Otorrino 2 Flashcards
1
Q
In the audio logic testing, what structures does physiologic measures evaluate?
A
Middle ear, cochlear and retro cochlear status
2
Q
What test does physiologic measures has?
A
- otoacoustic emissions testing for peripheral auditory status (OAE)
- Tympanometry
- acoustic reflex
3
Q
What does electrophysiologic testing evaluates
A
Peripheral auditory function and auditory nervous system function
4
Q
Involuntary Reflex caused by a strong contraction of the stapedius muscle, which is detonated by loud noises in order to protect the ear
A
Acoustic or stapedius reflex
5
Q
Three tests that audiologic testing comprises, and which ones are behavioral and objective
A
Behavioral tests: hearing sensitivity, and speech recognition like audiometry
Objective tests: physiologic measures en electrophysiologic, for example, tympanometry, acoustic reflex, auditory brainstem, response, etc.
6
Q
Introduction of noise to the non-test ear during a pure tone Audiogram with white noise to prevent crossover, usually done to identify asymmetric hearing loss 
A
Masking
7
Q
Test in which you put the patient in a Cavan to measure volume and frequency starting on the healthiest year
A
Puretone audiogram
8
Q
Symbols of the audiogram
A
Right - red
< - bone conduction
O - air conduction
Left - blue
> - bone conduction
X - air conduction
9
Q
Bone conduction can be below the air conduction on the audiometry
A
Force bone conduction must be above air conduction
10
Q
How to classify the audiometry based on the hearing loss patterns
A
Conductive
AC >25
BC <25
ABG >10
Sensory neural
AC >25
BC >25
ABG <10
Mixed
AC >25
BC >25
ABG >10
11
Q
How do you classification the magnitude of hearing loss and how many types are there?
A
Base of the Puretone average adding the threshold where is the AC symbol, falls in 500 1000 and 2000 Hz and dividing by 3
Mild 25 to 40
moderate 40 to 55
Moderate severe 55 to 70
Severe 70 to 90
Profound more than 90 
12
Q
What type of pathologies can cause a conductive hearing loss
A
otitis media, earwax, Tim panic membrane rupture, foreign body 
13
Q
What type of pathologies can calls sensory neural hearing loss
A
Presbiacusy, ototoxicity, tumors, trauma
14
Q
This test represents the lowest intensity, at which the patient can correctly repeat half of the spondaic words or other speech, stimuli
A
Speech audiometry
15
Q
Types of test done in pediatric patients for audiology testing
A
<6 months: behavioral observation audiometry
6 months - 2.5 years: visual reinforcement audiometry
2.5 to 4 years: play audiometry
16
Q
Test that measures of movement of the membrane by sealing the ear canal, pumping air and causing movement 
A
Tympanometry 
17
Q
Normal tympanometry threshold’s
A
DaPa > -50
MmHg 0.5-1.3
18
Q
Types of tympanometry patterns
A
Type A = sensorineural HL
Normal parameters
Type As = otoesclerosis
DaPa normal
mmHg <0.5
Type Ad = osicular chain luxation
DaPa normal
mmHg >1.3
Type B = otitis media/conductive HL y perforación
DaPa x
mmHg x
Type C = eustaquian tube disfunction (adenoid, rhinitis)
DaPa < -50
mmHg normal
19
Q
Nerve In Charge Of Moving stapedius muscle and, tympanic muscle
A
Stapedius- facial nerve
Tympanic - trigeminus
20
Q
Where is the place where the vestibular nerve crosses in the brain stem
A
Medial superior olive nucleus 
21
Q
Causes of an absent acoustics reflex threshold
A
Conductive hearing loss
Sensory neural hearing loss above 50 dB
Nerve lesion
Stapedius lesion
22
Q
Acoustic admittance testing is useful for the detection of middle ear, effusion in pediatric population. True or false
A
True
23
Q
Screening test used to track the movement of the outer cells. Useful in detection of hearing disorders, ototoxicity and retro cochlear pathology.
