26 Idiopathic Flashcards by brian langford

What condition would cause a tense sounding voice, vocal fatigue, and a prolonged closed phase with reduced vibratory and mucosal wave amplitude during videostrobe?

Glottic hyperabduction dysphonia

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What kind of dystonia is spasmodic dysphonia (SD)?

Focal

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What are the characteristics of focal dystonias?

Inappropriate and excessive efferent activity of motor neurons in small areas

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What are 2 types of SD

Adductor and Abductor

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Which type of SD is more common

Adductor

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What type of SD is characterized by a harsh, strained voice w/ inappropriate pitch breaks, breathiness, and glottal fry

Adductor SD

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What are the typical features of abductor SD

Breathy, effortful hypnotic voice w/ abnl whispered segments of speech

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The inability to sustain vowels during speech is suggestive of what d/o?

Adductor SD

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Voiceless consonant is suggestive of what d/o?

Abductor SD

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What percent of SD is familial

12%

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Which muscles are responsible for adductor SD?

Thyroarytenoid and LCA

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Which muscle is responsible for abductor SD?

PCA

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What is preferred method of tx for SD?

Chemical denervation w/ botox

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What are the 2 ways to deliver botox to PCA

Transcricoid and retrograde (rotating the larynx away from side of injxn)

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How can one confirm placement of needle in PCA?

Using EMG guidance, have pt sniff

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What can be done if SD sx persist after complete paralysis of PCA?

Inject the CONTRA PCA with very small increments of toxin or inject the cricothyroid muscle

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How is injection into cricothyroid muscle accomplished and how is proper placement confirmed

Peroral route; confirm by having pt sing an ascending scale and observing the increase in EMG activity as pitch increases

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What are the adverse effects of PCA injxn?

Stridor (particularly w/ exertion), airway compromise, dysphagia, aspiration

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What is the adductor laryngeal breathing dystonia?

Paradoxical adduction of the VF during inspiration, causing inspiratory stridor that worsens with exertion and disappears during sleep

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What effect does adductor laryngeal breathing dystonia have on the voice

None

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What syndrome is a/w blepharospasm

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Meige’s syndrome

Which muscles are involved in blepharospasm

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Orbicularis oculi, procerus, and corrugator supercilii

What causes hemifacial spasm

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A vascular loop, most commonly of the anterior or posterior inferior CBL art, impinging on root of CN VII

What is initial tx for hemifacial spasm?

What is the procedure of choice for these pts?

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baclofen

- microvascular decompression

Which muscles are injected when using botox for hemifacial spasm

Zygomaticus major and minor, levator anguli oris, risorius

What muscles are injected when using botox to tx oromandibular dystonia

masseter, temporalis, and medial and lateral pterygoids

What percent of pts w/ unilateral tinnitus have retrocochlear pathology

11%

What is the m/c cause of venous pulsatile tinnitus

Idiopathic intracranial hypertension syndrome (pseudotumor cerebri, benign intracranial HTN)

What is m/c cause of pulsatile tinnitus in young female pts

IIH

What are six etiologies of pulsatile tinnitus

- IIH - Jugular bulb abnlities - Hydrocephalus a/w stenosis of sylvian aqueduct - Inc ICP a/w Arnold-chiari synd - Abnl condylar and mastoid emissary veins - Idiopathic or essential tinnitus

What is the tx for IIH

Weight reduction and acetazolamide (250 mg TID) or lasix (20 mg BID) Lumbar-peritoneal shunt for pts w/ visual deterioration, persistent HA, or disabling tinnitus

What is the definition of sudden sensorineural hearing loss

>20 dB HL over at least three contiguous frequencies occurring w/in 3 days

In what percent of sudden SNHL can a definitive cause be determined?

10%

What % of SSNHL will turn out to have a vestibular schwannoma

What are 2 common theories of etiology of idiopathic SSNHL

Circulatory disturbance and inflammatory reaction (usu viral)

What is current standard of care for w/u and tx of idiopathic SSNHL

Otologic exam, audio, r/o retrocochlear pathology --tx w/ steroids, +/- antivirals (no), +/- diuretics

What lab studies are useful in w/u of idiopathic SSNHL

Coag profile (CBC, PT, PTT), viral studies, ESR

What is prognosis of idiopathic SSNHL

Overall recovery to functional hearing levels in 65-69%; no conclusive evidence that outcome is improved by medical tx

When is spontaneous recovery of hearing in SSNHL more likely

If pt is w/o vestibular sx and suffers only partial HL, particularly low freq (better prog if apex of cochlea involved)

What tx are used to try to optimize cochlear blood flow

Vasodilators (histamine, papaverine, verapamil, CO2) and blood thinners (defibrinogenation therapy, dextran, papaverine)

What evidence supports use of CO2 for SSNHL

Fisch et al. (1983) compared carbogen (95% oxygen and 5% carbon dioxide) inhalation therapy daily for 5 days with papaverine and low-molecular-weight dextran for 5 days and found a statistically significant improvement in hearing levels with carbogen therapy. These findings have not been replicated.

What evidence supports use of corticosteroids for SSNHL

Steroid therapy is among the few treatment methods in ISSNHL to have single modality, randomized, prospective studies demonstrating effectiveness.

What evidence supports use of antivirals for SSNHL

No randomized prospective studies have demonstrated effectiveness

What factors lead to best rate of recovery after SSNHL

Pts treated with steroids and vasodilators with worse initial PTA and SDS, younger age, and greater number of treatments are most likely to improve

When is middle ear exploration indicated in SSNHL

If loss occurs in an only hearing ear -- to r/o a fistula

What type of bony EAC growth is usu attached to tympanosquamous suture line

Osteoma

Indications for removal of EAC exostoses

Less than 1 mm aperture, recurrent otitis externa, and water trapping

What are sx of patulous ET

- Aural fullness - Autophony - Tympanophonia that improve when head is placed down b/w the legs - Onset occurs w/ wt loss or after RT to NP

What is tympanophonia

Audition of one's own breath sounds

What are some tx for patulous ET

- Reassurance - Wt gain - SSKI (10 gtt in juice po TID) - Premarin nasal spray (25 mg in 30 cc NS, 3 gtt per nose TID) - Occlusion of ET - Myringotomy and tympanostomy tube placement

26 Idiopathic Flashcards

(50 cards)