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Disease Processes > Degenerative > Flashcards

Degenerative Flashcards

1
Q

What is the rate of recurrence?

A

30-50% eventually have a recurrence; 10-20% within 1-2 weeks of the maneuver.

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2
Q

What percent of patients have scutum erosion associated with cholesteatoma?

A

42%.

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3
Q

What is the success rate of the Epley maneuver after only one manipulation?

A

50-77%.

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4
Q

What percent of cholesteatomas are complicated by a labyrinthine fistula?

A

5-10%.

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5
Q

What percent of cases of otosclerosis are bilateral?

A

85%.

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6
Q

What is the success rate after two manipulations?

A

95-97%.

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7
Q

What is a laryngocele?

A

Abnormal dilatation of the laryngeal saccule.

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8
Q

What are the most common manifestations of vertebrobasilar insufficiency (VBI)?

A

Abrupt, transient attacks of vertigo associated with bilaterally reduced caloric responses.

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9
Q

What are the two parts of a cholesteatoma?

A

Amorphous center surrounded by keratinized squamous epithelium.

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10
Q

What is the most commonly involved site of otosclerosis in the temporal bone?

A

Anterior to the oval window at the fissula ante fenestrum.

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11
Q

What is the treatment for vertigo secondary to vertebro-basilar insufficiency?

A

Aspirin or ticlid if aspirin sensitive.

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12
Q

What is the most common cause of pulsatile tinnitus in patients older than 50?

A

Atherosclerotic carotid artery disease.

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13
Q

What is the inheritance pattern of otosclerosis?

A

Autosomal dominant with incomplete penetrance (only 25-40% of carriers express the phenotype).

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14
Q

What does the “Blue Mantles of Manasse” refer to?

A

Basophilic appearance on hematoxylin and eosin staining of bone in the active stage of otosclerosis.

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15
Q

Where are internallaryngoceles located?

A

Beneath the mucosa of the false vocal cord and aryepiglottic folds.

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16
Q

Where do pharyngoesophageal/Zenker’s diverticula occur?

A

Between the oblique and transverse fibers of the inferior constrictor (Killian’s dehiscence), most commonly on the left, and between the cricopharyngeus and the esophagus (Killian-Jamieson area).

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17
Q

What are the deposits thought to consist of!

A

Calcium carbonate crystals, possibly resulting from microfractures of the temporal bone near the round window niche (also near the ampulla of the posterior SCC).

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18
Q

When do most laryngoceles present?

A

Can present at any time, but most commonly arise in the sixth decade of life.

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19
Q

Which theory is currently more favored?

A

Canalolithiasis.

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20
Q

What are the two types of tympanic membrane perforations?

A

Central and marginal.

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21
Q

What are the two types of cholesteatomas?

A

Congenital and acquired.

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22
Q

What are the two main theories of the pathophysiology of BPPV?

A

Cupulolithiasis theory: deposits gravitate, attach to, and stimulate the cupula. Canalolithiasis theory: deposits float freely within the SCCs under the influence of gravity.

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23
Q

How does this theory account for the latency of onset of nystagmus?

A

Delay is due to the adherence of deposits to the membranous wall of the labyrinth.

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24
Q

What is the typical route of spread of cholesteatomas originating in anterior mesotympanum?

A

Descend to the pouch of von Troeltch, and may involve the stapes, sinus tympani, or facial recess.

25
Q

In a patient with a cholesteatoma, what factors make the presence of a fistula highly unlikely?

A

Disease

26
Q

What is Eagle’s syndrome?

A

Elongation of the styloid process or ossification of the stylohyoid ligament resulting in nonspecific throat pain, foreign body sensation, and increased salivation.

27
Q

What problem results from rupture of the middle meningeal artery?

A

Epidural hematoma.

28
Q

What therapeutic maneuver is based on the canalolithiasis theory?

A

Epley.

29
Q

What toxin is the most common cause of cerebellar degeneration?

A

Ethanol.

30
Q

What is the significance of pain in a patient with cholesteatoma or chronic otitis media?