A
Oto acoustic emissions
24
Q
Anatomical site, which contains the tectorial membrane that causes the movement of the Celia, particularly external cilia
A
Corti organ
25
Tool for recording the very early latency vote potential’s from the cochlea and distal auditory nerve
Electrocochleograpgy
26
Test in which you put an electrode before head over there in the mastoid to measure evoked potential. Useful in babies, patients with palsy, autism, that can’t cooperate with audiometry. 
Auditory brainstem response
27
Parts of the pinna
Helix
Antihelix
Anti-tragus
Tragus
Lobule
28
Narrowest point of the external ear canal
Bony cartilaginous Junction
First third is cartilage and the second and third is bony structure
29
Ear epithelium
Stratified squamous
30
Which one of the following nerves doesn’t give innervation to the ear
Trigeminal facial Vegas, spinal or great auricular nerve
Spinal
31
Artery that gives irrigation to the medial ear canal and timpani membrane
Maxillary artery
32
Unilateral malformation’s present at birth classified with the Marx system
Microtia 
33
What grade of microtia that’s no recognizable landmarks of the pinna and has a peanut shape
3
34
Grade of microtia, when there’s a mild deformity, with a dysmorphic helix, and anti-helix
1
35
The absence of the external ear is called
Anotia or grade 4 microtia
36
Which type of hearing loss do patients with microtia present
Conductive hearing loss detected with auditory brainstem response
37
Is caused by the lack of antihelix fold in prominence of concha bowl
Protruding ears
38
Neck masses among the branchial, cleft anomalies associated with infection, and present with pain and swelling
First branchial Cleft anomalies
39
Accumulation of blood in the subpericondral space secondary to blunt trauma
Auricular hematoma
40
Pathology the presents with otalgia, otorrhea, hearing loss and tragus sign
Often caused by pseudomonas and S Aureus
Otitis externa
41
Inflammatory process of the EAC due to infection with fungi
Otomicosis
42
Pathology that presents usually with facial palsy, Otorrhea
In the otoscopy, you can see a **granulation tissue**
Skull base osteomielitis
43
Hypersensitivity that causes contact dermatitis
Type 4
44
Most common malignant neoplasm in the ear
Basal cell carcinoma 
45
Growth of the lamellar bone common in surfers
Exostosis
46
The middle ear cleft comprises 3 contiguous components:
eustachian tube,
the tympanic cavity (middle ear)
the mastoid air cells (antrum is the biggest cell)
47
Mucosa inflammation in absence of effusion caused by an infection which causes bulging
* Upper respiratory infection prior
* Otoscopy: Hyperemia, **Purulent** secretion posterior to the membrane
* **Fever**
ACUTE OTITIS MEDIA
48
common pathogens for otitis media
H. Influenzae, S. Pneumoniae, Moraxella catharalis
49
Intracranial OM complications
4
* Meningitis
* Otitic hydrocephalus
* Abscess
* Sigmoid sinus thrombophlebitis
50
**Increased intracranial pressure secondary to AO or OME.**
* Headaches, lethargy, and papilledema
* **no meningeal signs** or evidence of intracranial abscess
Otitic hydrocephalus
51
OM complication in which Patients present classically with diurnal or “picket fence” fever curves, septicemia, and **torticollis**.
Sigmoid sinus thrombophlebitis
52
OM complications (no intracraneal)
| 5
* Tympanic perforation
* Mastoiditis - Bezold abscess (sternocleoidmastoid)
* Petrous apicitis- Gradenigo syndrome
* Facial nerve palsy - indicator of tx with tympanostomy tubes
* Labyrinthitis - mixed hearing loss and Vertigus
53
Ephitelium of middle ears forms **sterile liquid** (mucous or secretion); common in children (manifested with speech delay or need to much volume to hear)
* **Asymptomatic**
* NOT painful
* Aural fullness
* Hearing loss
Otoscopy: liquid with air bubbles
OM with effusion
54
OE complications
| 4
* Conductive hearing loss
* Speech delay
* Atelectasis
* Choleastoma
55
Complication in medium ear that can expand locally destroying nearby structures, leading to serious long-term complications including facial paralysis, labyrinthitis, meningitis, and hearing loss.
| OE complication
Choleastoma
56
Recurrent AOM
* ≥ 3 episodes in a 6-month period
* ≥ 4 episodes in a 12-month period
with complete resolution of symptoms between episodes.
