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AUDE 5410 Aud-Vestib Disorders > Final Exam Study Guide (Prev. Material) > Flashcards

Final Exam Study Guide (Prev. Material) Flashcards

1
Q

Failure of canalization
Associated w/ microtia & ME anomalies
-More common in males

A

congenital aural atresia

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2
Q

what is seen in herpes zoster oticus

A

aka ramsay hunt syndrome / shingles

painful rash in ear canal, concha or below/behind auricle
HL & vertigo w/ CN VIII n involvement

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3
Q

what is seen in cerumen impaction

A

-Tymps →volume < .2 = complete obstruction & flat tymp
→volume >.2 = hole somewhere and might get pure tones

-Pure tones→mild CHL (up to 30dB)

-Otalgia

-Vertigo/Dizziness

-Coughing→arnold’s reflex (branch of CN X in EAC)

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4
Q

what is seen in otitis externa

A

Severe pain →swelling due to edema that causes the pain

-CHL

-Whitish, watery otorrhea

-Acute swelling that can close canal

acute: bacterial, swimmers ear, pain
chronic: seborrheic dermatitis, itchy, watery, swelling causing stenosis

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5
Q

what is seen in collapsing canals

A

Normal tymps

-CHL present @ or worse in HF w/ supras

-Thresholds become better w/ inserts or soundfield

Problem for younger children→ cartilage is not fully developed

-Older adults → cartilage is deteriorating

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6
Q

what is seen in otomycosis

A

-HL or a wet feeling

-Blue-black, green, yellow or white colored

-Debris visible

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7
Q

what is seen in necrotizing external otitis

A

-Immunocompromised PT w/ ear pain

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8
Q

what is seen in exostosis

A

Pain/discomfort

-Tinnitus

-Associated OE

-If large enough, can cause CHL

Bony growth that starts unilateral but ends usually bilaterally

irregular and multiple

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9
Q

what is seen in osteomasas

A

same as exostosis
smooth and regular

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10
Q

what is seen in osteoradionecrosis (ORN)

A

-Ear fullness

-Otalgia

-Foul odor

-CHL/SNHL

-Bloody otorrhea

-Tinnitus

-Microscopy→debris & granulation tissue, yellowish colored bone

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11
Q

what can be seen in otitis media

A

-Otoscopy →pneumatic otoscopy*, discolered ™, partial/complete bulging or retracted, perf, discharge, fluid lines/bubbles

-Immittance→ flat type b w/ HV = perf, flat type b NV = effusion, negative type c pressure = ET dysfunction

-ARTs→ abn/abs, unilateral OM = only ispi of unaffected present, bilateral oM = ipsi & contra bilaterally abn/abs

-Pure tones→WNL, CHL, mixed, SNHL, can fluctuate, could have ABG

-Speech→ normal supra threshold test, srt/pta in agreement

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12
Q

what can be seen in cholesteatomas

A

-Presents w/ HL first

-Otoscopy→ normal or perf present

-Tymps→any type depending on size, location & what is damaged
No damage to ™ or ossicles = normal
ME stiffness = As
Ossicular disarticulation=Ad
™ perf/ME full = B w/ LV
™ perf/ME not full = B w/ HV

-Audio→ depends based on where it is & stage it is picked up (norma→ just perf no ODl, CHL→ ossicular disartic, mixed

can recur even after surgery

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13
Q

what can be seen in OTSC

A

Otoscopy→normal or schwarze sign (reddish glow)
Tymps→type A or AS, only ME condition w/ normal tymps

-ARTs→ abn in most due to reduced mobility of stapes

-Audio→early =normal/mild CHL w/ rising, middle =CHL/Mixed w/ rising or flat, late=flattening of rising CHL/Mixed
(CHL doesn’t exceed 60-65 dB
Max CHL)
BC→Carhart’s notch (poor @ 2 by 15-20dB & narrows ABG), also associated w/

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14
Q

D/D for OTSC

A

Meniere’s (vertigo, tinnitus, LF SNHL)
Osteogenesis imperfecta (blue sclera, noise notch, fragile bones, collagen gene)
SSCD (3rd window, LF CHL but ARTs normal)

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15
Q

Normal ARTs with CHL

A

SSCD not OTSC

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16
Q

What is seen in ossicular disarticulation

A

-Otoscopy→perf, bleeding, rarely normal canal or ™, ME filled w/ blood or CSF

-Immittance→ Ad, ARTs abn

-pure tones→acute/delayed CHL or mixed

-Vestib→ BPPV, perilymphatic fistula/leak

Ice cream cone sign is abnormal on CT

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17
Q

what are s/s of paragangliomas

A

-Otoscopy→red mass in ME
-Immittance→ As or B & pulsating w/ jagged edges
-Audio→CHL & sometimes mixed

