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Clinical Medicine 2 > Lecture 10 (HEENT)-Exam 4 > Flashcards

Lecture 10 (HEENT)-Exam 4 Flashcards

1
Q

Fill in the blanks? Is this a left or right TM?

A
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2
Q

What are the outer, middle and inner ear structures?

A
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3
Q

Left or right?

A

left

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4
Q

What type of questions do you need to ask for history?

A
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5
Q

Approach to the Ear- Exam
* What do you need to palpate?
* What do you need to look at?
* What are the tests for hearing loss?
* What other exams can you do?

A
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6
Q

What are the external ear disorders?

A

o Cerumen impaction
o Otitis externa
o Trauma
o Foreign Bodies
o Neoplasms

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7
Q

Cerumen Impaction
* What does the cerumen do?
* often what?
* What are symtomes?
* How do you dx?

A
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8
Q

What are the different types of txts for cerumen impaction?

A

Treatment (if symptomatic)
* cerumenolytic agents (1st line)
* irrigation (avoid if perforation)
* manual removal

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9
Q

What is first, second, third and 4th line for Cerumen Impaction txt

A
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10
Q

Otitis Externa (swimmer’s ear)
* What is it?
* Common or not?
* What are the organisms?
* Can be what?
* What are the Risk factors?
* What are the types?

A
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11
Q

What is the clinical presentation of OE?

A

Clinical Presentation (acute)
* Rapid onset
* Ear ear pain/fullness
* Itching
* Drainage
* Tenderness

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12
Q

How do you clinical dx OE?

A

Clinical Diagnosis
* Visualize erythema and swelling of the ear canal
* Tenderness with palpation of tragus/auricle (tug test)
* otorrhea with otoscopy

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13
Q

Otitis Externa-
* What is the Treatment?
* What do you need to consider?

A
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14
Q

Otitis Externa-Treatment
* What are the different types of antibiotic drops/steriods? For how long?

A

Topical antibiotic drops +/-steroids x 7-10 days
* ciprofloxacin/dexamethasone otic (Ciprodex- can be $$$, less side effects, high potency)
* ciprofloxacin/hydrocortisone otic—(low-potency steroid)
* ofloxacinotic (no steroid)
* neomycin/polymyxin B/hydrocortisoneotic (Cortisporin- inexpensive, avoid if TM perforated)

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15
Q

Otitis Externa-Treatment
* if mild cases under a week, what can we try?
* What do you for a severe/ immunocompromised patients?
* What do you control?
* What can you do for supportive?
* What should you do if no improvement?

A
  • Mild cases <1 week- can try acetic acid (acidifying)
  • Severe/ immunocompromised-Topical + Oral Abx, consider wick placement
  • Pain control
  • Warm Compresses
  • Culture if no improvement
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16
Q

Otitis Externa-
* When does it resolve with meds and without meds?

A

Prognosis- Resolves in approximately 6 days with combo antibiotic/steroid drop.
* Typically resolves in 6 weeks without treatment

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17
Q

What should you tell people to prevent recurrence of OE?

A
  • Counsel on proper ear hygiene (no Q tips!)
  • Ear plugs/blow drying ears/shake head after water exposure
  • Alcohol/acetic acid drops (no clear evidence to support)
  • Remove hearing aids nightly and clean regularly
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18
Q

Malignant Otitis Externa
* Where does the infection spread to?
* Potentially what?
* What are the risk factors?
* What is it ususally caused by?

A
  • Infection spreads to bones of the skull
  • Potentially life-threatening
  • Risk factors= DM, immunocompromised, elderly
  • Usually caused byPseudomonas aeruginosa
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19
Q

Malignant Otitis Externa
* What are the sx?
* how do you dx?
* What is the txt?

A

Sx:
* Foul discharge, granulations, severe ear pain (can progress to cranial nerves palsies)

Diagnostics
* CT/MRI showing bone erosion

Treatment
* Long antipseudomonal IV abx course (ciprofloxacin) 4-6 wks
* ENT Consult
* Surgery if no improvement

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20
Q

Progression of malignant otitis externa can affect what cranial nerves?

A

cranial nerve VII, IX, XI, or XII

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21
Q

Fungal OE:
* When should you consider this?
* How do you dx?
* What is the txt?

A

ex of med: clotrimazole

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22
Q

External Ear Trauma:Auricular Hematoma
* What is it?
* What is separated?
* What is the clinical presentation?

