Neurootology Flashcards
Which of the right ear pure tone audiograms shown below most resemble the pattern expected with
Meniere’s disease?
c—Sensorineural hearing loss predominantly of the lower frequencies may be seen in Meniere’s disease
a. Normal right audiogram. b. Sensorineural
hearing loss: the commonest cause is presbyacusis, with usually high-frequency loss. c. Sensorineural hearing loss predominantly of the lower
frequencies may be seen in Meniere’s disease.
d. Mixed conductive and sensorineural hearing
loss: seen in patients with a combination of presbyacusis and middle ear pathology, or in a perilymph fistula. e. Conductive hearing loss: the
difference between AC and BC demonstrates
the conductive loss. f. Noise-induced hearing
loss: commonly affects the frequencies around
4 kHz initially
Vestibular schwannoma (acoustic neuroma) most commonly affects which one of the following nerves?
a. Cochlear nerve
b. Facial nerve
c. Inferior vestibular nerve
d. Superior vestibular nerve
e. Trigeminal nerve
d—Superior vestibular nerve
Superior vestibular nerve supplies the superior
semicircular canal, lateral semicircular canal and
the utricle. Inferior vestibular nerve supplies the
posterior semicircular canal and saccule
Vestibular-ocular reflex elicited during a right head turn is best described by which one of the following?
a. Relative motion between membranous
labyrinth and endolymph causes right
horizontal canal cupula to deflect towards
the utricle with reflex movement of eyes to
left with saccades to right 176
b. Relative motion between membranous
labyrinth and endolymph causes left horizontal canal cupula to deflect towards the
utricle with reflex movement of eyes to
left with saccades to right
c. Relative motion between membranous
labyrinth and endolymph causes right
horizontal canal cupula to deflect towards
the utricle with reflex movement of eyes to
left with saccades to left
d. Relative motion between membranous
labyrinth and perilymph causes right horizontal canal cupula to deflect towards the
utricle with reflex movement of eyes to
left with saccades to right
e. Relative motion between membranous
labyrinth and perilymph causes right horizontal canal cupula to deflect away from
the utricle with reflex movement of eyes
to right with saccades to right
a—Relative motion between membranous
labyrinth and endolymph causes right horizontal canal cupula to deflect towards utricle
(and left away) with reflex movement of eyes
to left with saccades to right.
In the brainstem auditory evoked response, which one of the following structures gives rise to wave V?
a. Cochlear nerve
b. Inferior colliculus
c. Lateral lemniscus
d. Superior olivary complex
e. Ventral cochlear nucleus
b—Inferior colliculus
The main indication for BAER is when an acoustic
neuroma is suspected due to asymmetrical sensorineural hearing loss. BAER testing is more cost
effective than MRI, but MRI provides additional
information. The most reliable indicator for
acoustic neuromas from the BAER is the increased
interaural latency in wave V. Sensitivity of BAER
for acoustic neuroma is approximately 90%.
A 25-year-old male had occasional difficulty in understanding speech over the telephone with his left ear. Brainstem auditory evoked
response is shown for both ears. Which one of the following is most likely?
a. Aminoglycoside toxicity
b. Gentamicin ototoxicity
c. Left acoustic neuroma
d. Right cochlear ischemia
e. Right glomus jugulare tumor
c—Left acoustic neuroma
Preoperative deafness on the operative side eliminates the possibility of recording intraoperative
BAEPs. Cases in which BAEPs are commonly
monitored include microvascular decompression
of cranial nerves (especially V and VII), resection
of acoustic neuroma, posterior fossa exploration
for vascular or neoplastic lesions, clipping of basilar artery aneurysm, and section of nerve VIII for
intractable tinnitus. Changes in BAER can be
caused by section/retraction of CNVIII, cerebellum, or brain stem; hypotension and hypocarbia;
drilling around the internal auditory canal; irrigation of nerve VIII; severe cerebellar edema; and
positioning of the head for retromastoid craniotomy. Patients with transient or persistent
increases in latency or decreases in amplitude
can be expected to have unchanged or only slight
worsening of hearing postoperatively. Patients
with complete but reversible loss of BAEP will
also have unchanged or mild worsening of hearing postoperatively. Patients with complete irreversible loss of BAEP will most likely have
complete or near complete loss of hearing in
the ipsilateral ear postoperatively.
In which one of the following situations is it
NOT appropriate to use intraoperative
brainstem auditory evoked response
monitoring?
a. Basilar artery aneurysm surgery
b. Microvascular decompression of CN V
c. Posterior fossa surgery
d. Resection of acoustic neuroma in a deaf
patient
e. Vestibular neurectomy for intractable
tinnitus
d—Resection of acoustic neuroma in a deaf
patient
Damage to hair cells in the basal turn of the
cochlea is likely to result in which one of the
following?
a. High frequency hearing loss
b. High-intensity hearing loss
c. Low-frequency hearing loss
d. Low-intensity hearing loss
e. Mid-frequency hearing loss
a—High frequency hearing loss
Which one of the following sites in the inner
ear does gentamicin exert its ototoxic effect?
a. Apical turn of cochlea
b. Cochlear nerve
c. Hair cells
d. Macula densa
e. Striavascularis
c—Hair cells.
Gentamicin ototoxicity results
in high tone sensorineural deafness through
its effects on outer hair cells in basal turn of
the cochlea.