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18
Q

what is a type a tymp

A

normal
intact tm
normal ME fxnw

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19
Q

what is a type Ad and when is it seen

A

high admittance

compliant system
ossicular disarticulation or loss of elastic fibers in TM

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20
Q

what is type As tymp and when would you see it

A

reduced admittance

stiff system from thick (scarred) tm or OTSC

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21
Q

what is type b tymp and when would you see it

A

reduced admittance/flat

ME fluid (OM)
TM perf
debris in EAC

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22
Q

when would you see type c tymp and what is it

A

intact TM w/ negative ME pressure
ETD
ME fluid

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23
Q

type b high volume

A

perf or pe tube

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24
Q

in type b tymp will you see any other parameters?

A

no because ™ is not moving in order to measure them
all you see is volume

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25
Q

type b low volume

A

obstruction - cerumen, debris, cholesteatoma

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26
Q

type b normal volume

A

fluid behind ear, cholesteatoma - something not allowing movement of ™ but volume is good

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27
Q

what if there is abn gradient/width

A

cannot include as jerger type

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28
Q

sensory portion of ART

A

afferent
VIII CN

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29
Q

interneurons of ARTs

A

ventral cochlear nucleus & SOC

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30
Q

motor portion of ART

A

efferent
CN VII

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31
Q

Acoustic reflexes are elicited between about

A

60 to 90 dB SL

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32
Q

what is SL in ARTs

A

is referenced to threshold level
if 1000 Hz is 30 dB you can elicit a reflex 60-90 above this and result is dB HL

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33
Q

Normal ARTs occur between ~ ______for pure tones

A

85 to 100 dB HL

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34
Q

Reflexes are above the level of cognitive control; they are involuntary/automatic

A

false
below

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35
Q

If the ART is measured on the same side to which a loud sound is presented, then it is

A

ipsi art

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36
Q

If the ART is measured on the opposite side to that to which the loud sound is presented, then it is

A

contra art

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37
Q

If tone is presented on the probe side, then it is

A

ispi

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38
Q

If tone is presented on the earphone side

A

contra

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39
Q

A normal ear should yield present ARTs from 500 to 2000 Hz at normal levels
4000 Hz, & occasionally 2000 Hz can normally be absent in older ears

A

true

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40
Q

how will a ME pathology affect art

A

even with 15 dB ABG can decrease intensity of signal going in

ART is abn/abs on same side and opposite equal to amount of ABG

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41
Q

a right-sided ME pathology will have

A

abnormal right ipsilateral and contralateral as well as left contralateral ARTs

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42
Q

what will bilateral ME pathology show in ARTs

A

all four ART patterns are abn

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43
Q

For a right cochlear pathology ARTs will show what

A

pattern of elevated/absent responses on the right side (both ipsilateral and contralateral) and present/normal responses on the left side (both ipsilateral and contralateral)

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44
Q

The signal will affect the ARTs once the cochlear hearing loss shows AC thresholds >

A

50 to 60 dB HL

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45
Q

ARTs occur for cochlear loss

A

at lower SLs (30 to 40 dB SL)

probably due to recruitment, a hallmark of cochlear impairment

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46
Q

R Cochlear path
AC thresholds below 50 to 60 dB HL; reflexes at lower SLs

A

all normal

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47
Q

R Cochlear path
AC thresholds above 50 to 60 dB HL

A

R ipsi & contra abn
L both normal

48
Q

R Cochlear path
Bilateral Cochlear pathology – AC thresholds above 60 dB HL

A

all abn

49
Q

Elevated/absent ARTs, which do not agree with the cochlear hearing loss are cause for suspicion of

A

retrocochlear pathology

50
Q

where is reflex decay done

A

contralateral at 500 & 1000 Hz because this is the most sensitive for vestib schwannomas

51
Q

what will ARTs show for CN VIII pathology

A

he side affected (wherever stimuli is delivered) will show abnormal ARTs, like a cochlear loss, only the ARTs will be abnormal at lower thresholds (sound effect)

52
Q

what would a R CN VIII path show for ART

A

right ipsi and r contra are abn
L are normal

53
Q

What is congenital aural atresia? What is a condition associated with it? What is the FDA approved device for it and at what age?

A

failure of canalization results in this
associated with microtia & ME anomalies
spontaneous, can occur with Treacher collins, trisomy 22, crouzon’s & hemifacial microsomia
FDA approves surgical BAHA for kids with bilateral or unilateral atresia after 5 yrs old
under 5 can use BC HA coupled to soft/hard headband

54
Q

Man with bilateral mixed HL from 500-4000 in the high frequencies. What could be the cause?