A
  • Direct trauma to the auricle
  • Separation of perichondrium from underlying cartilage, blood vessels torn, blood collects, hematoma forms
  • Clinical presentation- Bleeding/swelling from ear with history of trauma, swelling of the pinna +/- fluctuance
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23
Q

External Ear Trauma:Auricular Hematoma
* What is the txt?

A

Treatment: I&D to avoid deformity and necrosis (Cauliflower ear/wrestlers ear)
* Compression dressing (prevent reaccumulating)
* Empiric antibiotics

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24
Q

External Auditory Canal Abrasion
* MC occurs with what?
* What is the presentation?
* What is the txt?
* What is the complications?

A
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25
Q

Foreign Bodies of the Ear Canal
* Common in who?
* What is the MC ages? and groups of people?
* Often what?
* How do you diagnosis?

A
  • Fairly common in a Pediatrics (toys, beads, insects, etc)
  • Most common ages 1-6
  • Adults in sports and outdoor activities
  • Often asymptomatic
  • Diagnosis: Visualization with otoscope (check the nose too!)
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26
Q

Foreign Body Management->Insects
* What do you do before removal?
* Apply what to kill the bug? What can be the result?
* What is an alternative?
* May need what?

A
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27
Q

Foreign Body Management (excluding insects)
* What are the different options? What do you not do?
* There may be more than one foreign body so what do you do?
* ENT consult for what?

A
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28
Q

When do you refer and follow up with a foreign body?

A
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29
Q

If there is an abnormal lesion that doesn’t improve, what do you need to do and why?

A

If there is an abnormal lesion that doesn’t improve, refer!
* Basal cell carcinoma
* Squamous cell carcinoma
* Melanoma

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30
Q

Neoplasm: basal cell carcinoma
* MC what?
* Slow or fast?
* What do you need to do?
* What is the txt?

A
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31
Q

Neoplasm: squamous cell carcinoma
* Can be what?
* What do you need to do?
* What is the txt?

A
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32
Q

Neoplasm: melanoma
* What is it?
* Can be what?
* What do you need to do?

A
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33
Q

What are the middle ear disorders?

A
  • Otitis Media
  • Tympanic Membrane Perforation
  • Cholesteatoma
  • Mastoiditis
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34
Q

What is Acute Otitis Media (AOM)?

A

Acute, suppurative infectious process marked by the presence of infected middle ear fluid and inflammation of the mucosa lining the middle ear space

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35
Q

Otitis Media- Epidemiology
* MC what?
* What age groups gets it more?
* What are the different types?

A
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36
Q

Otitis Media- Pathogenesis
* What are the different causes?

A
  • Eustachian tube dysfunction with subsequent tube obstruction
  • Increased negative pressure
  • Accumulation of fluid
  • Microbial grown
  • Suppuration
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37
Q

What are the most common pathogens for AOM?

A
  • Most common pathogens – Streptococcus Pneumoniae, Haemophilus Influenzae, Moraxella catarrhalis, Staph aureus
  • Can also be viral (~ 16%)
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38
Q

What are the risk factors for AOM?

A
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39
Q

Otitis Media- Clinical Presentation
* What are the most common sxs?

A
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40
Q

how do you dx AOM? What do you see?

A
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41
Q

What is this?

A

Pneumatic otoscope
* TM does not move: OM
* TM moves: normal

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42
Q

What is this showing?

A
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43
Q

What is this?

A

AOM

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44
Q

What is this?

A
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45
Q

What is this?

A
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46
Q

Acute Otitis Media-Treatment
* What is the first choice for txt?
* What do you need to consider?
* Who gets abx therapy?
* What do adults get?
* Obs in who?

A

Antibiotic therapy –> #1 Amoxicillin
* Consider severity, age, risk factors, caregiver
* <6 months, severe sx, toxic appearing- Abx therapy
* Uncomplicated children Abx therapy
* Adults: amoxicillin or amoxicillin/clavulanate (Augmentin)
* Observation before abx if parental preference and low risk (explain risks/benefits/f/u)

47
Q

AOM

What is the dose of amox and for how long?
What do you use for Pain control of AOM?

A

Amoxicillin 90 mg/kg per day ( high dose) -divided in two doses, max 3g/day

Duration
* 10 days (<2 years, perf TM, or hx of recurrence)
* 5-7 days (> 2 years with intact TM and no recurrent hx)

Pain control- ibuprofen/acetaminophen

48
Q

Otitis Media- Antibiotics Alternatives
* What is first line?
* What do you give if recurrence?
* What do you give for PCN allergy (mild)
* What do you give for severe PCN allergy?

