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Flashcards in 208 ENT Deck (46):
1

Which part of the ear is affected in conducive hearing loss?

Outer/middle ear

2

Which part of the ear is affected in senrorineural hearing loss?

Inner ear/cochlear/auditory nerve

3

What is a positive Rinne's test?

When air conduction is greater than bone conduction

4

Which ear does the pt hear the sound in in a Weber's test in a unilateral conductive hearing loss?

In the affected ear

5

Which ear does the pt hear the sound louder in a Weber's test in a unilateral sensorineural hearing loss?

Away from the affected ear

6

What is myringosclerosis?

Chalky white patches on the eardrum which are benign and a result of previous damage

7

How many dB amplification does the pinna provide at 4kHz?

3dB

8

How many dB of amplification does the concha provide at 4-5kHz?

10dB

9

How many dB of amplification does the ear canal provide at 2.5kHz?

10dB

10

What is the net gain of amplification at 2.5kHz as the sound waves travel through the ear to the auditory nerves?

20dB

11

Name a cause of congenital conductive hearing loss

Atresia

12

What is the most common cause for sensorineural hearing loss?

Increasing age

13

Name 2 drugs which can cause sensorineural hearing loss

Gentamycin
Furosemide

14

Name 3 inflammatory conditions which can cause lesions of CN VIII and therefore a sensorineural hearing loss
(4 listed)

TB
Sarcoidosis
Neurosyphilis
Carcinomatous meningitis

15

What is otosclerosis?

Inherited disease where a small focus of spongy bone developing at fissula ante finestrum which maintly causes conductive hearing loss

16

What is the treatment of otosclerosis?

Surgery - fixation of the stapes with a prosthesis
Hearing aid

17

What is another name for secretory otitis media with effusion?

Glue ear

18

What condition can reoccur in pt's with glue ear?

Otitis media

19

What are the treatment options for glue ear?
(4 listed)

Watch and wait
Grommets
Grommets + adenoidectomy
Hearing aid

20

Which cells deteriorate in presbyacusis?

Hair cells / ganglion cells

21

What causes an acoustic neuroma?

Slow overgrowth of Schwann cells which cover the vestibular/cochlear nerves

22

Where do acoustic neuromas tend to reside once they have reached around 2-3cm?

Cerebellopontine angle

23

What type of hearing loss does acoustic neuromas cause?

Unilateral sensorineural hearing loss

24

What is the outcome of an untreated acoustic neuroma?

Hydrocephalus - the tumour grows into the cerebellopontine angle and occludes the cerebral aqueduct and 4th ventricle

25

What are the 2 factors thought to contribute to the formation of a cholesteatoma?

Epithelial migration coupled with negative middle ear pressure

26

Which direction do cholesteatomas tend to grow/migrate?

Superomedially

27

In which trimester of pregnancy can a congenital cholesteatoma start forming?

1st trimester

28

What are the possible complications of an untreated cholesteatoma?
(4 listed)

Facial nerve paralysis
Meningitis
Mastoid abscess
Brain abscess

29

What are the 3 red flags of vertigo?

1. Any cranial nerve symptoms
2.Weakess/ numbness in limbs
3. Gaze evoked nystagmus

30

What is the most common cause of isolated vertigo?

BPPV - benign paroxysmal positional vertigo

31

Which manoeuvre is performed to diagnose BPPV?

Dix-Hallpike

32

Which manoeuvre is curative in most pt's with BPPV?

Epley

33

What is the cause of BPPV?

Otoconia felling off the macula to create a mass behind the cupula

34

What causes Meniere's disease?

Build up of endolymphatic fluid in the inner ear due to restricted flow which causes distension and disruption to normal neuroepithelia. Also known as endolymphatic hydrops

35

What is the progression of symptoms in Meniere's disease?

Hearing loss and tinnitus followed by vertigo

36

What causes the ionic disequilibrium in Meniere's disease? What is the outcome of this?

Endolymph and perilymph mixing together which causes stimulation and damage of the neuroepithelium

37

What is betahistidine used to treat?

Prophylaxis of vertigo in Meniere's disease

38

What are the surgical options for Meniere's disease?
(4 listed)

1. Grommets + gentamycin into the middle ear
2. Saccus decompression (opening of the endolymphatic sac)
3. Chemical labyrinthectomy
4. Bony labyrinthectomy

39

What causes vestibular neuritis?

Inflammation of the vestibular nerve by a virus or arterial occlusion

40

What are the symptoms of vestibular neuritis?

Severe vertigo
N&V

41

What distinguishes vestibular neuritis from labyrinthitis?

Vestibular neuritis has preserved auditory function

42

What is prochloperazine used in the treatment of?

Vestibular neuritis - vestibular sedation

43

What can be observed in an examination of a patient with vestibular neuritis/labyrinthitis?

Nystagmus in all directions,

44

Name 3 introcerebral diseases which can cause vertigo

MS
Migraine
Posterior circulation stroke

45

Which ear is effected in a left beating nystagmus?

Right - the fast phase defines the nystagmus but the slow phase moves towards the affected side due to the unopposed action of the extraocular muscles

46

Where in the brainstem is the vestibular nucleus found?

Pons