Midterm 4 info (kulak + vertigo)

Question 1

how is the sound transferred from cochlea to temporal lobe auditory cortex?

Answer 1

By ipsilateral auditory nerve

Question 2

What are some tests that are done for audiological investigation?

Answer 2

1) Tune fork tests (Weber-Rinne)

2) Pure-tone audiometry measures thresholds for pure tone stimuli, speech audiometry for speech stimuli

3) Immitance audiometry
3-a) Tympanometry : evaluates eardrum mobility, measured with ear canal volume
* Type A: normal middle ear pressure, normal compliance
* Type B: non-mobile tympanic membrane (normal external canal volume indicates
effusion, large volume indicates perforation)
* Type C: negative middle ear pressure, normal compliance (Eustachian tube
dysfunction)

4) Stapedial reflex
* Tests integrity of cranial nerve 8 and 7, normally occurs at 70–100 dB HL

Question 3

What is tinnitus

Answer 3

Kulak çınlaması. Akustik bir uyaran olmaksızın hastanın bir ses algılaması

Thin or deep sounds that do not originate from the external
environment

Question 4

How is the distribution of congenital neurosensorial hearing loss cases in terms of hereditary, non hereditary or idiopathic?

Answer 4

Hereditary (50%) –> Non syndromic (%70) autosomal recessive + syndromic (%30) Usher, Pendred syndrome (ikisi de autosomal recessive)

Non hereditary (25%) –> CMV (most common cause of congenital viral deafness), mumps (most common cause of acquired sensorineural hearing loss) rubella, prematurity, maternal diabetes, hyperbilirubinemia

İdiopathic (%25)

Question 5

What are the features of Mumps and CMV in terms of hearing loss?

Answer 5

CMV–> most common cause of congenital viral deafness

Mumps –> most common cause of acquired sensorineural hearing loss

Question 6

Acquired neurosensorial hearing loss reasons

Answer 6

• Presbycusis (most common): progressive symmetric sensorineural hearing loss
  associated with aging, begins in high frequencies,
• Noise-induced hearing loss: (people who work in high-noise environments) often
  associated with a 4-kHz notch
• Post-meningitis: may be associated with labyrinthitis ossificans
• Cerebrovascular accident
• Ototoxic medication exposure
• Autoimmune inner ear disease
• Idiopathic, including sudden sensorineural hearing loss
• Vestibular schwannoma or meningioma: usually asymmetric and displays
  retrocochlear pattern (disproportionately poor word recognition compared to pure
  tone losses)
• Erosive inner ear disease (cholesteatoma, chronic otitis media without
  cholesteatoma)

Question 7

Reasons of conductive hearing loss?

Answer 7

• Otosclerosis
• Acute otitis media
• Chronic otitis media
• Eustachian tube dysfunction/serous otitis media
• Tympanic membrane perforation /w or wo supuration

Question 8

Primary otalgia types

Answer 8

• Auricular hematomas
• Ramsay Hunt syndrome
• Otitis externa
• Otitis media (non-perforated)

Question 9

Referred otalgia types (pain originate from outside of the ear)

Answer 9

• Temporomandibular diseases
• Tonsillitis
• Oro- and hypopharyngeal malignancy

Question 10

Otorrhea reasons/ types

Answer 10

• Otitis externa
• Otomycosis (fungus in the ear canal)
• Atopic dermatit of ear canal
• Acute otitis media (perforated)
• Chronic otitis media
• Cholesteatoma

Question 11

Vertigo vs dizziness

Answer 11

Vertigo vs dizziness–>
Unreal sense of rotationary movement vs any kind of altered sense of orientation

Mostly caused by peripheral lesions but 2 central lesions (vascular events of brainstem and cerebellum) are also present with vertigo vs arised from decompensated status of a peripheral lesion, vitamin Bl2
deficiency, folic acid deficiency or hyperlipidemia.

Dipnot: Dizziness is a symptom that the patient
can tolerate, but then the patient tends to seek help with
some delay

Question 12

What are some adverse affects of drugs on ear?

Answer 12

Vestibulotoxic drug intake may cause bilateral vestibular end-organ damage, which results in oscillopsia.

GABA analogs and some antidepressant drugs may cause dizziness.

Question 13

What are some tests done for nystagmus?

Answer 13

Head thrust, head shaking nystagmus, fistula testing

Question 14

What are some tests done for evaluation of vestibulospinal reflex (postural control test) ?

Answer 14

romberg test, fukuda stepping test, tandem gait test

Question 15

What are some important vertigo types?

Answer 15

Benign paroxysmal positional vertigo, meniere disease, vestibular neuronitis

Question 16

What are the features of Benign paroxysmal positional vertigo?

Answer 16

 One of the most common types of peripheral vertigo, arising as a result of debris in the posterior semicircular canal
 Sudden vertigo lasting seconds to minutes with head movement.
 Symptoms are often precipitated by turning to the affected side while In bed.
 No associated hearing loss.
Özel testi: Dix hallpike

May be associated with nausea, no spontaneous nystagmus, a normal neurological evaluation

Question 17

What are the features of meniere disease (AKA endolymphatic hydrops)?

Answer 17

 Idiopathic inner ear disorder
 Characterized by attack of episodic vertigo, fluctuating hearing loss, tinnitus and aural fullness
 There is no gender bias and patients typically present in the fifth decade of life.

Associated with allergy!
Çikolata ? SYPHILIS!!

Fluorescent treponemal antibody absorption (FTA-ABS) test to rule out syphilis. FTA-ABS testing is mandatory in any patient given the diagnosis of an idiopathic disease, because syphilis may perfectly imitate Meniere disease.

Question 18

What are the features of vestibular neuronitis?

Answer 18

third most common cause of peripheral vestibular vertigo
HSV-1 infection!
Vertigo lasting days after an upper respiratory infection.
No hearing loss.
No other neurological signs or symptoms.

Question 19

Info abt sensorineural and conductive hearing losses in terms of rinne and weber tests.

Answer 19

In Conductive Hearing Loss;
In Rinne test bone conduction longer than air conduction in affected ear
Weber test lateralizes to affected ear

In Sensorineural Hearing Loss;
In Rinne test air conduction longer than bone conduction in
both ear
Weber test lateralizes to unaffected ear