A
49
Q

Otitis Media-
When do you need to refer

A
50
Q

Otitis Media-Tympanostomy Tubes
* Who gets this?
* May cause what?
* Tubes permit what?
* Who do you refer to?

A
  • Recurrent AOM (4 or more episodes per year)
  • May cause TM sclerosis
  • Tubes permit drainage of the middle ear fluid, aeration, and return of mucosa to normal
  • Refer to ENT for placement
51
Q

What is this?

A
52
Q

Otitis Media-Follow- up
* When do you need to see patients who are txt with observation?
* What do you do if not beter?
* Monitor for what?
* Who are reliable reporters?
* What do you educate parents on?

A
53
Q

Otitis Media-Prevention & Prognosis
* What are the vaccines?
* What about breast feeding vs bottle?
* Without antibiotics, AOM often resolves within what?

A
  • Vaccine – Pneumococcal Vaccine (PCV) offers modest prevention (~7% risk reduction)
  • Influenza vaccine under age 6 offers modest prevention (~4%)
  • Exclusive breastfeeding until 6 months reduces risk (~43%)
  • Without antibiotics, AOM often resolves within 24 hours in ~ 60%

Pneumococcal 15-valent conjugate vaccine, also PCV 20 now available

54
Q

Otitis Media Effusion (Serous Otitis Media)
* What is it?
* What is the presentation?
* What are the otoscopic findings?
* When does it resolve?
* Differentiate from what?

A
55
Q
A
56
Q

What is this?

A

Otitis Media with Effusion
* Otoscopic findings of OME include visible fluid (often yellowish, but sometimes clear) behind an intact tympanic membrane.

57
Q

Otitis Media Effusion- Treatment
* What is the txt?
* When do you refer? What do they do?
* What has not been shown to be useful?

A
  • Watchful waiting (often spontaneous resolution <6 weeks)
  • Consider early surgical referral in children at risk for speech/learning problems
  • Tympanostomy tube placement if >3 months
  • Antibiotics, antihistamines, and steroids have not been shown to be useful in the treatment of OME
58
Q

What are the complications of AOM?

A
  • Cholesteatoma
  • Tympanic Membrane Perforation
  • Mastoiditis
  • Facial Nerve Palsy
59
Q

Tympanic Membrane Perforation
* occurs when?
* Due to what?
* What are the sx of rupture?
* How will it heal?
* Often resolves what?
* What do you need to ensure?
* When do you refer out?

A
60
Q

Cholesteatoma
* What is it? What happens?
* Rare complication of what?

A
  • Abnormal accumulations of epithelium in middle ear and mastoid
  • Skin cells become trapped in middle ear, proliferate, and erode bone and surrounding structures
  • Rare complication of AOM or OME, ET dysfunction (9/100,000)
61
Q

Cholesteatoma
* When do you suspect this?
* What are the sx?
* What does the exam show?
* How do you dx?

A
  • Suspect in any patient with a chronically draining ear
  • Sx: Ear drainage and hearing loss
  • Exam: Focal retractions and white mass behind intact TM
  • Dx: Temporal Bone CT
62
Q

Cholesteatoma
* What is the txt?
* What is the prognosis?
What are the complications?

A
  • Txt: ENT referral for surgery
  • Prognosis: Frequent recurrence
  • Complications: labyrinthitis, facial palsies and paralysis, meningitis and hearing loss
63
Q

What is this?$

A
64
Q

What is this?

A

Cholesteatoma

65
Q

Mastoiditis
* Usually happens when?
* What is the presentation?
* What does it show on exam?

A
  • Usually after weeks of inadequately treated AOM
  • Presentation: Postauricular pain/erythema, fevers
  • Exam: Tenderness and erythema posterior over mastoid bone
66
Q

Mastoiditis
* how do you dx it?
* How do you tx?
* What happens if it does not improve?

A
  • Dx: CT -reveals coalescence of the mastoid air cells due to bony septa destruction.
  • TX – IV antibiotics (first line)
  • No improvement->surgical drainage or mastoidectomy
67
Q

Tinnitus:
* What is it?
* Symptom with what?
* How many people deal with this?
* Hx of what?
* usually what?
* What type of escalation?
* Most common cause?
* What is the txt?
* Sometimes due to what?

