OTORRINO P2 Flashcards
Behavioral audiologic measures
-pure tone air conduction
-pure tone bone conduction
-speech-recognitios threshold (STR)
-suprathreshold speech recognition socres
Objetive physiological measures
-otoacousitc emissions
-acoustic admittance test battery
-tympanometry
-acoustic-reflex threshold (adaptation)
objective auditory electrophysiologic measures
- auditory evoked potentials testing/ electrocochleography (ECochG)
- auditory brainstem response (ABR)
-auditory middle latency response (AMLR)
-auditory steady state response (ASSR)
cortical auditory evoked potentials (CAEPs)
puretone audiogram: air-conduction thresholds (AC)
-frequencies 250, 500, 1000, 2000, 4000, 8000 hertz
-we can block the none tested ear with masking noise
puretone audogram: bone conduction thresholds (BC)
-frequencies: 250, 500, 1000, 2000, and 4000 Hz
-with a bone vibrator placed in the mastoid process of temporal bone.
-it shoul be in an isolated room
Normal hearing audiogram
-10 to 25 db
-x its frequency (Hz)
-y its dB
audiogram symbols
-red: right
-blue: left
-AC: circule (right) and X (left)
-BC: < (right) and > (left)
-AC masked: triangle (right) and square (left)
-BC masked: [ (right) and ] (left)
BC always arriba de AC
que indica HL en AC and BC
-AC: heraign problem in the conductive and/or sensorineural
-BC: just sensorineural
air bone GAP
difference of dB between AC and BC
-in normal hearign its < 10dB
normal hearing
-AC: < 25
-BC: <25
-ABG: <10
normal hearing with significant ABG
-AC: <25
-BC: <25
-ABG: >10
conductive HL
-AC: >25
-BC: <25
-ABG: >10
-ej: otitis media or external, ear wax, tumor on middle or external ear, eustachian tube dysfunction, genetic HL like treacher collins sx
sensorineural HL
-AC: >25
-BC: >25
-ABG: <10
-Ej: noise-induced HL, presbycusis, ototoxicity, meniere diseas, genetic HL like Connexian 26, Usher sx, acosutic neuroma, esclerosis multiple, sx caratgena, schwannoma
mixed HL
-AC: >25
-BC: >25
-ABG: >10
-ej: otosesclerosis and presbycusis, uno y uno
PTA pure tone average
-para ver la magnitud de la HL
-vemos los db de 500, 1000 y 2000 hz, los sumas y dividimos entre 3
-solo los valores de AC
Normal PTA
<25
mild PTA
25-40
moderate PTA
40-55
modeately severe PTA
55-70
severe PTA
70-90
profound PTA
> 90
high frequencie audiometry
-test at 9000, 10000, 11,200, 12,500, 14.000, 16.000, 18.000 y 20.000 Hz
-nos dice sobre early ototoxic effects (gentamicen, amicasin), early presbycusis or early noise-induced HL
interaural attenuation
The reduction in intensity of a signal, such as a pure-tone signal, as it travels by BC from the TE to the NTE (where the masking goes)
speech audiometry
–spondaic or speechrecognition threshold (SRT): based on spondaic words bisyllabic
-es a la intensidad mas baja a la que el px repite las palabras
Retrochoclear lession
with more dB, they hear more distortion instead of hearing ir louder
tympanometry
measures the movement of the tympanic membrane
-speaker at 225 hz
TPP tympanometric peak pressure
-unit: daPa
-its when the air pressure intriduced in to the external ear, equals de pressur ein the middle ear
TPP typanometric peak pressure
low: < -50 daPa its not normal, suggestive of eustachian tube dysfunction
normal: >.35 daPa
peak-compensated static-acoustic admittance
in adultos: 0.35-1.30
-abajo de eso: rigidez
-arriba: ossicular discontinuity or tympanic perforation
type A tympanometry
normal TPP
normal peak height
normal middle ear function
type Ad
-TPP normal
-admitance higher peak height >1.30
