Neurootology

Question 1

Which of the right ear pure tone audiograms shown below most resemble the pattern expected with
Meniere’s disease?

Answer 1

c—Sensorineural hearing loss predominantly of the lower frequencies may be seen in Meniere’s disease

Question 2

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

Answer 2

d—Superior vestibular nerve

Question 3

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

Answer 3

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.

Question 4

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

Answer 4

b—Inferior colliculus

Question 5

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

Answer 5

c—Left acoustic neuroma

Question 6

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

Answer 6

d—Resection of acoustic neuroma in a deaf
patient

Question 7

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

Answer 7

a—High frequency hearing loss

Question 8

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

Answer 8

c—Hair cells.

Question 9

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

Answer 9

c—Obvious weakness or disfiguring asymmetry; normal symmetry and tone at rest; incomplete eye closure.

Question 10

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

Answer 10

a—Cochlear nucleus

Question 11

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

Answer 11

a—Facial nerve

Question 12

Which of the labels below refers to the
modiolus?

Answer 12

a—Modiolus, the conical central axis of the
cochlea of the ear.

Question 13

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.

Answer 13

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

Question 14

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.

Answer 14

1¼g, Pure-tone audiometry,
2¼f, Play audiometry,
3¼e, Otoacoustic emission testing,
4¼b, Auditory brainstem response

Question 15

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.

Answer 15

1¼h, Ossicular dislocation,
2¼g, Noiseinduced hearing loss,
3¼k, Perilymph fis

Question 16

Genetic hearing loss:
a. Alport syndrome
b. Apert syndrome
c. Crouzon syndrome
d. Hersh syndrome
e. Jervell Lange-Nielsen syndrome
f. Neurofibromatosis type II
g. Pendred syndrome
h. Pierre-Robin sequence
i. Refsum syndrome
j. Seckel syndrome
k. Treacher-Collins syndrome
l. Usher syndrome
m. Waardenburg syndrome

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 child with iris heterochromia, hypertelorism and white forelock born with hearing loss.
2. A child with hematuria and high frequency hearing loss
3. A child born with profound deafness and prolonged QT interval.

Answer 16

1¼m, Waardenburg syndrome,
2¼a, Alport syndrome,
3¼e, Jervell Lange-Nielsen syndrome

Question 17

Dizziness:
a. Benign paroxysmal positional vertigo
b. Central vestibular dysfunction
c. Head injury
d. Labyrinthine fistula
e. Meniere’s disease
f. Migraine
g. Psychiatric disease
h. Vertebro-basilar ischemia
i. Vestibular neuronitis
j. Vestibular schwannoma

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 54-year-old who has had two previous
episodes of acute vertigo lasting a few
hours only, each preceded by hearing
loss, tinnitus and aural fullness in the
right ear.
2. A 72-year-old woman who has a 3 month
history of vertigo when turning her head
in bed, each lasting less than 1 min. Pure
tone audiogram shows symmetrical bilateral high frequency hearing loss.
3. A 65-year-old man presenting with
progressive unsteadiness, intermittent vertigo and right sided tinnitus. Pure tone
audiogram shows asymmetrical right sensorineural hearing loss.

Answer 17

1¼e, Meniere’s disease,
2¼a, BPPV,
3¼j, Vestibular schwannoma

Question 18

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

Answer 18

1¼p,
2¼n,
3¼l,
4¼m,
5¼q

Question 19

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

Answer 19

1¼g,
2¼b,
3¼a,
4¼h

Question 20

20. Audiogram symbols:
    a. O
    b. X
    c. ]
    d. [
    e. >
    f. <
    g. □
    h. ↘
    i. ↙
    j. Δ

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. Right ear, air conduction, masked
2. Left ear, air conduction, masked
3. Right ear, bone conduction, unmasked

Answer 20

1 j, Δ,
2 g, □,
3 f, <