57
Tympanostomy tube placement is the surgical **treatment of choice** for **chronic** **OME** in children < 4 years old.
True or false
True
58
Tympanostomy tube placement AND adenoidectomy is the surgical **treatment of choice** for **chronic** **OME** in children > 4 years old.
True or false
True
59
Chronic OME
the presence of effusion for ≥ 3 months
60
fever, headache, **photophobia**, fluctuating mental status, and neck rigidity during an episode of AOM
Meningitis post OM
61
**Outgrowth of the bone in the cartilaginoid-bone junction**; usually unilateral
- Pedunculated and hard
- Causes conductive hearing loss
Osteoma
62
Complication where the classic triad of symptoms includes retro-orbital pain, AOM, and **ipsilateral abducens nerve paresis**
| Para
Gradenigo syndrome from Petrous apicitis
| Petrous apicitis
63
main tumor of cerebellopontine angle tumor that can cause sensorineural HL
Schwanoma
64
Test indicated to trace movement of the outer hair cells
Otoacoustic emissions
65
Weber test interpretation
If sound lateralizes to one side
Sensorineural = lateralizes to UNAFFECTED SIDE
Conductive = lateralizes to AFFECTED side
66
Rinne test interpretation
(+) = normal/sensorineural = AC > BC
(-) = conductive = BC > AC
67
unilateral or asymmetric sensorineural hearing losses should undergo an MRI
True
68
Congenital cause of sensorineural Hearing Loss caracterized by **RETINITIS**
Usher syndrome
69
The predominant etiology of hearing impairment in children
Viral
70
Congenital cause of sensorineural Hearing Loss caracterized by **pigmentary abnormality**
Waardenburg
71
Age-associated hearing loss most common cause of hearing loss in adults; high-frequency hearing loss that eventually progresses to involve all frequencies
presbycusis
72
Sensorineural hearing loss is more commonly associated with what kind of fracture
transverse fractures
73
Fluctuating episodes of **hearing loss**, **vertigo**, **tinnitus**, and aural fullness.
The underlying pathophysiology is believed to be an **increase in fluid pressure within the endolymphatic** compartment that results in periodic tears in the delicate cochlear membranes.
Meniere disease
74
One of the most common types of peripheral vertigo
* **vertigo** lasting **seconds** to couple of minutes in certain positions
* **No spontaneous** nystagmus
* arising as a result of debris in the **posterior semicircular canal**.
**NO associated HEARING LOSS**
BENIGN PAROXYSMAL POSITIONAL VERTIGO
75
Characteristic fatigable **nystagmus** ONLY when performing manneuver **Dix Hallpike test**
BENIGN PAROXYSMAL POSITIONAL VERTIGO
76
Tx BENIGN PAROXYSMAL POSITIONAL VERTIGO
* Epley manneuver
*
77
Presents
* **unilateral**, fluctuating **sensorineural** **hearing loss** (often involving low frequencies)
* **vertigo** that lasts minutes to **hours**
* tinnitus typically increasing in intensity before or during the vertiginous attack
* **aural fullness**
MENIERE DISEASE
78
Meniere treatment
* Sodium restricted diet (≤ 2000 mg/d)
* diuretics (eg, diazide).
Refractory = gentamicin therapy
Acute exacerbation = oral steroids
79
The endolymphatic sac is also located along an imaginary line called
Donaldson line
80
sudden onset of **vertigo** with nausea and vomiting lasting **days** after an **upper respiratory infection**
* Spontaneous nystagmus
* suppressed by visual fixation
* NO headache
| Primary cause for acute *vertigo lasting days* is a brainstem **stroke**
## Footnote
The most likely cause is the reactivation of a latent **herpes** simplex virus type 1 (HSV-1) infection.
