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Otology Flashcards

1
Q

Where are high vs. low frequencies heard in the cochlea?

A

High - base

Low - apex

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2
Q

Neural pathway of hearing

A

E COLI

Eighth nerve
Cochlear nucleus
superior Olivary nucleus
Lateral lemniscus
Inferior colliculus
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3
Q

What are the SCC functional pairs?

A

1) Right + left horizontal SCCs
2) Left anterior + Right posterior (LARP)
3) Right anterior + left posterior (RALP)

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4
Q

Which way does nystagmus beat in peripheral lesions?

A

Classically it beats in the opposite direction of the lesion.

COWS:

  • Cold (lesion) Opposite
  • Warm (lesion) Same
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5
Q

Through what does the facial nerve exit the temporal bone?

A

Stylomastoid foramen

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6
Q

What are the portions of the temporal bone?

A 
Squamous
Petrous
Tympanic
Mastoid
Styloid
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7
Q

What divides the medial and lateral mastoid air cells?

A

Koerner’s septum

(remnant of petrosquamous suture line

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8
Q

What artery and vein travel through the superior semicircular canal?

A

Subarcuate artery/vein

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9
Q

What is seen on audiography with acute noise trauma-induced SNHL?

A

Notch at 4 kHz

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10
Q

Common causes of postop SNHL after otologic surgery

A

Immediate: Labyrinthine trauma
Delayed: Granuloma formation around prosthesis (stapes)

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11
Q

Patterns of hearing loss in Menieres disease

A

Fluctuating, unilateral, low frequency SNHL

Also tinnitus, vertigo, & aural fullness. Can be bilateral rarely.

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12
Q

Pattern of hearing loss from ototoxicity

A

Bilateral, high frequency SNHL with tinnitus

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13
Q

Common ototoxic drugs

A 
Aminoglycosides (also vestibulotoxic)
Loop  diuretics
Cisplatin
Aspirin
Quinine
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14
Q

Pattern of hearing loss from presbycusis

A

Down-sloping or flat SNHL

Good speech discrimination

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15
Q

Initial workup of a child who fails their newborn hearing test

A

CMV titers
GJB2 genetic testing

CMV is the most common congenital infx causing HL
GJB2 (connexin 26) is the most common inherited deafness

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16
Q

High risk factors for newborn SNHL

A 
Some congenital/childhood infections
LBW (5d
Bacterial meningitis
Asphyxia at birth
Mechanical ventilation (>10d)
Head trauma
Neurodegenerative disorders
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17
Q

What are the most common other conditions seen in deaf children?

A

1) Mental retardation
2) Visual impairment
3) Cerebral palsy

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18
Q

What test can determine which ear will perform better with a cochlear implant?

A

Promontory testing

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19
Q

Treatment options for tinnitus with normal hearing

A

Stop aspirin & caffeine
Counseling
Masking devices
Trial of antidepressants

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20
Q

Levels of hearing loss

A 
Mild (25-40 dB)
Moderate (40-55 dB)
Moderate-severe (55-70 dB)
Severe (70-90 dB)
Profound (>90 dB)
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21
Q

What is the maximal conductive hearing loss?

A

60 dB

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22
Q

Hearing loss in a total TM perforation

A

40 dB

If you see a greater conductive loss than this, consider additional pathology.

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23
Q

What are the ligaments of the middle ear ossicles?

A

Anterior malleal: Anterior process to anterior epitympanic wall
Lateral malleal: Lateral process to notch of Rivinus
Superior malleal: Head of malleus to roof of middle ear
Posterior incudal: Short process of incus to fossa incudis

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24
Q

Where do the tensor tympani & stapedius emerge from?