A 34-year-old female presents with a HouseBrackmann grade IV facial palsy. Which one
of the following best describes the clinical
findings?
a. Complete facial paralysis
b. Obvious asymmetry (not disfiguring);
noticeable synkinesis, contracture, or
hemifacial spasm; complete eye closure
with effort.
c. Obvious weakness or disfiguring asymmetry; normal symmetry and tone at rest;
incomplete eye closure.
d. Only barely perceptible motion with
asymmetry at rest
e. Slight weakness noticeable on close
inspection; slight synkinesis
c—Obvious weakness or disfiguring asymmetry; normal symmetry and tone at rest; incomplete eye closure.
Which one of the following best describes
the target region for an auditory brainstem
implant?
a. Cochlear nucleus
b. Inferior colliculus
c. Inferior olivary nucleus
d. Superior olivary nucleus
e. Vestibular nucleus
a—Cochlear nucleus
A 35-year-old NF-2 patient has sensorineural hearing loss and paresthesia of the posterior aspect of his right ear canal. MRI shows a large cerebellopontine angle tumor. Compression of which one of the following best explains the altered sensation?
a. Facial nerve
b. Glossopharyngeal nerve
c. Inferior vestibular nerve
d. Superior vestibular nerve
e. Vagus nerve
a—Facial nerve
Altered sensation in the posterior aspect of the
external auditory canal (Hitzelberger’s sign) is
secondary to compression of sensory fibers in
the nervusintermedius branch of VII.
Which of the labels below refers to the
modiolus?
a—Modiolus, the conical central axis of the
cochlea of the ear.
Which one of the following is most accurate
regarding caloric testing in the right ear?
a. Cold water irrigation causes endolymph in
lateral portion to become dense and fall
pulling the right horizontal canal cupula
away from the utricle, reducing the firing
rate and causes a nystagmus with fast
phase to the left.
b. Cold water irrigation causes endolymph in
lateral portion to become dense and fall
pulling the right horizontal canal cupula
away from the utricle, reducing the firing
rate and causes a nystagmus with fast phase
to the right.
c. Cold water irrigation causes perilymph in
lateral portion to become dense and fall
pushing the right horizontal canal cupula
towards the utricle, reducing the firing
rate and causes a nystagmus with fast
phase away from the stimulus.
d. Warm water irrigation causes endolymph
in lateral portion to become less dense and
fall pulling the horizontal canal cupula
away from the utricle, reducing the firing
rate and causes a nystagmus with fast
phase away from the stimulus.
e. Warm water irrigation causes perilymph
in lateral portion to become dense and fall
pulling the horizontal canal cupula away
from the utricle, reducing the firing rate
and causes a nystagmus with fast phase
away from the stimulus.
a—Cold water irrigation causes endolymph in lateral portion to become dense and fall
pulling the right horizontal canal cupula away from the utricle, reducing the firing rate
and causes a nystagmus with fast phase to the left
Audiometry:
a. Acoustic reflex
b. Auditory brainstem evokes response
c. Electrically evoked auditory potentials
d. Masking
e. Otoacoustic emission
f. Play audiogram
g. Pure-tone audiometry
h. Speech recognition threshold
i. Tympanometry
For each of the following descriptions, select the
most appropriate answers from the list above.
Each answer may be used once, more than once
or not at all.
1. A 9-year-old girl who is struggling to hear
in classes at school.
2. A 4-year-old boy whose parents are concerned he can’t hear them when not in
the same room.
3. A neonate with a family history of sensorineural deafness.
4. A 1-year-old who is being considered for
cochlear implantation.
1¼g, Pure-tone audiometry,
2¼f, Play audiometry,
3¼e, Otoacoustic emission testing,
4¼b, Auditory brainstem response
Hearing Loss:
a. Acoustic neuroma
b. Acute otitis media
c. Genetic
d. Glue ear (otitis medial with effusion)
e. Meniere’s disease
f. Meningitis
g. Noise-induced hearing loss
h. Ossicular dislocation
i. Otosclerosis
j. Ototoxicity
k. Perilymph fistula
l. Presbycusis
m. Tympanosclerosis
For each of the following descriptions, select the
most appropriate answers from the list above.
Each answer may be used once, more than once
or not at all.
1. A 24-year-old man is involved in a road
traffic accident and sustains a significant
head injury requiring admission to intensive care. After discharge to the ward he
reports hearing loss in his left ear. Pure tone
audiogram shows a 50 dB conductive hearing loss across all frequencies.
2. A 57-year-old with progressive bilateral
hearing loss over several years. Audiogram
shows sensorineural hearing loss particularly at the 4 kHz frequency.
3. A 40-year-old woman sustained a head injury following a fall from a pushbike. Since then she has experienced intermittent hyperacusis and fullness in her left ear, with dizziness. These are especially
particularly worse after heavy lifting or coughing.
1¼h, Ossicular dislocation,
2¼g, Noiseinduced hearing loss,
3¼k, Perilymph fis
Anatomy:
For each of the following descriptions, select the
most appropriate answers from the image above.
Each answer may be used once, more than once or
not at all.
1. Scala vestibuli
2. Scala media
3. Organ of Corti
4. Tectorial membrane
5. Oval window
1¼p,
2¼n,
3¼l,
4¼m,
5¼q
Cochlear anatomy:
Tympanic
cavity
Cochlear
duct
Inner
tunnel
Internal
spiral
tunnel
Nerve
For each of the following descriptions, select the
most appropriate answers from the image above.
Each answer may be used once, more than once
or not at all.
1. Inner hair cell
2. Outer hair cells
3. Tectorial membrane
4. Osseous spiral lamina
1¼g,
2¼b,
3¼a,
4¼h
