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7mo sem > Otorrino 2 > Flashcards

Otorrino 2 Flashcards

1
Q

In the audio logic testing, what structures does physiologic measures evaluate?

A

Middle ear, cochlear and retro cochlear status

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2
Q

What test does physiologic measures has?

A
  • otoacoustic emissions testing for peripheral auditory status (OAE)
  • Tympanometry
  • acoustic reflex
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3
Q

What does electrophysiologic testing evaluates

A

Peripheral auditory function and auditory nervous system function

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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

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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.

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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

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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

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8
Q

Symbols of the audiogram

A

Right - red
< - bone conduction
O - air conduction

Left - blue
> - bone conduction
X - air conduction

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9
Q

Bone conduction can be below the air conduction on the audiometry

A

Force bone conduction must be above air conduction

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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

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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 

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12
Q

What type of pathologies can cause a conductive hearing loss

A

otitis media, earwax, Tim panic membrane rupture, foreign body 

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13
Q

What type of pathologies can calls sensory neural hearing loss

A

Presbiacusy, ototoxicity, tumors, trauma

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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

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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

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16
Q

Test that measures of movement of the membrane by sealing the ear canal, pumping air and causing movement 

A

Tympanometry 

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17
Q

Normal tympanometry threshold’s

A

DaPa > -50
MmHg 0.5-1.3

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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

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19
Q

Nerve In Charge Of Moving stapedius muscle and, tympanic muscle

A

Stapedius- facial nerve
Tympanic - trigeminus

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20
Q

Where is the place where the vestibular nerve crosses in the brain stem

A

Medial superior olive nucleus 

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21
Q

Causes of an absent acoustics reflex threshold

A

Conductive hearing loss
Sensory neural hearing loss above 50 dB
Nerve lesion
Stapedius lesion

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22
Q

Acoustic admittance testing is useful for the detection of middle ear, effusion in pediatric population. True or false

A

True

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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

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24
Q

Anatomical site, which contains the tectorial membrane that causes the movement of the Celia, particularly external cilia

A

Corti organ

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25
Q

Tool for recording the very early latency vote potential’s from the cochlea and distal auditory nerve

A

Electrocochleograpgy

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26
Q

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. 

A

Auditory brainstem response

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27
Q

Parts of the pinna

A

Helix
Antihelix
Anti-tragus
Tragus
Lobule

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28
Q

Narrowest point of the external ear canal

A

Bony cartilaginous Junction

First third is cartilage and the second and third is bony structure

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29
Q

Ear epithelium

A

Stratified squamous

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30
Q

Which one of the following nerves doesn’t give innervation to the ear
Trigeminal facial Vegas, spinal or great auricular nerve

A

Spinal

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31
Q

Artery that gives irrigation to the medial ear canal and timpani membrane

A

Maxillary artery

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32
Q

Unilateral malformation’s present at birth classified with the Marx system

A

Microtia 

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33
Q

What grade of microtia that’s no recognizable landmarks of the pinna and has a peanut shape

A

3

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34
Q

Grade of microtia, when there’s a mild deformity, with a dysmorphic helix, and anti-helix

A

1

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35
Q

The absence of the external ear is called

A

Anotia or grade 4 microtia

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36
Q

Which type of hearing loss do patients with microtia present

A

Conductive hearing loss detected with auditory brainstem response

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37
Q

Is caused by the lack of antihelix fold in prominence of concha bowl

A

Protruding ears

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38
Q

Neck masses among the branchial, cleft anomalies associated with infection, and present with pain and swelling

A

First branchial Cleft anomalies

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39
Q

Accumulation of blood in the subpericondral space secondary to blunt trauma

A

Auricular hematoma

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40
Q

Pathology the presents with otalgia, otorrhea, hearing loss and tragus sign

Often caused by pseudomonas and S Aureus

A

Otitis externa

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41
Q

Inflammatory process of the EAC due to infection with fungi

A

Otomicosis

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42
Q

Pathology that presents usually with facial palsy, Otorrhea
In the otoscopy, you can see a granulation tissue

A

Skull base osteomielitis

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43
Q

Hypersensitivity that causes contact dermatitis

A

Type 4

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44
Q

Most common malignant neoplasm in the ear

A

Basal cell carcinoma 

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45
Q

Growth of the lamellar bone common in surfers

A

Exostosis

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46
Q

The middle ear cleft comprises 3 contiguous components:

A

eustachian tube,
the tympanic cavity (middle ear)
the mastoid air cells (antrum is the biggest cell)

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47
Q

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

A

ACUTE OTITIS MEDIA

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48
Q

common pathogens for otitis media

A

H. Influenzae, S. Pneumoniae, Moraxella catharalis

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49
Q

Intracranial OM complications

4

A
  • Meningitis
  • Otitic hydrocephalus
  • Abscess
  • Sigmoid sinus thrombophlebitis
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50
Q

Increased intracranial pressure secondary to AO or OME.
* Headaches, lethargy, and papilledema
* no meningeal signs or evidence of intracranial abscess

A

Otitic hydrocephalus

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51
Q

OM complication in which Patients present classically with diurnal or “picket fence” fever curves, septicemia, and torticollis.