A
68
Q

What are the inner ear disorders?

A
  • Acoustic neuroma
  • Barotrauma
  • Dysfunction of eustachian tube
  • Labyrinthitis
  • Vertigo (BPPV)
  • Meniere’s disease
69
Q

Acoustic neuroma (vestibular schwannoma)
* What is the MC?
* One of the mose common what?
* What ages does this occur in?
* Unilateral or bilateral?
* May have what?

A
70
Q

Acoustic neuroma:
* What is the presentation?
* How do you diagnosis?

A

Presentation:
* Unilateral hearing loss (95%-sensorineural), +/- disequilibrium (continuous), tinnitus

Diagnosis: Enhanced MRI or CT
* Can confirm hearing loss with audiogram

71
Q

Acoustic Neuroma
* What is the txt?

A

Treatment – Refer to ENT Surgery
* May do observation with repeat imaging

72
Q

Always get a MRI with what patients and why?

A

with unilateral, asymptomatic hearing loss
* Any individual with a unilateral or asymmetric sensorineural hearing loss should be evaluated for an intracranial mass lesion

73
Q

What is this?

A

acoustic neuroma

74
Q

Barotrauma
* What happens?
* What are common causes?

A
  • Increased barometric stress exerted on the middle ear can cause trauma
  • Common causes: air travel (#1), scuba diving, blast injuries

The problem is generally most acute during airplane descent, since the negative middle ear pressure tends to collapse and block the eustachian tube, causing pain.

75
Q

Barotrauma
* What is the presentation?
* How do you dx?

A
  • Presentation: ear pressure, hearing loss (conductive), pain, +/- tinnitus
  • Diagnosis: Clinical (suspect based on symptoms and history)
    * May visualize trauma (hemotympanum) on otoscope exam
76
Q

Barotrauma
* What is the txt?
* What do you do if no improvement in few days?
* What are some concering sx?

A

Treatment: Conservative-Usually resolves spontaneously
* Recommend bedrest, head elevation, avoid anything that increases pressure
* NSAIDS

No improvement in a few days->requires urgent referral to ENT
* SNL hearing loss& vertigo->concern for perilymph fistula

77
Q

Barotrauma
* What do you educate patients on?
* How do you prevent?

A

Patient Education:
* Avoid diving with TM perforation or URI

Prevention: Oral decongestants, antihistamines, and nasal decongestant sprays used prior to flying or diving
* Counsel to swallow, yawn, and autoinsufflatation

autoinsufflate(pinching nostrils closed while gently exhaling through the nose)

78
Q

What is this?

A

Tympanic membrane barotrauma (bleeding)

79
Q

Eustachian Tube Dysfunction
* ET connects to what?
* What does it provide?
* May dysfunction with that?
* Increases in who?
* Can be what?

A
  • ET connects middle ear to the nasopharynx
  • Provides ventilation and drainage for the middle ear
  • May dysfunction with URI, sinusitis, diving
  • Increased in kids, improves by age 6
  • Can hypo or hyper function
80
Q

Eustachian Tube Dysfunction
* What is the presentation?
* How do you dx?

A

Presentation:
* Fullness in ear, decreased hearing, popping of ears

Clinical diagnosis
* TM may be retracted or normal
* Can confirm with nasal endoscopy or tympanogram

81
Q

Eustachian Tube Dysfunction
* How do yuo tx it?
* What can you educate on?

A

Txt: Treat the underlying cause (rhinosinusitis, allergic, mass?)
* Rhinosinusitis -pseudoephedrine, antihistamines, nasal steroids, pain control
* autoinsufflation (if no active nasal infection)- Modified Valsalva

Education: Avoid travel, diving, rapid altitude change

82
Q

Labyrinthitis
* What is it?
* Not what?

A
  • Inflammation of the inner ear (labyrinth) or the nerves that connect the inner ear to the brain
  • Not dangerous, but incapacitating
83
Q

Labyrinthitis:
* What are causes?
* What is the presentation?

A
84
Q

Labyrinthitis- Diagnosis and Workup
* What do you need to consider?
* How do you dx?

A
  • Broad differential (consider vascular events in >60, HA, neuro deficits, risk factors)
  • Diagnosis is clinical (consider MRI to r/o other diagnoses)
85
Q

Labyrinthitis-
* What is the txt?
* What do you need to differentiate from?