A

Collapsing canals

55
Q

What is the external canal condition caused by radiation to the head and neck?

A

ORN

56
Q

what are the signs of impacted cerumen?
Mild CHL
tymps <.02 ml
Coughing
Dizziness

A

all

57
Q

What is not the sign of impacted cerumen?
Otalgia
Tymps >.03 ml?
Complaints of fullness
Mild CHL
Dizziness

A

Tymps >.03 ml?

58
Q

List 2 surgical complications of otosclerosis & discuss one of them

A

OTSC surgery can result in a perilymphatic fistula and a decrease in WRS. Regarding PLF, if implanted prosthesis gets misplaced after surgery it can puncture a hole into the inner ear space allowing perilymph to escape into the ME cavity
Another complication is

59
Q

Cholesteatomas are pseudotumors. Justify this. What are tymps findings of one that caused ossicular chain disarticulation? What is preferred treatment.

A

they are this because they are not considered tumors but they have same mannerisms like bone erosion, growth, and vasculature. They will take over and invade all structures that they contact, similarly to a tumor. In the R ear, tymps would show a type Ad with high static admittance. Surgery is the preferred treatment and antibiotics can be given beforehand to reduce inflammation and bleeding for surgery.

60
Q

What demographic group is most prone to otosclerosis

A

white women bw 20-40 yrs

61
Q

What is correct for ossicular disarticulation?
only caused by temporal bone fractures
typically self correcting condition
hemotympanum is never reported with this
can be caused by a single exposure to very high intensity sound

ARTs are normal if tympanic membrane is intact

A

can be caused by a single exposure to very high intensity sound

62
Q

Otosclerosis is a focal disease of

A

otic capsule

63
Q

SSCD is differential diagnosis for otosclerosis. Clinically, they are differentiated by

A

normal ARTs

64
Q

Jerger type Ad can be clinical finding in which disorders

A

ossicular disarticulation

65
Q

Jerger type b HV can be clinical finding in which disorders

A

cholesteatoma

66
Q

Glomus jugulare tumor can present with

A

unilateral CHL
unilateral mixed HL
tymp with jagged edges corresponding to PT pulse
intact but inflamed looking ™

67
Q

FN weakness/paralysis potential complication for what conditions

A

glomus tympanicum
chronic suppurative OM
cholesteatoma
gunshot wound to temporal bone

68
Q

what is a contraindication for surgery for OTSC

A

OTSC involvement of endolymphatic duct with meniere’s disease like s/s

69
Q

which infectious disease affect mother that results in congenital HL in fetus

A

CMV infection
rubella (german measles)
AIDS

70
Q

17 yr old female has chronic bilateral OM since 6 mos old. Has had plenty of PE tubes but none for the last 3 years. Has significant allergies and frequency neg ME pressure (type c) bilaterally. Last ME infection was reported 3 yrs ago. She noticed hearing in right ear is worse for the last year. Copious foul smelling discharge noted on otoscopy in R ear. Pure tones show mild - moderate CHL in R and normal in L. Type b HV in R and type A tymp in left.

She most likely developed which condition due to chronic OM and/or negative ME pressure in R ear

what is the best treatment for this?

A

cholesteatoma

surgery

71
Q

incorrect for glomus tumors

can arise from paraganglia cells on dome of internal jugular vein, arnold & jacobsons

glomus tympanicum can commonly grow to large size and cause hoarseness and dysphagia

several genes are associated with thee but most are sporadic

involvement of XII N indicates extensive growth of jugulare tumor

A

glomus tympanicum can commonly grow to large size and cause hoarseness and dysphagi

72
Q

causes profound permanent SNHL visual problems and neurological and motor deficits in affected babies

A

CMV

73
Q

HL secondary to ____ can result in cochlear ossification

A

meningitis

74
Q

an incudomalleolar disarticulation appears as an ______ sign on CT scans

A

broken ice cream cone

75
Q

one pathology/condition that could result in tymp with type b high ECV?