A

Sigmoid sinus thrombophlebitis

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52
Q

OM complications (no intracraneal)

5

A
  • 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
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53
Q

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

A

OM with effusion

54
Q

OE complications

4

A
  • Conductive hearing loss
  • Speech delay
  • Atelectasis
  • Choleastoma
55
Q

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

A

Choleastoma

56
Q

Recurrent AOM

A
  • ≥ 3 episodes in a 6-month period
  • ≥ 4 episodes in a 12-month period

with complete resolution of symptoms between episodes.

57
Q

Tympanostomy tube placement is the surgical treatment of choice for chronic OME in children < 4 years old.

True or false

A

True

58
Q

Tympanostomy tube placement AND adenoidectomy is the surgical treatment of choice for chronic OME in children > 4 years old.

True or false

A

True

59
Q

Chronic OME

A

the presence of effusion for ≥ 3 months

60
Q

fever, headache, photophobia, fluctuating mental status, and neck rigidity during an episode of AOM

A

Meningitis post OM

61
Q

Outgrowth of the bone in the cartilaginoid-bone junction; usually unilateral
- Pedunculated and hard
- Causes conductive hearing loss

A

Osteoma

62
Q

Complication where the classic triad of symptoms includes retro-orbital pain, AOM, and ipsilateral abducens nerve paresis

Para

A

Gradenigo syndrome from Petrous apicitis

Petrous apicitis

63
Q

main tumor of cerebellopontine angle tumor that can cause sensorineural HL

A

Schwanoma

64
Q

Test indicated to trace movement of the outer hair cells

A

Otoacoustic emissions

65
Q

Weber test interpretation

A

If sound lateralizes to one side
Sensorineural = lateralizes to UNAFFECTED SIDE
Conductive = lateralizes to AFFECTED side

66
Q

Rinne test interpretation

A

(+) = normal/sensorineural = AC > BC

(-) = conductive = BC > AC

67
Q

unilateral or asymmetric sensorineural hearing losses should undergo an MRI

A

True

68
Q

Congenital cause of sensorineural Hearing Loss caracterized by RETINITIS

A

Usher syndrome

69
Q

The predominant etiology of hearing impairment in children

A

Viral

70
Q

Congenital cause of sensorineural Hearing Loss caracterized by pigmentary abnormality

A

Waardenburg

71
Q

Age-associated hearing loss most common cause of hearing loss in adults; high-frequency hearing loss that eventually progresses to involve all frequencies

A

presbycusis

72
Q

Sensorineural hearing loss is more commonly associated with what kind of fracture

A

transverse fractures

73
Q

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.

A

Meniere disease

74
Q

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

A

BENIGN PAROXYSMAL POSITIONAL VERTIGO

75
Q

Characteristic fatigable nystagmus ONLY when performing manneuver Dix Hallpike test

A

BENIGN PAROXYSMAL POSITIONAL VERTIGO

76
Q

Tx BENIGN PAROXYSMAL POSITIONAL VERTIGO

A
  • Epley manneuver
    *
77
Q

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
A

MENIERE DISEASE

78
Q

Meniere treatment

A
  • Sodium restricted diet (≤ 2000 mg/d)
  • diuretics (eg, diazide).

Refractory = gentamicin therapy

Acute exacerbation = oral steroids

79
Q

The endolymphatic sac is also located along an imaginary line called

A

Donaldson line

80
Q

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

The most likely cause is the reactivation of a latent herpes simplex virus type 1 (HSV-1) infection.

