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EENT > Quiz 1: Outer, Middle, Inner Ear > Flashcards

Quiz 1: Outer, Middle, Inner Ear Flashcards

1
Q

The ossicles convert ___ energy into mechanical energy and amplify it, transferring it to the __ window of the cochlea

A

Sound

Oval

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2
Q

The eustachian tube is opened by which muscle?

A

Tensor veli palantini

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3
Q

Endolymph is found in the membranous labyrinth and has a high concentration of _____ and a lower concentration of ______.

A

Potassium
Sodium
(The only place in the body where this is found)

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4
Q

Which cranial nerve innervates the cochlea?

A

CN VIII

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5
Q

Track the structures that convert sound energy into a nerve impulse.

A

Outer ear –> ear canal –> TM –> ossicles –> cochlea –> endolymph –> organ of corti –> CN VIII –> temporal lobe

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6
Q

What is the name of the vascularization system that supplies blood to the inner ear?

A

Stria vascularis

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7
Q

The organ of corti is stimulated by the flow of _____ ions.

A

Potassium

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8
Q

Osteoma most often occurs in individuals with what hx?

BONUS POINT: which homeopathic?

A

History of cold-water exposure (swimmers or surfers).

Hekla lava.

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9
Q

When is AOM worse?

A

Evening

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10
Q

What is a sign in children, especially infants, that they might have AOM?

A

Anorexia

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11
Q

A retracted TM with a yellow to amber color and fluid would suggest _____ rather than _____.

A

Otitis media with effusion.

Rather than acute otitis media.

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12
Q

What is a highly specific finding upon otoscopy with AOM?

A

Bulging TM.

Spin— Specific rules in. If TM is bulging, very likely AOM.

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13
Q

What is a highly sensitive finding upon otoscopy with AOM?

A

Immobile TM.

Snout— Sensitive rules out. If TM is mobile, very likely not AOM.

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14
Q

An immobile TM that is retracted with a history of allergies suggests…

A

Otitis media with effusion.

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15
Q

In otitis media with effusion, Weber lateralizes to the _____ ear and Rinne will be _____>_____. What type of hearing loss is this?

A

Bad
BC>AC
Conductive

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16
Q

OME and AOM will show which type of tympanometry?

A

B type, a flat line

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17
Q

An infant rectal temp above _____, or oral above _____, mild ear fluid, tympanic erythema, might suggest _____. What other PE findings would you look for to rule in or out your dx?

A

100.4 F
99.5 F
AOM

Bulging ear drum
Immobile TM
Loss of bony landmarks

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18
Q

Complications: AOM (4)

A

Mastoiditis
Meningitis
Perforated TM
Cholesteatoma

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19
Q

Which bacteria are associated with suppurative complications?

A

P. aeruginosa

S. aureus

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20
Q

S/sxs: Mastoiditis (5)

A 
Bulging in the canal
Protrusion of the auricle 
Red behind the ear
Mastoid TTP
High fever
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21
Q

Use ______, ____, or _____ to soften cerumen.

A

Debrox
Calendula oil
Olive oil

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22
Q

Why should you not irrigate beans and grains to remove them from the ear canal?

A

They can swell and become more difficult to remove.

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23
Q

What is the main contraindication for irrigating the ear canal?

A

Perforation of the tympanic membrane.

24
Q

Name some risk factors for OM. There are a lot.

A 
Cranial facial bone structure
Allergies
Dairy
Prone sleeping
Second hand smoke
Race: native north american
Vit D deficiency
< 18 months
Season: incidence increases in fall, highest in Feb, decreases in the spring
Weaning from breast milk
Beginning school or day care
25
Q

Supine bottle feeding with snuffles that causes aspiration in to the eustachian tubes is called…

A

Toynbee phenomena

26
Q

Tx failure in otitis externa correlates most with…

A

Failure to clean out the canal (aural toilet [also, wtf?]).

Incorrect diagnosis.