A

cholesteatoma

76
Q

what do we see with rubella virus

A

german measles

Congenital HL cataracts, cardiovascular cataracts, possibly ID

77
Q

what do we see with CMV

A

Progressive & profound SNHL by age 3-5 (CI candidates)

-Decreased life expectancy, larger spleen & liver, “blueberry muffin” rash, & decreased immunity

Neurological deficits, blindness, ID, cardiovascular problems

78
Q

what do we see with AIDS

A

n all cases of sudden bilateral or unilateral HL→populations at risk should be considered for HIV

-OME, otalgia, vertigo, tinnitus, fullness, reduced OAEs, delayed ABR interwaves (from HIV or the drugs), recurrent/chronic OME

79
Q

what do we see with meningitis

A

high fever, stiff neck, malaise, nausea, vomiting

-Untreated→ blindness, paralysis, HL/deafness (acquired SNHL) & vertigo

80
Q

what do we see with perilymphatic fistual

A

Vertigo w/out HL
-HL w/out vertigo
-Symptoms not determined from Meneries (SNHL, vertigo, tinnitus, aural fullness)

-Audio: presentation of complex symptoms→ case hx, symptoms they present with; dix hallpike to see nystagmus

81
Q

Which nerve is involved in eye movements assessed during vestibular testing?

A

CN III - Occulomotor

82
Q

Which branch of the FN innervates the outer ⅔ of the tongue & can be sacrificed during ME surgery such as removal of cholesteatoma?

A

chorda tympani

83
Q

a left FN schwannoma will show an abnormal left ispilateral response and an abnormal _____ contralateral response

A

right

84
Q

what do we see in NIHL

A

Both TTS & PTS accompanied by tinnitus

-symmetrical

-profound SNHL is rare

-LF thresholds better than 40 dB HF thresholds rarely better than 75 dB

-Presbycusis can flatten noise notch

-Noise notch noted from 3-4 sometimes 6 kHz

85
Q

what do we see in acoustic trauma

A

-Otoscopy→TM perf or hemorrhage

-Audio→ similar to NIHL, noise notch at 3-6, HF sloping or flat (more common) configuration, mixed HL (OD)

-Tymps→Ad w/ OD

-ART→abs w/ OD

™ perf, OD, tinnitus, otalgia, HL and/or vertigo

86
Q

Osteopetrosis (bony dysplasia) is a disorder of aging that results in hardening of the cranial bones

A

false

87
Q

______ syndrome is a rare congenital disorder with possible multifactorial inheritance resulting in hypoplasia of CNs VI & CN VII

A

mobius

88
Q

what do we see in osteopetrosis

A

bony displasia

Congenital facial paralysis

-Vision & HL

89
Q

what do we see in mobius

A

congenital hypoplasia of 6 & 7 n

-Bilateral facial paralysis

-CN VI uni or bilateral paralysis (cross eyed)

-ID, deformities of extremities, musculoskeletal deformities

90
Q

In the case of Bell’s palsy, MEAR will be present if the lesion is ______ to the stapedius nerve

A

distal

91
Q

In the case of Bell’s palsy, MEAR will be present if the lesion is ______ to the stapedius nerve

A

distal

92
Q

what will we see in bell’s palsy

A

-partial/total unilateral facial paralysis → onset with 48 hr period,
fever & stiff neck @ onset, no hl/vertigo, no other cranial neuropathy, eye drying (due to lack of eye closure & lacrimation
-W/in 3-6 mos of onset→normal otoscopy, HL rare for pure tones, normal tymps, abnormal ARTs (proximal lesion to stapedius nerve), present ARTs (distal lesion to stapedius nerve)

93
Q

what is D/D for bells palsy

A

-CPA/skull based tumors

-vestib schwannoma

-OM

-Parotid gland tumors

94
Q

who is most at risk for bells palsy

A

-Most common cause of acute unilateral facial paralysis

-affects both sexes & right more

-Pregnancy increases risk 3 fold

95
Q

what would we see with facial neuromas

A

-Immittance→normal tymps, ARTs abn w/ lesion PROXIMAL to stapedius n & ARTs present w/ lesion DISTAL to stapedius n

-Pure tones→ SNHL

-ABR→ shows whether its acoustic or facial neuroma

  • Facial weakness usually gradual (⅔ of all cases), HL (~ 50%, SNHL, CHL, or mixed depending on tumor location - CHL occurs if lesion is on mastoid segment of FN invading ME cavity/ear canal/tympanic portion

-Others→tinnitus, otorrhea, ear canal mass, otalgia, vestibular symptoms

96
Q

what are D/D for facial neuromas

A

-OM w/ CHL (w/ or w/out cholesteatoma),
cholesteatoma paragangliomas, meningiomas,
acoustic neuroma (vestib schwannoma →because of SNHL that can be present in facial neuroma

