Quiz 3: Ears Flashcards
Conductive or Sensorineural Hearing Loss?
A. Problem with perception
B. Problem with transmission
C. Physical/mechanical problems limit mvmnt of sound wave thru ext./middle ear
D. Inner ear/brain
A. Sensorineural
B. Conductive
C. Conductive
D. Sensorineural
Name 2 causes of conductive hearing loss
Obstructed external ear canal, perforated TM, dislocated or sclerosed ossicle(s), OM or serous OM
Name 2 causes of sensorineural hearing loss
Acoustic trauma (prolonged exposure to loud noise), barotrauma (pressure trauma ie divers, climbers), head trauma ie fracture of temporal bone, Abx, cocaine, infx, aging, acoustic neuroma, sudden SNHL, Meniere dz, vascular dz, MS
Tinnitus: Subjective or Objective? A. Can be heard listening over pts' ear B. Audible only to pt C. Causes: vascular malformations/issues D. Causes: acoustic trauma, CNS tumor, infx, ear wax
A. Objective
B. Subjective
C. Objective
D. Subjective
What questions would you ask a pt with tinnitus?
Nature of the sound: episodic/constant, pitch, quality, type of sound, pulsatile/constant, bi- or unilateral
Loud noises? Head trauma? hearing problems, dizziness, balance, recent dental work, bruxism, stress, ototoxic drug use, smoking, caffeine, HTN, anxiety, insomnia?
True Vertigo or Non-vertigo?
A. Lightheadedness or disequilibrium
B. Caused by asymmetry in vestibular system
C. Postural instab., N/V, sweating, worse w head mvmnt
D. Most common
A. Non-Vertigo
B. True Vertigo
C. True Vertigo
D. True Vertigo
Peripheral or Central Vertigo? (both True Vertigo)
A. Nystagmus unidirectional w fast component towards normal ear, horizontal w rotation
B. Other neuro signs absent
C. Postural instability severe, pt can fall while walking
D. Hearing loss/tinnitus is absent
A. Peripheral
B. Peripheral
C. Central
D. Central
Peripheral or Central Vertigo? (both True Vertigo)
A. Nystagmus is any direction, can change direction
B. Hearing loss/tinnitus may be present
C. Postural instability unidirectional, walking is preserved
D. Other neuro signs often present (ataxia, numbness)
A. Central
B. Peripheral
C. Peripheral
D. Central
1 Sn/Sx of Lightheadedness and 2 causes
“Graying out” of vision, palor, roaring in ears
Hypoperfusion of brain from HTN, cardiac arrhythmia, drugs, shock, etc.
1 Sn/Sx of Disequilibrium and 2 causes
Occurs only when standing or walking (gait impairing), unsteady w/o dizziness, “dizziness in feet, not head”
Source of problem may be cerebellum, stroke, basal ganglia, frontal lobe tumor, etc.
2 questions to ask Vertigo pt during Hx
Sudden/gradual onset
Duration (seconds, minutes, hrs or days)
2 things to check during PE of Vertigo pt
orthostatic BP, nystagmus (horiz, vert, rotational), vestibular imbalance (eyes closed)
Red flag concomitants for earache/ear pain (otalgia)?
Diabetes or immunocompromised pt, redness/pain over mastoid, severe swelling of canal meatus, chronic pain with head/neck symptoms
Name 2 causes of ear discharge (otorrhea) (acute and chronic)
Acute d/c: Acute OM w TM perf., post T-tube, CSF leak from head trauma, OE (infx or allergy)
Chronic d/c: CA of ear canal, cholesteatoma, chronic purulent OM, foreign body, mastoiditis
Red flag concomitants for otorrhea?
head trauma, CN dysfunction, fever, erythema of ear, diabetes or immunocompromised pt
AOE/OE, AOM, OME, or CSOM?
A. Most common complication of AOM if unresolved
B. Chronic inflamm. of middle ear than lasts >= 6 wks
C. Involves otorrhea
D. Chronic form often follows psoriasis, seb. derm., excema and see dry flaking tissue
A. OME
B. CSOM
C. CSOM, possible AOE
D. OE
AOE, AOM, OME, or CSOM?
A. Child moody/irrit, tugs on ear, disrupted sleep
B. Hearing loss/inattentive, mild pain, ear fullness/popping, nasal d/c, sore throat
C. Hearing loss, chronic purulent d/c, painless
D. Pinna & tragus painful when pressed/tugged
A. AOM
B. OME
C. CSOM
D. AOE
AOE, AOM, OME, or CSOM?
A. TM amber or gray, retracted or neutral, fluid/bubbles
B. TM is intact, normal pearly gray
C. TM usually bulging & red/cloudy/yellow
D. TM has decreased mobility
E. TM chronically perforated
A. OME B. AOE C. AOM D. AOM, OME E. CSOM
AOE, AOM, OME, or CSOM?