A

Tensor tympani = cochleariform process of eustachian tube

Stapedius = pyramidal eminence

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25
What are the symptoms of Ménière's?
SNHL Tinnitus Episodic vertigo Also aural fullness, otalgia
26
How long does vertigo last in Ménière's?
20 minutes to 24 hours classically
27
Treatment options for Ménière's Disease
``` Non-ablative: Low salt diet Increase water intake HCTZ Betahistine Vestibular rehab PE tube and pressure system ``` Ablative: Gentamycin/Streptomycin Endo lymphatic sac decompression/shunt Labyrinthectomy
28
What axis do the malleus & incus rotate around?
Anterior mallear ligament | Posterior incudal ligament
29
What are the 3 physical advantages in sound transmission within the middle ear?
``` Catenary lever (shape of eardrum) = 2:1 Ossicular lever (manubrium:long process of incus) = 1.3:1 Hydraulic lever (size of TM vs. stapes footplate) = 21:1 ```
30
Ossicular vs. accoustic coupling
``` Ossicular = trasmission of sound to the cochlea via ossicles Accoustic = transmission through the cochlea (round/oval window interactions) ```
31
What is a Carhart notch?
Bone conduction depression that peaks at 2000 Hz Caused by ossicular fixation Is not real, just artifact
32
Air-bone gap seen in ossicular fixation
Sideways hourglass | The air-bone gap is greatest at the low & high frequencies
33
Air-bone gap seen in ossicular discontinuity
Parallel lines 50-60 dB apart across all frequencies
34
What are the tumors found in the temporal bone?
``` Exostoses EAC SCC Glomus tumor Adenoma Congenital cholesteatoma Endolymphatic Sac Tumor (ELST) ```
35
Exostoses vs. Osteomas
Exostoses: Sessile, multiple, bilateral Osteomas: Pedunculated, unilateral
36
How does early otosclerosis present on CT?
Lucency at the fissula ante fenestram | fenestral otosclerosis; just anterior to oval window
37
Otoscopic sign of otosclerosis
Schwartz sign (Flamingo's pink sign) Hyperemia of the promontory behind the TM
38
Diagnosis of otosclerosis
HL can be SNHL, CHL, or mixed | Inverted acoustic reflexes
39
Four most common CPA tumors
1) Vestibular shwannoma 2) CPA meningioma 3) Epidermoids 4) Schwannomas of other CN's
40
CPA epidermoid appearance on MR
Low T1, High T2 (cystic) | Restricted diffusion
41
Differentiating meningiomas & acoustic neuromas on MR
``` Meningiomas = Sessile, dural tail AN = Globular, may extend into IAC ```
42
What are the causes of otic capsule demineralization?
``` Cochlear Otospongiosis Osteogenesis imperfecta Paget disease Fibrous dysplasia Osteoradionecrosis Otosyphilis ```
43
Which orientation of temporal bone fracture portends greater risk?
Transverse fractures More risk of facial paralysis or SNHL, especially if otic capsule is violated
44
Imaging findings for an aberrant carotid
"7 sign" on angio | Soft tissue mass on promontory
45
What is the auditory pathway?
``` Eighth n. Cochlear nucleus Olivary nucleus (superior) Lateral lemniscus Inferior colliculus Medial geniculate Auditory cortex ```
46
What systemic viruses can cause hearing loss?
``` Varicella-Zoster Mumps Measles HIV CMV Rubella ```
47
What systemic bacterial infections can cause hearing loss?
Syphilis | Lyme disease
48
What granulomatous diseases can cause hearing loss?
Langerhans cell histiocytosis Sarcoidosis GPA
49
What systemic autoimmune diseases have otologic manifestations?
``` Cogan's syndrome Polyarteritis nodosa Relapsing polychondritis Rheumatoid arthritis GPA ```
50
What is Heerfordt syndrome?
AKA Uveoparotid fever Manifestation of sarcoidosis that includes parotitis, uveitis, fever, and facial n. paralysis
51
What is seen in. Cohan syndrome?
Keratitis Vertigo Tinnitus Hearing loss
52
Timeframe of SSNHL and AIED
SSNHL: Unilateral and develops within 72h AIED: Eventually bilateral and takes weeks to months
53
What type of hearing loss is seen with Paget's?
Mixed hearing loss
54
What is a pure tone temporary threshold shift?
SNHL following exposure to loud noise, which recovers almost completely within 24 hours
55
What is the typical progression of an audiogram in a patient with NIPTS?
NIPTS = noise induced permanent threshold shift Begins in higher frequencies, progresses to lower frequencies. Typically shows a notch at 3, 4 or 6 kHz with recovery at 8 kHz
56
What level of noise intensity is considered dangerous for acoustic trauma?
140 dB Acoustic trauma is a single exposure to a very intense short-duration sound
57
At what level does chronic noise exposure become dangerous for NIPTS?
Greater than 80 dB
58
What is significant about the rate of degeneration observed in ARPTS vs. NIPTS?
NIPTS is decelerating ARPTS is accelerating Can be used to differentiate the two clinically
59
What are the side effects of Cisplatin?
Ototoxicity Nausea/vomiting Nephrotoxicity Peripheral neuropathy
60
What are common ototoxic medications?
``` Cisplatin Aminoglycosides Loop diuretics Macrolides Vancomycin ASA/NSAIDs ```
61
What is considered a narrow or wide IAC?
Narrow <3mm (absent or hypoplastic CNVIII) | Wide >10mm (stapes gusher)
62
T1 & T2 MRI characteristics of cholesteatomas
T1 Low | T2 High
63
T1 & T2 MRI characteristics of meningiomas
Both isointense
64
T1 & T2 MRI characteristics of cholesterol granulomas
High on both T1 & T2
65
T1 & T2 MRI characteristics of schwannomas
T1 & T2 isointense | Foci of high T2 intensity
66
In what direction do the VA & CA run in the temporal bone?
VA runs perpendicular | CA runs parallel (different cut)
67
What does the inferior vestibular nerve innervate?
PSI Posterior SCC Saccule Inferior vestibular nerve Superior innervates everything else (SSCC, LSCC, utricle)
68
Where does the vagus supply sensory innervation to the ear?
Arnold's n. Supplies conchal bowl and EAC
69
Where does the auriculotemporal supply sensory innervation to the ear?
Helical crus and superior 1/3
70
Where does the lesser occipital supply sensory innervation to the ear?
Middle 1/3 of helix
71
Where does the great auricular supply sensory innervation to the ear?
Lower 1/3 and lobule

ENT (10 decks)

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