A

Txt:
* Viral (secondary to URI)- supportive treatment (antihistamines, antiemetics, vestibular suppressants <24hrs)
* Consider oral steroids (Grade 2C) if no contraindications (short-term relief, long term outcome uncertain)
* Vestibular rehab in ongoing
* Bacterial- (with otitis media or meningitis)- Abx treatment

Differentiate from vestibular neuritis (auditory function preserved, no cochlear involvement)

86
Q

Vertigo
* What is it?
* Occurs in what conditions?
* Difficult to do what?

A
  • Sensation of self motion when no motion occurs
  • Occurs in conditions affecting the vestibular sensory organs of inner ear, cerebellum and brainstem and the connections between them.
  • Difficult to diagnose and determine etiology
87
Q

Vertigo:
* What are the two types?
* What is the most common cause of vertigo?

A

Must differentiate peripheral from central causes
* Peripheral: Sudden onset, +/- tinnitus and hearing loss; horizontal nystagmus
* Central: Onset is gradual, no associated auditory symptoms, neuro symptoms

Most common:Benign paroxysmal positional vertigo (BPPV)

88
Q

What are some of the peripheral and central causes of vertigo?

A
89
Q
A
  • Walk test before discharging from an ED!
  • Peripheral- hearing loss/tinnitus
  • Central- usually no ear complaints
  • Good neuro exam required either way document your neuro exam
90
Q

Benign Paroxysmal Positional Vertigo –(BPPV)
* Most common what?
* What is the pathogenesis?

A
  • Most common form of peripheral vertigo (about 1⁄2 of vertigo cases)
  • Pathogenesis: Occurs when calcium debris are displaced spontaneously into the semicircular canals
91
Q

Benign Paroxysmal Positional Vertigo –(BPPV)
* What is the presentation?

A

Presentation: Recurrent, short episodes of vertigo (seconds to 1 min)
* Usually provoked by head movements
* +/- N/V (intermittent)
* +/-imbalance
* Dizziness lasting minutes to hours is not BPPV

92
Q

Benign Paroxysmal Positional Vertigo –(BPPV)
* how do you dx and txt it?

A
  • Dx: Dix-Hallpike maneuver (move to supine position at head 45 angle) and normal neuro exam
    * DHM: delayed nystagmus (2-40secs) which lasts less than a minute + moderate vertigo
  • Treatment: Epley maneuver (can refer to physical therapy)
93
Q

Meniere’s Disease
* What type of condition?
* Believed to be associated with what?

A
  • Idiopathic condition (exact cause unknown)
  • Believed to be associated with excess endolymph fluid in the inner ear (endolymphatic hydrops)
94
Q

Meniere’s disease:
* What is the presentation?

A
  • Presentation (classic triad): Episodic vertigo, tinnitus, hearing loss (sensorineural, low frequency)
  • Though hearing loss comes and goes, there is an expected progressive loss of hearing in the low frequencies
95
Q

Meniere’s Disease- Diagnosis (Clinical)
* What do you need to document?
* What hearing loss and how do you know?
* What else is present?
* What do you need to exclused?

A
96
Q

Meniere’s Disease- Treatment options
* What do you do first?
* What are the pharm therapies?

A
97
Q

Meniere’s Disease- Treatment options
* What do you do if refractory sx?
* What do you do for perisitent disequilibrium?

A

Refractory Symptoms: Refer to ENT
* Steroids orally or intratympanic
* Middle ear injection of Gentamycin
* Surgical options: decompression

Persistent disequilibrium: Vestibular rehabilitation

  • For patients with MD and persistent disequilibrium symptoms between attacks, we suggest referral for vestibular rehabilitation therapy (Grade 2C). Helps compensate
  • Hearing loss may accompany Meniere disease or posterior circulation ischemia (due to infarction of the labyrinth) and is not pathognomonic of Meniere disease)
98
Q

Hearing Loss- Epidemiology
* How much of the global population live with hearing loss?
* ~15% of American adults aged 18 and over report what?
* 2 to 3 out of every 1000 neonates are born with what?
* 30 million people in US are exposed to what?
* Increased prevalence of hearing loss with what?

A
  • Nearly 20% of the global population live with hearing loss
  • ~15% of American adults aged 18 and over report some trouble hearing
  • 2 to 3 out of every 1000 neonates are born with a detectable hearing loss
  • 30 million people in US are exposed to dangerous noise levels on a regular basis
  • Increased prevalence of hearing loss with age (43% ages 65-84)
99
Q

Hearing Loss- Pathophysiology
* What is conductive hearing loss?
* What is sensorinerual hearing loss?
* What is mixed loss?