97
Q

when should you refer for vestib schwannomas

A

unexplained unilateral or asymmetric HL
15 dB thresh difference bw ears @ 2 adjacent frequencies for unilateral HL and 20 dB thresh difference bw ears @ 2 adjacent frequencies for bilateral HL
unexplained unilateral or asymmetric tinnitus or vertizo/dizziness
aural fullness
facial paralysis/weakness
asymmetric WRS w/ NU-6 lists
> 15%?
other tests: rollover, ARTs, RDs, ABRs

98
Q

when should you refer for SSNHL

A

IMMEDIATE referral
pure tones → sudden decrease or asymmetry in hearing of at least 30 dB w/ at least 3 consecutive test frequencies
onset for over no more than 72 hrs
corticosteroid treatment is most effect given w/in 2 wks of onset

99
Q

when should you refer for OM

A

flat (wide width) w/ normal ECV
cloudy ™ and/or air bubbles or air-fluid line or bulging ™
repeat tymp in 6-8 wks to monitor and refer if needed

100
Q

when to refer for PE tubes

A

flat w/ large ECV → patent tubes (open)
asymptomatic PTs w/ patent → follow managing physicians advice on care & f/u
symptomatic PTs w/ patent → refer to managing physician
symptoms → blood, otorrhea, otalgia, significant CHL
flat w/ normal ECV → obstructed tubes, possible O

101
Q

when to refer for perf

A

flat tymp w/ large ECV → ™ perf
can be visualized on otoscopy
asymptomatic & undiagnosed PT → follow dry ear precautions and refer to otolaryngologist
asymptomatic & diagnosed previously → follow managing physicians treatment
symptomatic PTs, whether diagnosed or not → refer to managing physician
symptoms→ otorrhea, blood, otalgia, significant CHL

102
Q

when to refer for ossicular discontinuity

A

Ad, narrow width, high admittance, hyper flaccid
significant CHL across audiogram
refer for medical eval

103
Q

when to refer for OTSC

A

A or As, narrow width, normal compliance, unremarkable otoscopy
refer for medical eval w/ CHL & BC notch @ 2kHz

104
Q

when to refer for tinnitus

A

somatic tinnitus→ pulsatile tinnitus, refer
mood disorder suicidal ideation w/ it → refer to mental health provider
symptoms associated w/ head or neck movement including tinnitus modulation
otalgia, otorrhea, dizziness, vertigo

105
Q

when to refer for dizziness

A

PT w/ atypical findings to BPPV → symptoms not provoked by head position & negative Dix-Hallpike
PT w/ BPPV w/ no improvement after 2-3 canalith reposition treatments

106
Q

what does ME path look like on ARTs for L

A

abn L ispi & contra and abn right contra

107
Q

what does me path for bilateral look like on ARTs

A

all abn reflexes

108
Q

what is seen in ANSD

A

disruption of neural synchrony
-ECochG & ARTs absent → 8th n involvement

-Present OAEs until blood supply compromised

-Abs ABR w/ present CM(OHC produced)→no wave 5 latency increase, response reverses based on stim polarity

-Poor WRS in noise

-Audio can have varying severity & configurations

-Contralateral suppression w/ OAEs abs

109
Q

who is at risk for ANSD

A

-Premature & very low birth weight

-Prolonged NICU stay

-Anoxia/hypoxia

-Hyperbilirubinemia

110
Q

how is ANSD diagnosed

A

-Present OAEs & reversal ABR, abs ART→anything involving 8th n is abnormal

-Actual hearing thresh typically ~10 to 15 dB HL better than ABR thresh

111
Q

what is management of ANSD

A

*question is not how severe HL is but how severe dys-synchrony is

-CI can be either success or not→ neural integrity compromised will not be

112
Q

what is seen in HHL/cochlear synaptopathy

A

-Loss of connection bw auditory n fibers & hair cells

-Adversely affects fine speech structure decoding & speech perception especially seen in noise

-Not seen on an audiogram

Classic complaint→ “I can hear but I cannot understand what people say”

113
Q

what is seen in presbycusis

A

Formula→genetics / (age + noise + ototoxic drugs)

-Slow, progressive HF sloping SNHL

-speech perception especially w/ noise & reverberation

-Recruitment

114
Q

what is seen in ABR w/ CHL

A

absolute latencies are pushed out but relative interwave latencies were retained within normal limits

115
Q

what is seen in ABR w/ SNHL

A

wave 1 is prolonged (~ 2 ms)
wave 5 has normal latency (~ 6 ms)
Latency-intensity function shows a wave V not repeatable at 45 dB nHL – a higher hearing threshold

116
Q

whatdoes BS show in ABR

A

only wave 1 present

117
Q

what does vestib schwan show in ABR

A

diminished wave I and absent wave III & V

AUDE 5410 Aud-Vestib Disorders (18 decks)

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