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ENT > Otology/Audiology > Flashcards

Otology/Audiology Flashcards

1
Q

Congenital cholesteatoma

A
  • Anterior and superior
  • TM intact and normal
  • No previous history of ear discharge, perforation or ear surgery
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1
Q

Carharts notch

A

Seen in otosclerosis - decrease in bone conduction of 10-15dB at 2kHz

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2
Q

Facial recess boundaries

A

facial nerve, chorda tympani, incus buttress

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3
Q

Gradenigo’s syndrome

A

petrous apicitis - retroorbital pain, lateral rectus palsy, otorrhea

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4
Q

Henneberts phenomenon

A

pressure induced vertigo and/or nystagmus (SSC dehiscence)

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6
Q

Malleus anatomy

A

head, neck, manubrium, anterior process, lateral process

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7
Q

Ossicular disruption hearing loss

A

60db hearing loss

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7
Q

Most common area of facial nerve dehiscence

A

Tympanic segment

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8
Q

Rollover

A

Retrocochlear pathology

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9
Q

Schwartz sign

A

Otosclerosis - increased vascularity of the promontory seen through the ear drum

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11
Q

Sensation of auricle

A

C3, C2, X, V3, VII

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12
Q

Stapedius insertion

A

Pyramidal process

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13
Q

Incus anatomy

A

body, short process, lenticular process

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14
Q

Stapes anatomy

A

Head, neck, anterior crus, posterior crus, footplate

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15
Q

Tensor tympani insertion

A

Cochleariform process

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16
Q

TM perforation hearing loss

A

20dB

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17
Q

Tullios phenomenon

A

sound induced vertigo and/or nystagmus (SSC dehiscence)

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18
Q

What is the orientation of the semicircular canals?

A
  • Superior
  • Lateral
  • Posterior
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19
Q

Intratympanic segments of facial nerve

A
20
Q

What is a type 1 tympanoplasty?

A

Type 1 involves repair of the tympanic membrane alone, when the middle ear is normal.

A type 1 tympanoplasty is synonymous to myringoplasty.

21
Q

What is a type 2 tympanoplasty?

A

Type 2 involves repair of the tympanic membrane and middle ear in spite of slight defects in the middle ear ossicles.

22
Q

What is a type 3 tympanoplasty?

A

Type 3 involves removal of ossicles and epitympanum when there are large defects of the malleus and incus.

The tympanic membrane is repaired and directly connected to the head of the stapes.

23
Q

What is a type 4 tympanoplasty?

A

Type 4 describes a repair when the stapes foot plate is movable, but the crura are missing.

The resulting middle ear will only consist of the eustachian tube and hypotympanum.

24
Q

What is a type 5 tympanoplasty?

A

Type 5 is a repair involving a fixed stapes footplate.

25
Q

Describe the orientation of the IAC nerves?

A

Bills bar
Falciform crest

26
Q

What are the fissures of Santorini?

A

Two (usually) vertical fissures in the anterior portion of the cartilaginous external auditory canal, filled with fibrous tissue.

Can lead to spread of malignancy from parotid to EAC, and vice versa

27
Q

What is Hyrtl’s Fissure?

A

Transient anatomic landmark in petrous temporal bone and usually closes by 24th week of gestation.

Located between the otic capsule and the jugular bulb

Can persist, and cause a perilabyrinthine CSF fistula

28
Q

What is the foramen of Huschke?

A

Also known as the Foramen Tympanicum

Located at the anteroinferior aspect of the EAC, posteromedial to the TMJ, in the tympanic portion of temporal bone

If persists after 5 years of age, may lead to TMJ pathology or salivary discharge into the EAC with mastication

May also predispose to spread of infection or tumor from EAC to infratemporal fossa or vice versa.

29
Q

List the anatomy of the tympanic membrane

A

Right TM

30
Q

List the anatomy of the pinna

A

Concha cymba, concha cavum

31
Q

Where is Prussak’s space?

A

Bordered laterally by Shrapnell’s membrane, superiorly by the scutum and lateral malleal ligament, inferiorly by the short process of the malleus, and medially by the neck of the malleus

Important because it is a site for pars flaccida acquired cholesteatoma

32
Q

What is the average surface area of the tympanic membrane?

A

65-80 mm2

33
Q

At what age do the ossicles and the TM reach full size?

A

Birth

34
Q

What is the pouch of von troeltsch?

A

anatomical spaces between the malleolar folds and the tympanic membrane

35
Q

What is Ramsay Hunt Syndrome?

A

Herpes Zoster Oticus

essentially herpes zoster with a facial
nerve palsy, may also affect other cranial nerves

Pathophysiology

primary infection or reactivation of herpes simplex virus (HSV), remains dormant in the cranial nerves and the cervical plexus

30–50% risk of residual facial weakness after an acute episode (higher risk than Bell’s palsy)

Symptoms

acute peripheral facial palsy, painful vesicular lesions in the concha or EAC (often misdiagnosed as external otitis media), alterations in taste, may have hearing loss and vertigo, may involve
other cranial nerves

Diagnosis

clinical history and physical exam, complement fixation and serum titers confirm diagnosis

Treatment

antivirals (acyclovir) and corticosteroids for 10 days, analgesics, and eye protection, rare to consider surgical facial nerve decompression

36
Q

Where is a cochlear implant placed?

A

Scala tympani

37
Q

Ototoxic medications

A
  1. Furosemide
  2. Aspirin
  3. Beta-blockers
  4. Quinine
  5. Aminoglycosides (e.g. gentamicin)
38
Q

How many dB loss is required to have a negative Rinne’s test?

A

25dB

39
Q

What is the most common intracranial complication of acute otitis media?

A

Meningitis

40
Q

What is the most common extracranial complication of acute otitis media?

A

Mastoiditis

41
Q

What is the most common cause of *acquired *hearing loss?

A

Otitis media

42
Q

Most common cause of genetic hearing loss?

A

Most cases of genetic hearing loss are autosomal recessive and nonsyndromic.

Hearing loss that results from abnormalities in connexin 26 and connexin 30 proteins likely account for 50% of cases of autosomal recessive nonsyndromic deafness in American children.

43
Q

Most common cause of syndromic hearing loss?

A

Usher syndrome is the most common cause of autosomal recessive hearing loss.

The incidence of Usher syndrome is approximately 3-5 per 100,000 in the general population and 1-10% among profoundly deaf children.

44
Q

What is the key histopathological feature in Otosclerosis?

A

Blue mantles of manasseh

45
Q

Features of Malignant (necrotizing) Otitis Externa

A

AKA Skull base osteomyelitis

Progressive Pseudomonas osteomyelitis in the temporal bone

Diabetes mellitus remains most important associated condition

Infection from the EAC spreads to the skull base via fissures of Santorini.

Leads to bony destruction, can lead to cranial neuropathies (FN most common at stylomastoid foramen)

Will see granulation tissue, purulence, even bone at inferior EAC at bony-cartilaginous junction. TM not involved.

46
Q

What is the difference between an Osteoma and Exostosis?

A

Osteoma of the EAC is singular

Exostosis is multiple (aka surfers ear in picture below)

Facial nerve injury very common in aggressive removal of exostosis*

ENT (17 decks)

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