Otolaryngology

Question 1

Hearing Loss

Answer 1

• Affects 1/3 pts ≥ 65yo
• Associated with depression, social isolation, poor self-esteem, cognitive decline
• RF: prior noise exposure, middle ear dz, vascular dz
• Fnal effects of aging on auditory system: hearing loss for pure tones, hearing loss for speech, problems understanding difficult speech
• Anatomic effects: atrophy and disappearance of sensory cells in inner ear, calcification of membranes in inner ear, degen of fibers in eighth cranial nerve, reduced number of cells in auditory cortex
• Cerumen impaction and presbycusis are common causes of hearing loss in the elderly
• Conductive loss – caused by impaired sound transmission to the inner ear (d/t blockage like cerumen)
  
  • Weber test à lateralization to the affected ear
  • Rinne test à greater bone conduction than air conduction on the affected side
• Sensorineural loss – occurs w/ damage/impairment of the inner ear or neural pathways
  
  • Weber test à lateralization to the unaffected side
  • Rinne test à air conduction > bone conduction

Question 2

Presbycussis

Answer 2

• Age related, sensorineural, MCC elderly hearing loss
• BL, symmetric, high-frequency hearing loss
• RF: advanced age
• Cochlea = primary site of pathogenesis

Question 3

Ototoxic Medications

Answer 3

• Abx: aminoglycosides, erythromycin, tetracycline, vancomycin
• Antimalarials: chloroquinine, quinine
• Antineoplastics: cisplatin, bleomycin, 5-FU, nitrogen mustard
• Salicylates: ASA
• Diuretics: loop diuretics

Question 4

Vertigo

Answer 4

• Illusion of mvmnt, usually rotation
• Arises from disturb of vestibular system or connecting pathways
• MCC = acute neurolabyrinthitis, recurrent vestibular syndromes, BPPV, and posterior circulation TIAs
• Sensation of movement in the absence of any actual movement
• Peripheral vertigo
  
  • Sudden onset, n/v, tinnitus, hearing loss, nystagmus
  • Labyrinthitis
    
    • Acute severe vertigo w/ hearing loss and vertigo of several days to a week
• Central vertigo = more gradual onset and vertical nystagmus
• Diagnosis
  
  • BPPV – Dix-Hallpike maneuver
• Tx
  
  • Meclizine
  • Physical therapy maneuvers

Question 5

Acute Neurolabrythitis

Answer 5

• Caused by viral or vascular injury of all or part of one vestibular labyrinth
• Rapid onset vertigo with N/V, sweating, horizontal nystagmus
• Younger people à resolves within a week
• Older adults à resolves more slowly, leaves residual disequilibrium
• Tx: supportive à meclizine or promethazine, low dose benzos

Question 6

Recurrent Vestibular Syndromes

Answer 6

• Recurrent attacks of vertigo (hrs to days)
• When accompanied by hearing loss and tinnitus à Meniere’s dz
  
  • Progressive low freq hearing loss over time
  • Tx: salt restriction and diiretics
• When only dizziness à recurrent vestibulopathy
  
  • Milder than Meniere’s

Tx: sxatic tx using antihistamines such as meclizine

Question 7

BPPV

Answer 7

• Extremely common cause of dizziness among elderly
• Bouts less than one minute related to position change
• Hearing loss, tinnitus and cranial nerve defs are generally ABSENT

Question 8

Dental Problems

Answer 8

• Caries
  
  • Diet high in carbs is major RF for dental decay along with decline in cog and physical fn, institutionalization, and dry mouth (from meds)
  • MC form of dental caries in older adults is root caries
• Periodontal dz
  
  • Progressive (begins as inflamm of gingiva) – can progress to dz that destroys alveolar bone supporting teeth
  • Primary cause of tooth loss in adults
  • RF = poor oral hygiene, smoking, DM, osteoporosis, osteopenia, genetics, and hyposalivation
  • Management: brushing, flossing, tooth scaling by dental professionals, chlorhexidine gluconate rinse and Listerine, improved management of systemic dzs (DM, osteoporosis), smoking cessation, etc.
• Mouth dryness
  
  • Xerostomia and hyposalivation
  • Salivary flow does not decline with age!! Medical conditions and their tx are associated with dryness
    
    • Meds = sedatives, antipsychotics, antianginal, antidepressants, antihistamines, antihypertensives, antiparkinsons, diuretics, and anticholinergis
  • Sjogren’s is MC salivary gland disorder
• Oral cancer
  
  • Black males have 30% higher incidence rate than white males for reasons not well understood
  • Often presents as white, red, or red and white masses and may be ulcerated