A. From AOM that perforated, trauma to head/ear
B. Risks: prior T-tube, allergy, adenoid hyprtrphy, season
C. From infx, swimmers ear, trauma, forceful cleaning
D. Risks: daycare, smoker(s) in house, bottle feeding
A. CSOM
B. OME
C. AOE
D. AOM
Complication of CSOM?
Persistent chronic infx can destroy parts of the ossicles leading to conductive hearing loss. In a child this can lead to delayed intellectual development.
Cholesteatoma, Acute Mastoiditis, Otosclerosis, or Tympanosclerosis?
A. Sclerosis of TM from chronic OM, post T-tube
B. Suppurative infx
C. Growth of kerat. squam. epi. in ME & pars tensa
D. AD metabolic bone dz affects ossicles bilaterally
A. Tympanosclerosis
B. Acute Mastoiditis
C. Cholesteatoma
D. Otosclerosis
Cholesteatoma, Acute Mastoiditis, Otosclerosis, or Tympanosclerosis?
A. Can grow into inner ear –> sensorineural hearing loss
B. Refer - urgent - go to hospital for IV Abx
C. Leads to stiffening of TM & impaired conduct. hearing
D. Bilat. conductive hearing loss, tinnitus, vertigo
A. Cholesteatoma
B. Acute Mastoiditis
C. Tympanosclerosis
D. Otosclerosis
Cholesteatoma, Acute Mastoiditis, Otosclerosis, or Tympanosclerosis?
A. Redness, swelling, tenderness behind ear, fever, hearing loss, profuse creamy ear d/c, throbbing pain
B. Whitish plaque (crescent) on TM
C. Painless otorrhea (constant or frequently recurrent)
A. Acute Mastoiditis
B. Tympanosclerosis
C. Cholesteatoma
Labyrinthitis: Viral or Bacterial?
A. Sudden unilat hearing loss, severe vertigo, N/V
B. Occur w meningitis, infx of ME/mastoid
C. Profound hearing loss, severe vertigo, ataxia, N/V; Now rare
D. URI preceeds onset in 50% cases
A. Viral
B. Bacterial
C. Bacterial
D. Viral
What is Ramsey-Hunt syndrome?
Herpes Zoster Oticus.
Unique form of viral labyrinthitis.
Reactivation of latent varicella-zoster years after primary infx.
Deep burning auricular pain then eruption of vesicular rash in EAC and concha. Vertigo, hearing loss, and facial weekness.
2 things to check on PE of viral labyrinthitis?
spontaneous nystagmus towards normal side with diminished or absent caloric response in affected ear. Hearing loss mild to moderate (higher frequencies)
Of the conditions of the inner ear... (Viral and bacterial labyrinthitis, Vestibular neuritis, BPPV, Accoustic Neuroma, Meniere's Disease) Which one(s) involve vertigo WITHOUT hearing loss?
Vestibular Neuritis & BPPV
Vestibular Neuritis, BPPV or Accoustic Neuroma?
A. Sudden vertigo triggered by certain body positions
B. Benign temporary sudden acute vertigo, horizontal nystagmus, ataxia
C. URI often preceeds; seasonal; viral
D. Unilateral progressive SN hearing loss (HA, face numb)
A. BPPV
B. Vestibular neuritis
C. Vestibular neuritis
D. Accoustic neuroma
Vestibular Neuritis, BPPV or Accoustic Neuroma?
A. Benign slow growing tumor fr Schwann cells of CN VIII
B. Type of nystagmus related to part of inner ear affected
C. More common in 4th or 5th decade of life
D. 90% due to posterior semicircular canal canalithiasis
A. Accoustic neuroma
B. BPPV
C. Vestibular neuritis
D. BPPV
Meniere’s T or F?
A. Classic triad = 1. Prodrome (fullness), 2. Tinnitus/hearing loss/N/V, 3. Vertigo
B. Conductive hearing loss prog. over time
C. Affects M>F, elderly
D. Do complete neuro exam, esp CN exam
A. True
B. False, sensorineural loss progress over time
C. False, affects M=F, early to mid adulthood
D. True
DDx for Meniere’s?
Migrane HA, hypothyroidism, labyrinths, MS, OM, ischemic stroke, subarachnoid hemorrhage, TIA, vestibular neuritis, acoustic neuroma, salicylate toxicity
Common causes of Toxic Vestibulopathy
- Abx (aminoglycoside) - bilat vest damage, blurred vision while moving head
- Aspirin - Reversible tinnitus, hearing loss, dizziness
- Alcohol - reversible positional nystagmus
BPPV: T or F?
A. Gradual onset and resides in 3-5 days
B. Etio: head/ear trauma, Meniere’s, OM, SSNHL, otosclerosis
C. Std clinical test = Tumarkin test
D. Sx: vertigo, N/V, occas. “foggy” sensation
A. False - Starts violently/gone in 20-30 sec
B. True
C. False - Dix-Halpike maneuver
D. True
