Idiopathic Flashcards
What is the definition of sudden sensorineural hearing loss?
>20 dB hearing loss over at least three contiguous frequencies occurring within 3 days.
In what percent of these cases can a definite cause be determined?
10%.
What percent of patients with unilateral tinnitus have retrocochlear pathology?
11%.
What percent of cases of SD are familial?
12%.
What causes hemifacial spasm?
A vascular loop, most commonly of the anterior or posterior inferior cerebellar artery, impinging on the root of VII.
Voiceless consonant is suggestive of what disorder?
Abductor SD.
What are the two types of SD?
Adductor and abductor.
Which is more common?
Adductor SD.
Which of these is characterized by a harsh, strained voice with inappropriate pitch breaks, breathiness, and glottal fry?
Adductor SD.
The inability to sustain vowels during speech is suggestive of what disorder?
Adductor SD.
What is tympanophonia?
Audition of one’s own breath sounds.
What are the symptoms of patulous eustachian tube?
Aural fullness, autophony, tympanophonia that improve when the head is placed down between the legs; onset often occurs with weight loss or after irradiation to the nasopharynx.
What is the initial treatment for hemifacial spasm?
Baclofen.
Which has a male predilection?
Both.
What are the typical features of abductor SD?
Breathy, effortful hypnotic voice with abnormal whispered segments of speech.
What is the preferred method of treatment for SD?
Chemical denervation with botulinum toxin.
What are the two common theories on the etiology of idiopathic sudden sensorineural hearing loss (ISSNHL)?
Circulatory disturbance and inflammatory reaction (usually viral).
What laboratory studies are useful in the workup?
Coagulation profile (CBC, PT, PTT), viral studies, ESR.
What are the two types of bony growths in the external auditory canal?
Diffuse exostoses and osteomata.
Which is more common?
Exostoses.
Which is more likely to be bilateral?
Exostoses.
Which is more likely to be seen in surfers?
Exostoses.
What evidence supports the use of carbon dioxide for ISSNHL?
Fisch et al. (1983) compared carbogen (95% oxygen and 5% carbon dioxide) inhalation therapy daily for 5 days with papaverine and low-molecular-weight dextran for 5 days and found a statistically significant improvement in hearing levels with carbogen therapy. These findings have not been replicated.
What kind of dystonia is spasmodic dysphonia (SD)?
Focal.
What condition would cause a tense sounding voice, vocal fatigue, and a prolonged closed phase with reduced vibratory and mucosal wave amplitude during videostroboscopy?
Glottic hyperabduction dysphonia.
What is the most common cause of pulsatile tinnitus in young female patients?
Idiopathic intracranial hypertension (IIH) syndrome.
What is the most common cause of venous pulsatile tinnitus?
Idiopathic intracranial hypertension syndrome (pseudotumor cerebri, benign intracranial hypertension).
When is spontaneous recovery of hearing more likely?
If patient is without vestibular symptoms and suffers only partial hearing loss, particularly low frequency (better prognosis if apex of the cochlea is involved).
When is a middle ear exploration indicated?
If the loss occurs in an only-hearing ear-to rule out a fistula.
What are the characteristics of focal dystonias?
Inappropriate and excessive efferent activity of motor neurons in small areas.
What can be done if symptoms persist after complete paralysis of the posterior cricoarytenoid?
Inject the contralateral posterior cricoarytenoid muscle with very small increments of toxin or inject the cricothyroid muscle.
What are five other venous etiologies of pulsatile tinnitus?
Jugular bulb abnormalities; hydrocephalus associated with stenosis of the Sylvian aqueduct; increased intracranial pressure associated with Arnold-Chiari syndrome; abnormal condylar and mastoid emissary veins; and idiopathic or essential tinnitus.
What are the indications for removal of exostoses?
Less than 1mm aperture, recurrent otitis externa, and water trapping.
What muscles are injected when using botulinum toxin to treat oromandibular dystonia?
Masseter, temporalis, and medial and lateral pterygoid muscles.
What syndrome is associated with blepharospasm?
Meige’s syndrome.
What is the procedure of choice for patients with hemifacial spasm?
Microvascular decompression.
What evidence supports the use of antivirals for ISSNHL?
No randomized, prospective studies have demonstrated this therapy to be effective.
What effect does adductor laryngeal breathing dystonia have on the voice?
None.
Which muscles are involved in blepharospasm?
Orbicularis oculi, procerus, and corrugator supercilii.
Which is usually attached to the tympanosquamous suture line?
Osteomata.
What is the current standard of care for the workup and treatment of idiopathic sudden sensorineural hearing loss?
Otologic exam, audiogram, and rule-out retrocochlear pathology-treatment with steroids, +I- antivirals, +I- diuretics.
What is the prognosis ofiSSNHL?
Overall recovery to functional hearing levels in 65-69%; no conclusive evidence that outcome is improved by medical treatment.
What is adductor laryngeal breathing dystonia?
Paradoxical adduction of the vocal folds during inspiration, causing inspiratory stridor that worsens with exertion and disappears during sleep.
What factors lead to the best rate of recovery after ISSNHL?
Patients treated with steroids and vasodilators, with worse initial PTA and SDS, younger age, and greater number of treatments are most likely to improve.
How is injection into the cricothyroid muscle accomplished, and how is proper placement confirmed?
Peroral route; confirm by having the patient sing an ascending scale and observing an increase in EMG activity as the pitch increases.
Which muscle is responsible for abductor SD?
Posterior cricoarytenoid muscle.
What are some treatments for patulous eustachian tube?
Reassurance, weight gain, SSKI (10 gtt in juice po TID), Premarin nasal spray (25 mg in 30 cc NS, 3 gtt per nose TID), occlusion of the ET, and myringotomy and tympanostomy tube placement.
What evidence supports the use of corticosteroids for ISSNHL?
Steroid therapy is among the few treatment methods in ISSNHL to have single modality, randomized, prospective studies demonstrating effectiveness.
What are the adverse effects of posterior cricoarytenoid injections?
Stridor (particularly with exertion), airway compromise, dysphagia, and aspiration.
Which muscles are responsible for adductor SD?
Thyroarytenoid and lateral cricoarytenoid muscles.
What are the two ways to deliver botulinum toxin to the posterior cricoarytenoid muscle?
Transcricoid and retrograde (rotating the larynx away from the side of injection).
What percent of these cases will turn out to have a vestibular schwannoma?
Up to 4%.
How can one confirm placement of the needle in the posterior cricoarytenoid muscle?
Using EMG guidance, have the patient sniff.
What treatments are used to try to optimize cochlear blood flow?
Vasodilators (histamine, papaverine, verapamil, carbon dioxide) and blood thinners (defibrinogenation therapy, dextran, papaverine).
What is the treatment for IIH?
Weight reduction and acetazolamide (250 mg TID) or furosemide (20 mg BID); lumbar-peritoneal shunt for patients with visual deterioration, persistent headaches, or disabling tinnitus.
Which muscles are injected when using botulinum toxin to treat hemifacial spasm?
Zygomaticus major and minor, levator anguli oris, and risorius.