A

Expanding mass or empyema in the antrum.

31
Q

What are mixed laryngoceles?

A

External laryngoceles with a dilated internal component.

32
Q

What features on history distinguish far-advanced-otosclerosis from profound SNHL?

A

Family history of otosclerosis; progressive hearing loss usually of long duration; history of hearing aid use that is no longer beneficial or present use of a hearing aid with benefit beyond that which would be expected for the severity of the hearing loss; paracusis; and previous audiograms indicating an air-bone gap.

33
Q

What are the terms used to describe involvement of the oval window and cochlea?

A

Fenestral otosclerosis and retrofenestral otosclerosis, respectively.

34
Q

Which ossicle is most commonly involved in patients withcholesteatoma?

A

Incus.

35
Q

What are the three types of laryngoceles?

A

Internal, external, and combined.

36
Q

What are the histopathologic findings of patients with far-advanced-otosclerosis?

A

Invasion of otosclerotic foci into the cochlear endosteum and the stapes footplate.

37
Q

Where does cholesteatomas are complicated by a labyrinthine fistula most often occur?

A

Lateral semicircular canal (75%).

38
Q

Which of these is associated with cholesteatoma?

A

Marginal.

39
Q

What virus is thought to play a role in the etiology of otosclerosis?

A

Measles.

40
Q

Which layer of the otic capsule does otosclerosis involve?

A

Middle endochondral layer.

41
Q

What condition is characterized by generalized tension in all laryngeal muscles?

A

Muscular tension dysphonia.

42
Q

What genetic mutation has been implicated as a possible cause of otosclerosis?

A

Mutation of the CO-1 gene on chromosome 17q.

43
Q

How is far-advanced otosclerosis (FAO) defined?

A

Otosclerosis with an air conduction threshold greater than 85 dB and a bone conduction threshold not measurable.

44
Q

What are the three layers of the otic capsule?

A

Outer periosteal layer, inner periosteal layer (endosteum), and the middle endochondral layer.

45
Q

What are the four etiologies of vocal cord immobility?

A

Paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar.

46
Q

What features on physical exam distinguish FAO from profound SNHL?

A

Patients with FAO more likely will have a soft voice with better quality than expected for the degree of hearing loss and the ability to hear a 512 Hz tuning fork placed on the teeth, dentures, or gums.

47
Q

How do laryngoceles become external?

A

Penetrate the thyrohyoid membrane at the site of entry of the superior laryngeal artery and nerve.

48
Q

What percent of cases occur in the posterior SCC? Horizontal SCC?

A

Posterior (80-95%); horizontal (5-20%).

49
Q

What are the most common sites of origin of primary acquired cholesteatomas?

A

Posterior epitympanum, posterior mesotympanum, and anterior epitympanum (in descending order of frequency).

50
Q

What conditions accelerate hearing loss in patients with otosclerosis?

A

Pregnancy, estrogen replacement.

51
Q

What are the two types of acquired cholesteatomas?

A

Primary and secondary.

52
Q

What is the difference between a primary and a secondary cholesteatoma?

A

Primary usually occurs in the attic at Shrapnell’s membrane and starts as a retraction pocket; secondary is associated with chronic middle ear infection and TM perforations.

53
Q

What are the two types of esophageal diverticula?

A

Pulsion and traction.

54
Q

Which of these is associated with high intraluminal pressure?

A

Pulsion.

55
Q

Which of these is Zenker’s diverticulum?

A

Pulsion.

56
Q

What therapeutic maneuver is based on the cupulolithiasis theory?

A

Semont.

57
Q

What is the typical route of spread of cholesteatomas originating in the posterior epitympanum?

A

Starting from Prussak’s space, penetrate posteriorly to the superior incudal space lateral to the body of the incus, and progress to the aditus and the antrum.

58
Q

At what age does otosclerosis peak in incidence?

A

Third decade.

59
Q

In which patients is Muscular tension dysphonia most commonly seen?

A

Untrained occupational and professional voice users.

Disease Processes (9 decks)

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