Ear Clinical Correlates

Question 1

What is the most importnat part of an ear workup?

Answer 1

taking a good history

Question 2

What tuning fork is usually used for rinne and weber?

Answer 2

512

Question 3

What’s probably the most important scor eyou get out of an audiogram?

Answer 3

the speech discrimination score, since this is what patient’s really care about

Question 4

What is considered a normal hearing threshold?

Answer 4

less than 25 DB

Question 5

What are you measuring in tympanometry?

Answer 5

the impedence of the ear drum in comparison to the pressure behind the ear drum

Question 6

What’s the most common cause of sensorineural hearing loss?

Answer 6

presbycusis - age-related sound induced progressive hearing loss (loss of the hair cells)

Question 7

What happens in otosclerosis?

Answer 7

it’s an autosomal dominant disease where you get bony growth of the stapes, such that it stuffens and you get conductive hearing loss

Question 8

What is a way to prevent otosclerosis? What is the treatment?

Answer 8

fluoride prevents

hearing aids to stapedectomy with proshtesis

Question 9

What symptoms would a patient complaint of in an acoustic neuroma?

Answer 9

asymmetric hearing loss

vertigo

facial nerve paralysis

aural fullness

trigeminal numbness

diplopia

Question 10

What is the difference between subjective and objective tinnitus?

Answer 10

subjective: perception of sound in the abscence of acoutstic, electrical or external stimulus

Objective: perception of sound caused by internal body sound or vibration

Question 11

What type of hearing loss is associated with subjective tinnitus and which is associated with objective tinnitus?

Answer 11

subjective is associated with high frequency sensorineural hearing loss

objective tinnitus is exacerbated by conductive hearing loss - the “inner” sounds aren’t masked by normal external sounds anymore

Question 12

Compare the following: vertigo, dysequilibrium, and imbalance

Answer 12

vertigo = illusion of movement

dysequilibrium = sense of poor coordination with erect posture or movement

imbalance = implies orthopedia or neuro problem

Question 13

What are some tests to include in the vestibular work up?

Answer 13

H&P obviously

MRI or CT

Electronystagmography

Rotary chair

vestibular evoked myogenic potentials

Question 14

What is hte most common cause of vertigo?

Answer 14

benign paroxysmal positional vertigo

Question 15

What is thought to be the cause of benign paroxysmal positional vertigo

Answer 15

post-trauma or post-viral infection, the otoconia get dislodged and roll around in the semicircular canals

Question 16

What does a presentation of benign paroxysmal positional vertigo look like?

Answer 16

positional vertigo that is latent after movement and brief

normal hearing

Question 17

How do you diagnose benign paroxysmal positional vertigo

Answer 17

with the Dix-hallpike maneuver and history

Question 18

What are the symptoms of meniere’s disease?

Answer 18

episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, aural fullness, progressive

often totally asymptomatic between spells

Question 19

What’s tricky about the meniere’s disease diagnosis?

Answer 19

it’s really a diagnosis of exclusion

you need to rule out things that can mimic meniere’s, like stroke or tumor

Question 20

What is vestibular neuronitis?

Answer 20

a viral infection of the vestibular nerve - it causes vertigo, but no hearing loss

Question 21

How do you treat a bacterial labyrinthitis?

Answer 21

you have to use IV antibiotics because ear drops wont get to th einner ear

also vestibular suppressants

Question 22

What is anotia? What is the treatment?

Answer 22

Developmental issue where there is NO ear

may or may not be a middle and inner ear

treat with a reconstruction or prosthesis. if middle ear is intact, use a bone anchored hearing aid

Question 23

What is microtia?

Answer 23

developmental issue where the ear is not completely formed

this can range from almost unnoticeable (grade 1) to having only a few bits of cartilage sticking off (grade 3)

Question 24

What is hte most common external anomaly?

Answer 24

lop ear (abscence of the anihelical fold, so ears kinda stick out)

Question 25

What is a preauricular pit?

Answer 25

it's an area that didn't fuse completely and a fistula forms from the sinus to the front ot he ear. You can get drainage form the area and they often become infected

Question 26

What is an auricular appendage?

Answer 26

it's arrested development or fusion of the hillocks of his, resulting in a cartilage part of the ear located int he wrong spot

Question 27

What is relapsing polychondritis and how does it affect the ear?

