pathology of ear

Question 1

what is the other name for swimmers ear

Answer 1

otitis externa

Question 2

what are the causes of otitis externa

Answer 2

infectious, allergic or dermatologic
normally colonized with gram positive organisms (S. aureus or epidermidis)

Question 3

what is the presentation of otitis externa

Answer 3

otalgia, pruritis, discharge
may have diminished hearing secondary to partial occlusion
may have pain with external manipulation of the ear

Question 4

what increases kids risk of inner ear infection

Answer 4

eustachian tube anatomy (more horizontal)

Question 5

what is the most common cause of otitis media (AOM)

Answer 5

viral pathogens - RSV, rhinovirus, enterovirus, coronavirus, influenza, adenovirus
bacterial: S. pneumonia, H. influenzae (M/c)

Question 6

what is the most common cause of AOM in kids < 6 months

Answer 6

chlamydia trachomatis

Question 7

what can suppurative AOM lead to

Answer 7

ruptured tympanic membrane

Question 8

what are the common causes of ruptured TM

Answer 8

suppurative AOM
barotrauma and blunt trauma

Question 9

what is mastoiditis

Answer 9

suppurative infection of mastoid air cells
complication of AOM
purulent fluid within the mastoid will cause possible abscess
causes bone restoration
concern that infection increases risk of spread to CN, temporal and CNS

Question 10

what is the presentation of mastoiditis

Answer 10

AOM that has worsened
pain over mastoid process
fever/chills
otalgia
post-auricular erythema and tenderness

Question 11

at what age are the eustacian tubes adult sized

Answer 11

age 6

Question 12

what does the eustachian tube allow for

Answer 12

drainage and ventilation of the middle ear

Question 13

what is Eustachian tube dysfunction (ETD) associated with

Answer 13

inability to regular pressure
decreased protection: reflux of nasopharyngeal pathogens
decreased clearance

Question 14

what is the presentation of ETD

Answer 14

otalgia
retracted TM
effusion
decreased pneumatic changes
hearing diminished

Question 15

what is otalgia

Answer 15

ear pain/ache

Question 16

what makes up the inner ear

Answer 16

semicicular canals
oval window
facial nerve
vestibulocochlear nerve
cochlea

Question 17

what is acoustic neuroma

Answer 17

benign tumors of Schwann cells of the vesticulochochlear nerve (CN8) - m/c occurs at the porus acusticus ( where cells transition from CNS to PNS)
very slow growing if tumor grows at all

Question 18

what is the concern if a pediatric patient presents with acoustic neuroma

Answer 18

concerning for neurofibromatosis type 2 (NF2)
typically presents with bilateral tumors
affects chromosome 22
leads to defect in tumor suppressor gene within Schwann cells

Question 19

What is the presentation of acoustic neuromas

Answer 19

associated with mass affect on VN, cerebellar compression..
if cochlear nerve involved - decreased hearing, tinnitus
vestibular nerve - gait instability
compression of CN5 - facial paresthesias, pain
CN7 - change in taste, facial paralysis, xerostomia
can compress on cerebellum/brainstem = ataxia

Question 20

what are the different types of vertigo

Answer 20

peripheral (semicircular canals, vestibule, vestibular nerve)
central (cerebellum/brainstem)

Question 21

what causes BPPV

Answer 21

calcium debris in the semicircular canal
-canalithiasis - m/c in posterior canal
causes false activation of hair cells similar to that of endolymph moving when there was a real stimuli
false sense of spinning

Question 22

what is labrythinitis and vestibular neuritis

Answer 22

vestibular neuritis is inflammation of vestibular branch of CN8
labrythitis is inflammation of labyrinth
both typically associated with viral or post viral inflammation

Question 23

what does labrynthitis and vestibular neuritis result in

Answer 23

peripheral vertigo
N/V, instability
unidirectional horizontal nystagmus

Question 24

what diseases can causes peripheral vertigo

Answer 24

menieres
vestibular neuritis
labrynthisis
acoustic neuroma
BPPV

Question 25

what is the perception of sound that are not related to external stimuli

Answer 25

tinnitus

Question 26

what are tinnitus inducing medications

Answer 26

loop diuretics (furosemide)
salicylates
NSAIDS
Quinine
ABX (aminoglycosides, erythromycin, vancomycin)
chemo
topical (propylene glycol, antiseptic, ethanol, polymixinB, neomycin)

Question 27

what is conductive hearing loss

Answer 27

unable to conduct the sound waves from external ear to inner ear (disorder within the external or middle ear)

Question 28

what can be associated with conductive hearing loss

Answer 28

edema/inflammation
otitis media/externa
ETD
Trauma of TM
middle ear barotrauma
cerumen build up
tumor
psoriasis
malformation
cholesteotoma
otosclerosis

Question 29

what is sensorineural hearing deficit

Answer 29

hearing deficit due to pathology within the INNER ear

Question 30

what are non-hereditary causes of sensorinueral hearing deficit

Answer 30

infection during cochlear development. -CMV, hepatitis, rubella, toxoplasmosis, HIV, syphilis, meningitis
teratogenic meds, drugs, ETOH

Question 31

what are the hereditary causes of sensorineural hearing deficit

Answer 31

autosomal dominant or recessive
m/c associated with abnormal connexin 26 (protein needed to help with cellular communication)
may present initially or progress throughout life
may also have congenital malformation with atresia of cochlea

Question 32

what is age related hearing loss called

Answer 32

presbycusis

Question 33

what are ototoxic drugs that can lead to sensorineural hearing deficit

Answer 33

aminoglycosides
vancymycin
erythromycin
loop diuretics
antimalarials
sildenafil
cocaine

Question 34

what autoimmune disesase can affect sesorinueral hearing deficit

Answer 34

SLE
RA
Sjogrens syndrome
Kawasaki disease
temporal arteritis

Question 35

what vascular diseases can affect sesorinueral hearing deficit

Answer 35

CVA
TIA
cerebellar infarct
inner ear hemorrhage

Question 36

what causes menieres disease

Answer 36

endolympathic hydrops
episodic vertigo, unilateral tinnitus and hearing loss

Question 37

what can cause endolymphatic hydrops

Answer 37

trauma
chronic OM
congenital hearing deficit
labyrinthine concussion
leukemic infiltrates
otosclerosis
paget disease
post surgical complications
syphilis
viral labrythitis