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ENT > Otology > Flashcards

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
Q

What are the symptoms of Ménière’s?

A

SNHL
Tinnitus
Episodic vertigo

Also aural fullness, otalgia

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26
Q

How long does vertigo last in Ménière’s?

A

20 minutes to 24 hours classically

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27
Q

Treatment options for Ménière’s Disease

A 
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

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28
Q

What axis do the malleus & incus rotate around?

A

Anterior mallear ligament

Posterior incudal ligament

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29
Q

What are the 3 physical advantages in sound transmission within the middle ear?

A 
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
Q

Ossicular vs. accoustic coupling

A 
Ossicular = trasmission of sound to the cochlea via ossicles
Accoustic = transmission through the cochlea (round/oval window interactions)
31
Q

What is a Carhart notch?

A

Bone conduction depression that peaks at 2000 Hz
Caused by ossicular fixation
Is not real, just artifact

32
Q

Air-bone gap seen in ossicular fixation

A

Sideways hourglass

The air-bone gap is greatest at the low & high frequencies

33
Q

Air-bone gap seen in ossicular discontinuity

A

Parallel lines 50-60 dB apart across all frequencies

34
Q

What are the tumors found in the temporal bone?

A 
Exostoses
EAC SCC
Glomus tumor
Adenoma
Congenital cholesteatoma
Endolymphatic Sac Tumor (ELST)
35
Q

Exostoses vs. Osteomas

A

Exostoses: Sessile, multiple, bilateral

Osteomas: Pedunculated, unilateral

36
Q

How does early otosclerosis present on CT?

A

Lucency at the fissula ante fenestram

fenestral otosclerosis; just anterior to oval window

37
Q

Otoscopic sign of otosclerosis

A

Schwartz sign
(Flamingo’s pink sign)

Hyperemia of the promontory behind the TM

38
Q

Diagnosis of otosclerosis

A

HL can be SNHL, CHL, or mixed

Inverted acoustic reflexes

39
Q

Four most common CPA tumors

A

1) Vestibular shwannoma
2) CPA meningioma
3) Epidermoids
4) Schwannomas of other CN’s

40
Q

CPA epidermoid appearance on MR

A

Low T1, High T2 (cystic)

Restricted diffusion

41
Q

Differentiating meningiomas & acoustic neuromas on MR

A 
Meningiomas = Sessile, dural tail
AN = Globular, may extend into IAC
42
Q

What are the causes of otic capsule demineralization?

A 
Cochlear Otospongiosis
Osteogenesis imperfecta
Paget disease 
Fibrous dysplasia 
Osteoradionecrosis 
Otosyphilis
43
Q

Which orientation of temporal bone fracture portends greater risk?

A

Transverse fractures

More risk of facial paralysis or SNHL, especially if otic capsule is violated

44
Q

Imaging findings for an aberrant carotid

A

“7 sign” on angio

Soft tissue mass on promontory

45
Q

What is the auditory pathway?

A 
Eighth n. 
Cochlear nucleus
Olivary nucleus (superior)
Lateral lemniscus
Inferior colliculus
Medial geniculate
Auditory cortex
46
Q

What systemic viruses can cause hearing loss?

A 
Varicella-Zoster
Mumps
Measles
HIV
CMV
Rubella
47
Q

What systemic bacterial infections can cause hearing loss?

A

Syphilis

Lyme disease

48
Q

What granulomatous diseases can cause hearing loss?

A

Langerhans cell histiocytosis
Sarcoidosis
GPA

49
Q

What systemic autoimmune diseases have otologic manifestations?

A 
Cogan's syndrome
Polyarteritis nodosa
Relapsing polychondritis
Rheumatoid arthritis
GPA
50
Q

What is Heerfordt syndrome?

A

AKA Uveoparotid fever

Manifestation of sarcoidosis that includes parotitis, uveitis, fever, and facial n. paralysis

51
Q

What is seen in. Cohan syndrome?

A

Keratitis
Vertigo
Tinnitus
Hearing loss

52
Q

Timeframe of SSNHL and AIED

A

SSNHL: Unilateral and develops within 72h
AIED: Eventually bilateral and takes weeks to months

53
Q

What type of hearing loss is seen with Paget’s?

A

Mixed hearing loss

54
Q

What is a pure tone temporary threshold shift?

A

SNHL following exposure to loud noise, which recovers almost completely within 24 hours

55
Q

What is the typical progression of an audiogram in a patient with NIPTS?

A

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
Q

What level of noise intensity is considered dangerous for acoustic trauma?

A

140 dB

Acoustic trauma is a single exposure to a very intense short-duration sound

57
Q

At what level does chronic noise exposure become dangerous for NIPTS?

A

Greater than 80 dB

58
Q

What is significant about the rate of degeneration observed in ARPTS vs. NIPTS?

A

NIPTS is decelerating
ARPTS is accelerating

Can be used to differentiate the two clinically

59
Q

What are the side effects of Cisplatin?

A

Ototoxicity
Nausea/vomiting
Nephrotoxicity
Peripheral neuropathy

60
Q

What are common ototoxic medications?

A 
Cisplatin
Aminoglycosides
Loop diuretics
Macrolides
Vancomycin
ASA/NSAIDs
61
Q

What is considered a narrow or wide IAC?

A

Narrow <3mm (absent or hypoplastic CNVIII)

Wide >10mm (stapes gusher)

62
Q

T1 & T2 MRI characteristics of cholesteatomas

A

T1 Low

T2 High

63
Q

T1 & T2 MRI characteristics of meningiomas

A

Both isointense

64
Q

T1 & T2 MRI characteristics of cholesterol granulomas

A

High on both T1 & T2

65
Q

T1 & T2 MRI characteristics of schwannomas

A

T1 & T2 isointense

Foci of high T2 intensity

66
Q

In what direction do the VA & CA run in the temporal bone?

A

VA runs perpendicular

CA runs parallel (different cut)

67
Q

What does the inferior vestibular nerve innervate?

A

PSI
Posterior SCC
Saccule
Inferior vestibular nerve

Superior innervates everything else (SSCC, LSCC, utricle)

68
Q

Where does the vagus supply sensory innervation to the ear?

A

Arnold’s n.

Supplies conchal bowl and EAC

69
Q

Where does the auriculotemporal supply sensory innervation to the ear?

A

Helical crus and superior 1/3

70
Q

Where does the lesser occipital supply sensory innervation to the ear?

A

Middle 1/3 of helix

71
Q

Where does the great auricular supply sensory innervation to the ear?

A

Lower 1/3 and lobule

ENT (10 decks)

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