Otolaryngology

Question 1

What is menieres disease

Answer 1

It is a disease that is thought to arise form abnormal fluid and ion homeostasis in the inner ear

Question 2

What are the clinical features of Meniers (hint it is a triad)

Answer 2

• Vertigo which may last from a few minutes to a couple of hours.
• Tinnitus
• Sensorineural hearing loss

Question 3

What are common causes of Vertigo and what are their respective durations.

Answer 3

BPPV - lasts only a couple of seconds
Meniere’s disease - last from a couple of minutes to several hours
Vestibular neuritis - lasts for several days and patient may be unstable for several weeks
CNS lesions - cause persistent true vertigo lasting more than 3 weeks which strongly suggests CNS cause and warrants appropriate treatment.

Question 4

What are the medications used for the symptomatic relief for acute vertigo?

Answer 4

Anti-histamines
        -Meclizine
        -Cyclazine
        -Dimenhydrinate
        -Diphenhydramine
Benzodiazapines
        -Clonazapam
        -Diazepam
        -Lorazepam
Anti-emetics
        -Domperidone
        -Metaclopromide
        -ondensatron
For acute emergency senarios
        -Diphenhydramine (anti-histamine)
        -Domperidone (anti-emetics
        -metaclopromide

Question 5

What is a neural complication of advanced ear disease

Answer 5

Ipsilateral facial nerve palsy

Question 6

If the Rinnes test shows that the patient cannot hear bone conduction at all but can hear air conduction the patient is most likely to have….

Answer 6

This shows a significant sensorineural deficit.

Question 7

What is a positive Rinne test indicate?

Answer 7

It indicates that the air conduction is better than the bone conduction. I can be present in mild sensorineual loss

Question 8

Input from which organs are responsible for balance?

Answer 8

Input from eyes
input from proprioceptors
Balance organs of the ears
Therefore when examining a patients balance each system must be tested separately.

Question 9

What is the head thrust / Halmagyi test

Answer 9

It is used to test the vestibular-ocular-reflex. This reflex allows us to keep our eyes on an object while turning our heads.

Question 10

What are the 2 components and functions of he vestibular system?

Answer 10

The semicircle canals which monitor rotational movements.
The otoliths which monitor linear acceleration
The vestibular system sends information neurone structures which are important for eye movement and control muscles which keeps a person upright.

Question 11

What is the Romberg test?

Answer 11

It is used for testing a lesion in the labyrinthine.
The test is performed by getting the patient to stand with their feet together and their eyes closed. Patients often sway to the side of the lesion.

Question 12

What is the stepping or marching test (fukuda or unterberger)

Answer 12

Test of vestibular dysfunction. Get patient to close eyes and march on the spot. Patients will often pivot towards the side of the lesion

Question 13

What are three basic audiometry test

Answer 13

Pure tone Audiometry - used to identify hearing threshold levels. It requires a level of co-operation and therefore is used in children and adults
Speech audiometry - patients are presented with phonetically balanced words
Tympanometry - carried out by the introduction of low frequency sound and measuring reflected sound energy