A
100
Q

Hearing Loss- Screening
* Should be part of what?
* Screening for hearing is done during what?
* Any detected hearing loss in primary care should be referred for what?
* Screen who reg?
* What is an audiologist?

A
  • Should be a part of every yearly H & P (physical diagnosis/Bates)
  • Screening for hearing is done during well child visits for peds
  • Any detected hearing loss in primary care should be referred for audiologist testing
  • Screen the elderly regularly
  • Audiologist-professional licensed medical professional who works in various settings treating patients with hearing loss and balance disorders
101
Q

Sensorineural Hearing Loss
* Associated with that?
* What are the etiologies?

A
102
Q

Presbycusis
* What is this?
* What is do patients present with?
* Common but what?
* Cause is what?
* Vastly undertreated, has what?
* how do you screen?

A
103
Q

Presbycusis
* What are common complaints?
* how do you dx?

A

Common complaints:
* inability to hear or understand speech in a noisy environment
* difficulty understanding consonants
* inability to hear high-pitched voices or noises
* tinnitus

Diagnostics: Screening questions, Weber/Rinne, otoscope exam, refer to audiology

104
Q

Presbycusis
* What is the txt?

A

Treatments:
* Adaptative techniques and environmental modifications
* Hearing aids beneficial but underutilized
* Cochlear implantation an option those who have not benefited from hearing aids

105
Q

Conductive Hearing Loss
* What is it?
* What are some causes?

A

Impairment of the passage of sound vibrations to the inner ear:
* Obstruction (eg, cerumen)
* Mass loading (eg, middle ear effusion)
* Stiffness (eg, otosclerosis)
* Discontinuity (eg, ossicular disruption)

106
Q
  • What are some etiologies od conductive hearing loss?
  • Often correctable with what?
A

Etiologies:
* Cerumen impaction
* Transient eustachian tube dysfunction due to upper respiratory tract infection
* Chronic ear infection (OM, cholesteatoma)
* Trauma (perforation)
* Otosclerosis
* Perforations of the tympanic membrane

Often correctable with medical or surgical therapy, or both

107
Q

Weber
* What is a normal test?
* What about conductive and sensorinerual hearing loss?

A

Weber –Normal test- sound heard equally in both ears
* Tuning fork placed on midline of head –tone is heard loudest in ear with hearing loss
* Unilateral conductive hearing loss- tone is heard loudest in ear with hearing loss
* Unilateral sensorineural hearing loss – the tone is heard louder in the normal ear

108
Q

Rinne
* how do you do it?
* What is normal?
* What is conductive?

A
  • Tuning fork held against mastoid bone, then, comparing its sound when held lateral to the patient’s ear (air conduction)
  • Normal is when tone can still be heard (AC>BC)
  • Conductive hearing loss- Bone conduction sounds louder than air conduction (BC>AC)
109
Q
A
110
Q
  • What are hearing Loss Red Flags?
  • What do you need to do?
A
111
Q

Hearing Loss- Treatment
* What do you need to stop or decrease?
* Treat what?
* What do you do if TM is an issue?
* What can help hearing?

A
112
Q

Hearing loss-Prevention
* Avoid what? (3)
* What should you wear?

A
113
Q

Patient presents c/o hearing loss. Weber test lateralizes to the left ear. Rinne test of left ear is bone conduction greater than air conduction (BC>AC). Rinne test of the right ear is air conduction greater than bone conduction (AC>BC).
What hearing loss does this suggest?

A Right-sided conductive hearing loss
B Left-sided conductive hearing loss
C Right-sided sensorineural hearing loss
D Left-sided sensorineural hearing loss
E Mixed conductive and sensorineural hearing loss

A

B Left-sided conductive hearing loss

114
Q

Patient presents c/o hearing loss. Weber test lateralizes to the left ear. Rinne test of left ear is air conduction greater than bone condition (AC>BC). Rinne test of the right ear is air conduction greater than bone conduction (AC>BC).
What hearing loss does this suggest?

A Right-sided conductive hearing loss
B Left-sided conductive hearing loss
C Right-sided sensorineural hearing loss
D Left-sided sensorineural hearing loss
E Mixed conductive and sensorineural hearing loss

A

C Right-sided sensorineural hearing loss

Clinical Medicine 2 (16 decks)

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