-ej: ossicular discontinuity
type As
-reduced height at the peak (admitance < .35)
-normal TPP
-stiffening middle ear, like otoesclerosis
type B
flat tympanogram
-stiffening middle-ear pathology or tympanic membrane perforation (or a patent tympanostomy tube), ear wax, foreign body, air fluid levels
type C
-negative TPP (<-50)
-eustachian tube-dysfunction
little bones:
-malleus (pegado al timpano)
-incus (de enmedio)
-stapes (parece una Y)
Acoustic reflex
-se oye un ruido fuerte en un oido, y se contraen los 2 musuclos
-primary muscle involved: stapedius, su origen es in the pyramidal eminene of the tympanic cavity, y se inerva por 1 branch of facial nerve
-at high intesities: the tensor tympani (inervado por trigeminal nerve
pathway acoustic reflex
-ipsylateral: Coclea –> NC8 –> nucleo coclear–> facial nerve (7) –>stapiduis
-contralateral: coclea –> NC8 –> nucleo coclear–> contralteral meadlle supirior oliva nucleos –> facila nerve motor –> stapiduis (el contralateral)
otoacustic emissions
-records the sound of the movement of the outer hair cells
-dx of hering disordes in infants
Auditory brainstem responses (ABRs)/ brainstem auditory evoked potentials (BAEPs)
it evaluates all the auditory pathway
anatomy of the external ear (pinna)
-24 mm length with 1-2 ml volume
-lateral 1/3 its fibrocartilage
-medial 2/3 it sbone
-junction de esos es narrowest poinr
pinnas skin
-Stratified squamous epithelium
-subcutaneous layer: hair follicles, sabaceos glands and ceruminous glands, 1mm
-osseous canal: 0.2 mm
Cerumen
-secreciones glandulares + epitelio desprendido
-hydrophobic
-acid pH
-antibacterial effects
pinna innervation
-laterally, inferiorly, and posteriorly by the great auricular nerve (cervical plexus).
-Arnold’s nerve (a branch of the vagus nerve) innervates the inferior bony canal (concha and floor ear canal)
-posterosuperior bony EAC by branches of the facial nerve
-anterior (tragus and roof): auriculotemproal branch of V3 of the trigeminal nerve
microtia
-malformaciones evidentes
Marx system:
-G1: deformidad leve el helix y antihelix
-G2: (atypical microtia): tissue deficiency and defromity
-G3: peanut ear
-G4: absence
tx microtia
-observation
-protesis
-single stage reconstrutction with implant
-staged autologous costochondral reconstruction. (4 stages)
atresia and stenosis
-la microtia esta asociada
-tienen conductive HL moderate severe
-risk of chloesteatoma
-CT scan para ver si es candidato a cx
protruding ears (prominauris)
- increase in the distance from the helical rim to the mastoid (due to a lack of the antihelical fold and prominence of the conchal bowl)
-usually bilateral
-normal Auriculocephalic angle 20-25° with Auriculomastoid distance 15-20 mm
tx: otoplasty (esthetic)
First branchial cleft anomalies
-10% de las BCA
-Fusion 1st and 2nd branchial arch por incomplete obliration of 1 BC
-hay infeccion, dolor, hinchazon, escurrimiento
-clasificacion Work: tipo 1 (duplicates the membranous EAC ) and tipo 2 (mas comun, duplicates both the membranous and cartilaginous EAC.)
tx: complete excision, no si esta infectada
external ear trauma: hematoma auricular
-accumulation of blood in the subperichondrial space
-el cartilago depende de la vascularizacion del pericondrio via diffusion
-necrosis del cartilago, predispone a infecciones
-cauliflower ear
tx: quinolones, drainage and ferula
auricular laceration
-trauma –> laceracion o avulsion
-reparacionn expedita y prevencion de infecciones
-tx: quinolones, vendaje, secondary reconstruction