VESTIBULAR NEURONITIS
81
Nerve commonly affected in neuronitis
superior vestibular nerve
82
Tx vestibular neuronitis
* vestibular suppressants
* antiemetics
* antiviral HSV
83
Vertigo when exposed to loud noises
Tullio phenomenon
84
Vertigo with pressure changes in the ear
Hennebert sign
85
* Vertigo induced by loud noises, pressure on the external auditory canal
* Autophony
* Nystagmus
* Conductive Hearing loss
SUPERIOR SEMICIRCULAR CANAL DEHISCENCE
86
The central compensation for vestibular injury occurs via
Cerebellum
87
primary pathophysiological site in Bell palsy
the meatal foramen BUT he said fallopian canal in ear
| “physiological bottleneck”
88
Patología donde
* Acute onset (<48 hour)
* **unilateral** **paresis** consistent with peripheral nerve dysfunction
* Dysfunction of cranial nerves V, VIII, IX, and X
* Others: Pain or numbness affecting the ear, midface, and tongue taste disturbances hearing loss and dizziness
* **instead of closing the eye, the eyeball goes upward**
Bell palsy
89
Syndrome of **acute peripheral facial palsy** associated with otalgia and **varicellalike** cutaneous **lesions** that may involve the external ear
Ramsay Hunt syndrome
90
House Brackman scale
| 6
1 - normal
2 - complete **eye closure w/little effort**, moderate forehead movement, slight mouth assymetry w/movement - normal at rest
3 - **not** **disfiguring** facial **assymetry**, synkinesis, hemifacial spasm, slight forehead movement, **eye close w/effort** - normal at rest
4 -**disfiguring facial weakness**, no forehead movement, **incomplete eye closure**, assymetrical mouth movement - normal at rest
5 - **assymetry at rest**,slight noticeable movement, no forehead movement, incomplete eye closure, **slight mouth movement**
6 - NO FACIAL FUNCTION
91
Tx bell palsy
* Steroid therapy
* Antiviral therapy
* Physical therapy
92
* Progression of a facial palsy **>3 weeks**
* Facial hyperkinesia, particularly hemifacial spasm, antecedent to the palsy
* Associated dysfunction of regional cranial nerves
* Prolonged otalgia or facial pain
* **Mass in the middle ear**, external ear canal, digastric region, or parotid gland
* **Recurrent ipsilateral palsy**
| Most frequently a facial neuroma
FACIAL NERVE NEOPLASMS
| Tx surgery
93
Multisystem infection induced by the tickborne strain of the Borrelia burgdorferi spirochete
* **Erythema migrans** (targetshaped rash)
* Interval between the onset of the rash and facial palsy is **less than 2 months**
* Facial palsy associated with other neurological deficits
LYME DISEASE
94
Evidence of prior or existing **suppurative otitis media**, or if there is a history of prior otologic surgery, an otogenic etiology should be suspected
* **Palsy** is often progressive over a **2day to 3day interval**
* Hearing loss, otorrhea, and vestibular symptoms
ACUTE OTITIS MEDIA AND MASTOIDITIS!
95
* Infection by **Pseudomonas aeruginosa** is the primary offending agent
* patients with diabetes mellitus or in others who are immunocompromised
* **GRANULATION TISSUE** at the **bonycartilaginous junction**
Dx: Gammagraphy w/gallium
NECROTIZING (MALIGNANT) OTITIS EXTERNA
96
Tx NECROTIZING (MALIGNANT) OTITIS EXTERNA
* Antibiotic IV (quinolone) 8-12 week
* debridement
* Radioisotope scanning
97
**Möbius syndrome** encompasses a wide spectrum of anomalies due to **dysgenesis** at the level of the **brainstem** with resultant neuromuscular deficits peripherally.
**Facial and Abducens**
Congenital Perinatal Facial Palsy
98
Define the salivary glands
| 6
* 2 parotid glands
* 2 submandibular glands
* 2 principal sublingual glands
99
The secretions of the parotid and submandibular glands are primarily stimulated by
autonomic nervous system
100
* **largest** of the paired major salivary glands
* Location: lateral to the masseter muscle anteriorly and extends posteriorly over the sternocleidomastoid muscle behind the angle of the mandible.