27
Q

Benefits of Abx in OM:

A

Decrease in mastoiditis
Decrease in meningitis
(Though recent reports suggest that untreated AOSM has similar rates of complications whether an antibiotic are prescribed or withheld)
Good tx for < 2yo with bilateral OM

28
Q

The NNT to reduce pain with Abx.

A

16 patients (17%)

29
Q

Risk of Abx use in OM.

A

Increased rate of recurrence.

Increased bacterial resistance.

30
Q

Infectious chondritis ____ the lobe and is usually unilateral, while relapsing polychondritis _____ the lobe and is usually bilateral.

A

Includes

Spares

31
Q

Risk factors: otitis externa

A

Change in pH from acid to alkaline
Increased temp and humidity
Mild trauma, frequent cleaning

32
Q

Hx: otitis externa

A

Swimming
Trauma
Dermatitis
Q-tip abuse

33
Q

Malignant otitis externa affects immunocompromised patients particularly…

A

Those with DM, alcoholism, severe malnourishment.

34
Q

What may you see in the ear canal of Malignant OE?

A

Granulation tissue

35
Q

Complications: Malignant OE

A

Osteomyelitis, hearing loss, facial nerve paralysis, death.

36
Q

Next steps: Suspected malignant OE in office.

A

Refer to ENT for MRI or CT.

37
Q

DDx: ear pain with WNL otoscopic exam and no loss of hearing.

A 
Referred Pain from:
TMJ (most common)
Molar
Cervical spine pain
Malignancies
38
Q

Red flag pts with referred ear pain include:

A 
Smokers
Alcohol abuse
>50 yo
DM
(These pts have a higher risk of a serious occult cause of ear pain)
39
Q

Which Abx ear drop is indicated in tx of OE and perforated TM? Why?

A

Fluoroquinolone due to excellent coverage for Pseudomonas and lack of ototoxicity.

40
Q

Homeopathy: OE

A

Hepar sulph:

41
Q

Most common bacteria found in AOM:

A

S. pneumonia

42
Q

Homeo: What do you look at when deciding if AOM sxs are an exacerbation of a chronic state or a true acute?

A

Physical generals. If it is a new PG then give an acute.

43
Q

Are Abx effective for OME?

A

No

44
Q

What is a helpful question to ask a pt with a cc of dizziness?

A

Ask the pt to describe their sxs without using the term dizziness.

45
Q

An internal sense of spinning or the feeling that the room is spinning around oneself is called:

A

Vertigo

46
Q

Most common cause of vertigo can be found in the _____ ____.

A

Peripheral labyrinth

47
Q

What are common types/origins of “dizziness” a patient might describe?

A

Vertigo
Syncope or presyncope
Disequilibrium
Lightheadedness (wastebasket term)

48
Q

What are pre-syncope and syncope, and what organ system should you always think of first with these?

A

Pre-syncope: lightheadedness, muscular weakness, blurred vision, feeling faint.
Syncope: loss of consciousness and posture, described as “fainting” or “passing out.”
Think CARDIAC first!
Most common cause of both is a sudden drop in blood pressure.

49
Q

Peripheral vertigo refers to dysfunction somewhere in the _____ or ____ ear.

A

Middle

Inner

50
Q

Peripheral vertigo: nystagmus is ______ and _____.

A

Unidirectional

Horizontal

51
Q

Central vertigo refers to dysfunction of the ____ ___ or _____.

A

Brainstem

Cerebellum

52
Q

Central vertigo: Nystagmus qualities?

A

Bidirectional

Downbeat aka true vertical

53
Q

Sxs of central vertigo include:

A

Weakness, dysarthria, vision changes, paresthesia, altered mental status, ataxia or other motor/sensory

54
Q

What is the most useful physical exam for differentiating peripheral and central vertigos? How to interpret?

A

Head Impulse Test (test vestibular-ocular reflex).

In peripheral vertigo, you will perceive a “catch-up” saccade after when the head thrust is in the direction of the lesion.
(Test will be negative in central vertigo).

55
Q

What direction of nystagmus implies BPPV (peripheral vertigo) upon Dix-Hallpike maneuver?

A

Upbeat

Downbeat implies central vertigo

EENT (3 decks)

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