temporary threshold shift
  • tinnitus
  • TM rupture
  • vertigo
  • otalgia
  • bleeding from external canal
  • FB
59
Q

How are people exposed to solvents and heavy metals?

A
  • inhalation
  • getting on skin
  • spills
  • explosions
  • water contamination
  • consumption
60
Q

Symptoms of organic solvent exposure

A
  • disequilibrium
  • vision problems
  • HL
  • abnormal olfaction
  • neurologic
  • headaches
  • memory loss
  • mood swings
  • coordination difficulties
  • delayed reaction time
61
Q

solvent effects on inner ear

A
  • cochlear damage
  • supporting cells
  • OHCs
  • vestib damage
  • sensory cells
  • synergistic effect when mixed
62
Q

solvent effects on retrocochlear/central

A
  • VIII nerve damage

- cerebellum/brainstem damage

Medical Audiology (1 decks)

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