* Divided by the branches of the seventh cranial nerve (VII).
* The **Stensen duct**
Parotid gland
101
* Second largest salivary glands in the body
* Divided by the posterior edge of the mylohyoid muscle
* The **Wharton duct**, is inelastic and therefore, when obstructed **causes pain**
Submandibular gland
102
* Locatin: in the submucosa, superficial to the mylohyoid muscle.
* Multiple small or “minor” sublingual ducts called **ducts of Rivinus**, which open directly into the oral cavity.
* The lingual nerve descends laterally to the anterior end gland
Sublingual Glands
103
Saliva is produced by the** clustered acinar cells** (500 to 1500 mL) and contains electrolytes, enzymes (eg, ptyalin and maltase), carbohydrates, proteins, inorganic salts, and even some antimicrobial factors and its acid
True or False
False, its alkaline
104
hyperproduction of saliva
Ptyalism
105
# INFECTIOUS DISEASE
* **most common viral** disorder causing parotitis and is contagious.
* Acute, **bilateral swelling** of the parotid glands
* **Pain**, **erythema**, tenderness, malaise, fever, and occasionally trismus.
* Peak incidence in young **children** aged 4 to 6 years.
Mumps (Paramyxovirus)
106
# INFECTIOUS DISEASE
stasis of salivary flow in patients, obstruction, of the ducts then follows.
* Acute **painful**
* fever and **purulent salivary secretions**.
* Risk factors include dehydration, trauma, immunosuppression, and debilitation
* Untreated may lead to an abscess
Tx: rehydratation, IV antibiotic, warm compresses
acute suppurative sialadenitis
107
1º gland affected in Sialolithiasis
**submandibular gland** , more susceptible to calculi formation than the parotid gland because of the **longer course of its duct,** higher salivary mucin and alkaline content, and higher concentrations of calcium and phosphate.
108
# NONINFECTIOUS INFLAMMATORY DISEASE
* Acute, **painful** swelling
* **Aggravation of symptoms with eating**; swelling may subside after approximately 1 hour.
* A stone in the floor of the mouth may be palpated
Sialolithiasis
109
# Chronic sialadenitis - NONINFECTIOUS INFLAMMATORY DISEASE
* Autoimmune disorder
* PAINLESS
* parotid enlargement, **xerostomia**, and **keratoconjunctivitis** sicca.
* It also may be associated with a connective tissue disease
High risk for development of **malignant lymphoma** in primary Sjögren syndrome.
More commonly seen in **postmenopausal women**
| Chronic sialadenitis
Sjögren syndrome
110
# INFECTIOUS DISEASE
* Painless,
* bilateral enlarged parotid glands
* **Xerostomia**
* Associated **cervical lymphadenopathy**
Hiv infection of the parotid glands
111
Treatment Sialolithiasis
Depends on the location of the calculus
* **Anterior portion** of the submandibular duct = **Intraoral** Extraction
* Symptomatic stone embedded in the body of the parotid gland or larger stones = **Surgical** Excision
112
# NONINFLAMMATORY DISEASE
Rare, noninflammatory condition that causes **bilateral**, diffuse, and **painless** **enlargement** of the salivary glands (parotid gland is the most affected)
This condition may also cause **degenerative changes** to the autonomic innervation of the glands.
**Alcohol** risk factor
Sialadenosis
113
Differencia in type 1 cysts and type 2
type 1
anteroinferior to the ear lobule.
type 2
sternocleidomastoid muscle or the external auditory canal
114
# NONINFLAMMATORY DISEASE
**Dilatations of the minor salivary gland** ducts frequently in the lip (60%–70%), buccal mucosa, **floor of the mouth (ranula)**, and palate.
Mucoceles
115
# Neoplasic Lesion
Benign mixed tumors, are the most common neoplasms of the salivary glands.
Pleomorphic adenomas
116
# Neoplasic Lesion
* known as papillary cystadenoma lymphomatosum and is found almost exclusively in the parotid gland.
