Otology

Question 1

conductive vs sensory hearing loss

Answer 1

conductive hearing loss = disruption of sound waves to get to inner ear (outer, TM, middle ear)

sensory = irrev damage to hair cells or cochlear structures in translating sound to electrical

Question 2

conductive loss on audiogram

Answer 2

affects all freq in hearing

damaged air conduction
normal bone conduction

bone conduction = how well inner ear functions

Question 3

sensory hearing loss on audiogram

Answer 3

affects high freq initially

no difference between bone and air conduction because no conduction problem (sound wave still reach cochlea but just no electrical transduction)

bone conduction = how well inner ear functions

Question 4

acute otitis media

1) symptoms
2) physical exam
3) signs of perf

4) treatment

Answer 4

1) pain, fullness, pressure, hearing loss
2) inflammed TM, can’t see through,
3) erythema, edema, otorrhea, perf

4) watch wait in low risk or amoxicillin high dose
tympanocentesis for culture or acute pain (extraordinary) to decr pressure
myringotomy/mastoid for complex to drain TM

Question 5

if fluid left in middle ear after 3 months in acute otitis media what do you do

Answer 5

can be normal does not have to be infected

Question 6

otitis media with effusion
1) symptoms in ear

2) motor effects
3) often due to

Answer 6

1) pain, fullness, pop, irritability, sleep problem, conductive hearing loss,
2) school problem, imbalance, delay gross motor, speech or language development
3) recurrent AOM

4) pressure-equalizer tube surgery to drain fluid since eustacian tube not in right place
or adenoidectomy if nasal obstruct or apnea

Question 7

otitis media with effusion

what does not work

Answer 7

antibiotics
histamines
steroids
DON’T WORK

Question 8

externa otitis media due to

Answer 8

inflamm of external ear

swimmer’s ear, diabetes

Question 9

suppurative (pus) otitis media

1) caused by (2)

Answer 9

1) TM perf from trauma, infection, tube

or cholesteatoma = skin drawn into mid ear and pinched off (keratin ball) can grow/erode labyrinth causing vertigo and CN 8 palsy

Question 10

most common cause of persist draining ear in adult

Answer 10

cholesteatoma

Question 11

TM perforation
1) can lead to …

2) treatment

Answer 11

1) cholesteatoma = pars flaccida

2) treat with tympanoplastic surg if not yet cholesteatoma

Question 12

Otosclerosis
1) age group, race, gender

2) disorder of …
3) progression
4) treatment

Answer 12

1) 30-50, white, women
2) disorder of bone remodeling, can cause stapes fixation –> sensorineural hearing loss
3) progressive uni/bilateral hearing loss
4) stapedectomy to free foot plate and replace with prostethic

Question 13

genetics of otosclerosis
inheritance
assoc with
mutation

Answer 13

AD variable penetrance
assoc with measles virus/bone disorders

COL1A1 and aggrecan mutation

Question 14

congenital aural atresia

malformation where?
treatment?

Answer 14

malformation of external auditory canal, TM, middle ear, or ossicles

surgery

Question 15

presbycusis
1) progression

2) assoc with
3) symptoms
4) where is impairment

Answer 15

1) gradual progressive, bilateral
2) aging

3) decr hearing threshold sensitivity
decr high freq sensitivity
can’t understand suprathreshold speech (understand loud speech)
can hear things but can’t understand details of words

4) central auditory process

Question 16

Noise trauma
1) comes from?

2) phenomenon of …
what is seen on audiogram

3) due to?

Answer 16

1) comes from acute or chornic loud noise
2) temporary threshold shit –> 4 kHz notch (resonant freq so energy amplified here)
3) resonance of outer ear

Question 17

Meniere’s disease = endolymphatic hydrops

1) mechanism
2) symptoms

Answer 17

1) swelling of endolymphatic space from problem with stria vascularis and loss of endocochlear potential (poor ion movement)
2) vertigo more than 20 min, tinnitus, fullness, fluctuating hearing loss

Question 18

meniere’s disease

1) uni or bilateral
2) progression
3) treatment

Answer 18

1) usu unilateral
2) chronic with acute phase and remission, unpredictable course, reach burnout or flat hearing loss
3) diuretic for swelling, Mg2+ for vertigo, surgery if not responsive

Question 19

CN8 schwannoma
1) describe basics

2) assoc with which nerve
3) two forms

Answer 19

1) benign, slow growing tumor
2) vestib nerve&raquo_space; acoustic > facial

3) NF2 = mutation in gene for merlin in cell-cell or cell-matrix
OR

sporadic = double mutation at merlin

Question 20

CN8 schwannoma

early vs late signs and symptoms

Answer 20

early = hearing loss
unilateral tinnitus
mild/fleeting vertigo

late = facial numbness, ataxia, HA, visual loss, long tract signs, death by herniation

Question 21

CN8 schwannoma

treatment

Answer 21

1) watchful waiting

2) surgical resection
radiosurg or radiotherapy

Question 22

causes of sensory hearing loss

Answer 22

1) presbycusis
2) noise trauma
3) ototoxicity
4) meniere’s
5) CN 8 schwannoma

Question 23

causes of conductive hearing loss

Answer 23

1) acute otitis media
2) otitis media with effusion
3) TM perf
4) otosclerosis
5) congential aural atresia

Question 24

word recognition score means

Answer 24

ability to discriminate words presented at normal conversational loudness levels (0-100%).

represents the “neural” aspect of hearing ability (inner hair cell, 8th nerve and central auditory pathways)

Question 25

if you see unilateral hearing loss on audiogram think what

asymmetric hearing loss

Answer 25

meningioma or acoustic neuroma

Question 26

difference between bone and air conduction
normal bone
abnormal air

Answer 26

conductive hearing loss

Question 27

most common viral cause of congenital hearing loss

most common cause of genetic hearing loss

Answer 27

CMV in utero

AR non-syndromic due to mutation in connexin 26/GJB2

Question 28

disordered inner ear fluid homesotasis assoc with

Answer 28

1) vasculitis
2) DM, hypothyroid, renal failure, arteriosclerosis
3) immune related

flat, moderate, and severe sensorineural hearing loss

Question 29

causes of neural hearing loss

Answer 29

8th nerve tumors
auditory neuropathy
multiple sclerosis