Answer 27

it's an autoimmune diseases that causes inflammation affecting cartilginous areas like the ears, nose, joints, and airways you get inflamed ear

Question 28

How cna you tell the difference between a relapsing polychondritis and a cellulitis of the auricle?

Answer 28

polychondritis will have elevated ESR, CRP, and IgG, but normal CBC whereas cellulitis will have normal IgG and abnormal CBC

Question 29

What is nodularis chronicus helicus?

Answer 29

It's a benign area of growth in the external ear, which is common in olde rpatients it looks like a skin cance,r but it's not - very painfult though

Question 30

What is a keloid and how do you treat it\>

Answer 30

it's development of scar tissue after trauma, like piercing the ears if early, inject iwth steroids if too big, excise and then inject with steroids

Question 31

What is an auricular hematoma and why do they need to be treated?

Answer 31

it's a hematoma in the external ear that's caused by trauma you have to treat them with incision, drainage, and bolster If you don't trea thtme, the patient will end up with a cauliflower ear deformity

Question 32

What are hte most common organisms that cause a cellulitis of the pinna?

Answer 32

staphylococcus streptococcus pseudomonas

Question 33

What is an ear canal osteoma? Is it an issue?

Answer 33

It's a benign bony projection intot he canal - often seen in orweigians and people who have been exposed to cold water (so minnesotans) it's really not an issue at all - surfical excision is rearely neeed

Question 34

What is the treatment for carcinaoms of the ear canal?

Answer 34

excision and/or radiation

Question 35

What will you see in herpes zoster oticus?

Answer 35

purulent ulcers in and around the ear - vesicles it's super painful, decreases hearing, facial nerve paralysis

Question 36

What are some things that can cause otorrhea?

Answer 36

otorrhea = ear drainage otitis media, externa, allergy, trauma, CSF leak

Question 37

What is ear canal stenosis?

Answer 37

it's when the ear canal is too small - can be congenital, post-trauma, or post-infeciton often you'll need surgery to widen it because small amoutns of wax will plug it

Question 38

What is otomycosis?

Answer 38

fungal growht in the ear - it will look like modly bread pretty much

Question 39

What is the risk factor for developing otomycosis?

Answer 39

1. prior antibacterial drops for an ear infection

Question 40

What is the treamtent for otomycosis?

Answer 40

debridement and antifungal drops

Question 41

What method for cerumen removal do otologists prefer?

Answer 41

instrument techniques like suctioning, curetting, or grasping with alligators they really don't use irrigation

Question 42

What symptoms will you see in a tympanic membrane perforation

Answer 42

ear pain, hearing loss, otorrhea, tinnitus

Question 43

What is the management for a TM perf?

Answer 43

they don't all require surgery - many will heal with time if you're not doing surgery, you need to keep the ear dry til it heals

Question 44

What is bullous myringitis?

Answer 44

an inflammation of the TM with serous bullae formation - associated with virus or mycoplasma

Question 45

What is tympanosclerosis?

Answer 45

white plaque formaiton on the TM (hyaline or calcium) after trauma like tubes for otitis media benign if it only affects the TM, if it involves the middle ear you might have some conductive loss

Question 46

What is a cholesteatoma?

Answer 46

a soft ball of keratin that ends up int he ear and causes bone erosion

Question 47

What is the treatment for cholesteatoma?

Answer 47

all of them have to be surgically excised to prevent complete destruction of the ear

Question 48

What are the 3 most common pathogens that cause acute otitis media?

Answer 48

S. pneumoniae, H influenza, Moraxella catarrhalis

Question 49

What is a serous otitis media? WHat is the management?

Answer 49

if's when you have fluid behind the TM but no infection antibiotics will do nothing make them go home and if it's still there in 12 weeks, put in tubes

Question 50

Why might a child have a red TM and still be completely healthy?

Answer 50

crying iwll turn the TM red

Question 51

What is the management for acute otitis media/

Answer 51

oral antibiotics (or topical antibiotic drops if the TM is already perforated).

Question 52

What are the indications for PE tubes?

Answer 52

recurrent OM - over 3 episodes in 3 months or over 4 episodes in a year persistent effusin over 3 months poor response to ABx cleft palate immnocompromis chronic eustachian tube dysfunction