Otology

Question 1

Winkler’s Nodule. Chondrodermatitis nodularis helices

Answer 1

Pinna nodule in old men, painful. Looks like basal cell. Associated with pressure or trauma
Tx: avoid sleeping on pillow, steroid injection, excisional biopsy but high recurrence

Question 2

Pink pinna nodule with chalky substance inside

Answer 2

Gout. Utica acid crystals.

Tx: medical control of gout, anelgesics

Question 3

Ochronosis

Answer 3

Painful pinna nodule. Patients with alkaptonurea… black tissue

Question 4

Marginal TM perfect

Answer 4

Involves the annulus. Less likely to heal on its own

Spontaneously healed TM perf results in a dimeric membrane

Question 5

Otosclerosis

Answer 5

60% have family hx
Measles virus has been implicated
Increased osteoclastic activity then osteoblasts make immature bone
Usually oval window but can also be round window
Could progress to involve the inner ear and have SNHL
CO2 Carhart Notch 2k
Schwartze sign: hyperemia behind TM from increased vascularity, so active phase

Question 6

Cochlear otosclerosis CT findings

Answer 6

Halo sign with less dense bone around the optic capsule

Question 7

Perilymph gusher

Answer 7

X-linked and associated with other anomalies like wide IAC. Risk of SNHL and meningitis
Tx: seal vestibular opening with graft, place prosthesis, pack and close. Lumbar drain for large or persistent leak