* Bilateral
* associated risk with **smokers**
Dx: biopsy with **oncocytes**
Tx Complete excision of the affected portion of the gland with uninvolved margins
Warthin tumor
117
A hybrid between an endotracheal tube and a face mask. It can easily be **inserted blindly**
**Contraindications** to using this airway therefore include patients with full stomachs or hiatal hernias, pregnancy, obesity, and abdominal surgeries -- **Aspiration**
Laryngeal Mask Airway
118
The **definitive nonsurgical control of the airway** is via **DIRECT LARINGEAL intubation** or in situations in which **intubation is contraindicated**
True or false
true
119
Principal causes of difficult airway in adults vs children
Children
Congenital airway anomalies (eg, laryngomalacia, choanal atresia, hemangioma, tracheomalacia) and acute inflammatory causes
Adult
trauma
120
Can effectively ventilate the upper airway regardless of whether it is placed into the trachea or into the esophagus
**Contraindicated** in **pediatric** and very small adult patients.
Combitube/King Airway
121
Device that makes easier to manage past obstructing lessions and edema
Jackson slide laryngoscope
122
* Can be performed either via a nasal or an oral route.
* Performing the technique on a **patient while awake and breathing spontaneously**
* the method of choice when **transoral access to the larynx is difficult**
FIBER OPTIC (guided) INTUBATION
123
In **emergency** situations, is generally considered the procedure of **choice**
cricothyroidotomy
124
# “cannot intubate, cannot ventilate.”
indications for establishing an **urgent** surgical airway:
| 6
1. severe **maxillofacial** **trauma** in which injuries make the airway inaccessible for translaryngeal intubation
2. significant **laryngeal** **trauma** in which intubation may potentially cause more damage
3. excessive **hemorrhage** or emesis **obscuring** landmarks required for successful intubation
4. **cervical** **spine** **injury** with vocal cords that are difficult to visualize
5. **failed** **translaryngeal** intubation
6. cases where **nonsurgical** means (bag-mask ventilation; LMA) are not possible or have **failed**
125
A tracheotomy is a procedure that exteriorizes the trachea to the cervical skin
True or false
False, a tracheotomy is generally described as a procedure that involves opening the trachea
A tracheostomy is a procedure that exteriorizes the trachea to the cervical skin
126
indications for performing a tracheotomy include:
| 6
1. bypassing an **upper airway obstruction**
2. providing a means for assisting **mechanical ventilation** (ie, chronic ventilator dependence),
3. enabling pulmonary hygiene
4. temporarily securing an airway in patients undergoing major **head and neck surgery **
5. relieving obstructive sleep apnea
6. eliminating pulmonary “dead space.”
127
Incision used for emergency tracheotomy
Vertical between 2-3 ring
| hepful in obese patients
128
** most emergent surgical airway** done through a transverse incision and can complicate in **stenosis**
CRICOTHYROIDOTOMY
129
Postoperative Considerations
1) **humidifying** inspired air is necessary to prevent crusting and tracheitis
2) **suctioning** the tube and trachea on a frequent basis
3) Bjork flaps removed 3-5 days
130
Before decannulation:
* disease process resolved
* Good airway patency
* adequate airway after 24-hour tube occlusion
131
Early tracheotomy complications
* Infection
* Hemorrhage
* Subcutaneous **emphysema** (air is trapped in the subcutaneous tissues from suturing)
* **Pneumomediastinum** (air is sucked through the wound or from coughing into the deep tissue planes of the neck and into the mediastinum)
* Pneumothorax
* Tracheoesophageal **fistula** (tracheal incision is made too deep)
* **Recurrent laryngeal nerve injury**
* Tube displacement (minimized using stay sutures or the Björk flap)
132
Late tracheotomy complications
* **Tracheal-innominate artery fistula**. One of the most dire complications when the major vessel is eroded by **pressure** **necrosis** from the tracheotomy cuff or directly from the tip of the tube itself. Revealed by **minor sentinel bleeding**
* Tracheal stenosis
* Delayed tracheoesophageal fistula
* Tracheocutaneous fistula (after decannulation of a long-standing tracheotomy)