A

VESTIBULAR NEURONITIS

81
Q

Nerve commonly affected in neuronitis

A

superior vestibular nerve

82
Q

Tx vestibular neuronitis

A
  • vestibular suppressants
  • antiemetics
  • antiviral HSV
83
Q

Vertigo when exposed to loud noises

A

Tullio phenomenon

84
Q

Vertigo with pressure changes in the ear

A

Hennebert sign

85
Q
  • Vertigo induced by loud noises, pressure on the external auditory canal
  • Autophony
  • Nystagmus
  • Conductive Hearing loss
A

SUPERIOR SEMICIRCULAR CANAL DEHISCENCE

86
Q

The central compensation for vestibular injury occurs via

A

Cerebellum

87
Q

primary pathophysiological site in Bell palsy

A

the meatal foramen BUT he said fallopian canal in ear

“physiological bottleneck”

88
Q

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
A

Bell palsy

89
Q

Syndrome of acute peripheral facial palsy associated with otalgia and varicellalike cutaneous lesions that may involve the external ear

A

Ramsay Hunt syndrome

90
Q

House Brackman scale

6

A

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
Q

Tx bell palsy

A
  • Steroid therapy
  • Antiviral therapy
  • Physical therapy
92
Q
  • 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

A

FACIAL NERVE NEOPLASMS

Tx surgery

93
Q

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
A

LYME DISEASE

94
Q

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

A

ACUTE OTITIS MEDIA AND MASTOIDITIS!

95
Q
  • 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

A

NECROTIZING (MALIGNANT) OTITIS EXTERNA

96
Q

Tx NECROTIZING (MALIGNANT) OTITIS EXTERNA

A
  • Antibiotic IV (quinolone) 8-12 week
  • debridement
  • Radioisotope scanning
97
Q

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

A

Congenital Perinatal Facial Palsy

98
Q

Define the salivary glands

6

A
  • 2 parotid glands
  • 2 submandibular glands
  • 2 principal sublingual glands
99
Q

The secretions of the parotid and submandibular glands are primarily stimulated by

A

autonomic nervous system

100
Q
  • 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
A

Parotid gland

101
Q
  • 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
A

Submandibular gland

102
Q
  • 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
A

Sublingual Glands

103
Q

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

A

False, its alkaline

104
Q

hyperproduction of saliva

A

Ptyalism

105
Q

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.
A

Mumps (Paramyxovirus)

106
Q

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

A

acute suppurative sialadenitis

107
Q

1º gland affected in Sialolithiasis

A

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
Q

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
A

Sialolithiasis

109
Q

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

A

Sjögren syndrome

110
Q

INFECTIOUS DISEASE

  • Painless,
  • bilateral enlarged parotid glands
  • Xerostomia
  • Associated cervical lymphadenopathy
A

Hiv infection of the parotid glands

111
Q

Treatment Sialolithiasis

A

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
Q

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

A

Sialadenosis

113
Q

Differencia in type 1 cysts and type 2

A

type 1
anteroinferior to the ear lobule.

type 2
sternocleidomastoid muscle or the external auditory canal

114
Q

NONINFLAMMATORY DISEASE

Dilatations of the minor salivary gland ducts frequently in the lip (60%–70%), buccal mucosa, floor of the mouth (ranula), and palate.

A

Mucoceles

115
Q

Neoplasic Lesion

Benign mixed tumors, are the most common neoplasms of the salivary glands.

A

Pleomorphic adenomas

116
Q

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

A

Warthin tumor

117
Q

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

A

Laryngeal Mask Airway

118
Q

The definitive nonsurgical control of the airway is via DIRECT LARINGEAL intubation or in situations in which intubation is contraindicated

True or false

A

true

119
Q

Principal causes of difficult airway in adults vs children

A

Children
Congenital airway anomalies (eg, laryngomalacia, choanal atresia, hemangioma, tracheomalacia) and acute inflammatory causes

Adult
trauma

120
Q

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.

A

Combitube/King Airway

121
Q

Device that makes easier to manage past obstructing lessions and edema

A

Jackson slide laryngoscope

122
Q
  • 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
A

FIBER OPTIC (guided) INTUBATION

123
Q

In emergency situations, is generally considered the procedure of choice

A

cricothyroidotomy

124
Q

“cannot intubate, cannot ventilate.”

indications for establishing an urgent surgical airway:

6

A
  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
Q

A tracheotomy is a procedure that exteriorizes the trachea to the cervical skin

True or false

A

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
Q

indications for performing a tracheotomy include:

6

A
  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
Q

Incision used for emergency tracheotomy

A

Vertical between 2-3 ring

hepful in obese patients

128
Q

** most emergent surgical airway** done through a transverse incision and can complicate in stenosis

A

CRICOTHYROIDOTOMY

129
Q

Postoperative Considerations

A

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
Q

Before decannulation:

A
  • disease process resolved
  • Good airway patency
  • adequate airway after 24-hour tube occlusion
131
Q

Early tracheotomy complications

A
  • 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
Q

Late tracheotomy complications

A
  • 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)

7mo sem (11 decks)

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