Ear: Middle Ear And Beyond (Final)

Question 1

The “Big Four” Ear Complaints

Answer 1

1. Hearing Loss
2. Equilibrium or balance problems
3. Dizziness, vertigo
4. Tinnitus (auditory paresthesia)

Question 2

Cholesteatoma

Answer 2

-A benign tumor near eardrum
-Appears as a white mass behind or on eardrum

Question 3

Most cholesteatomas are due to repeated:

Answer 3

Middle ear infections

Question 4

Symptoms of Cholesteatoma

Answer 4

Hearing loss, dizziness, pressure in ear, ear ache, drainage of pus

Question 5

Treatment of Cholesteatoma

Answer 5

-Surgery to remove growth completely/reconstruct damaged ossicles or eardrum
-Goal: Preserve hearing and equilibrium/balance

Question 6

Vestibular Schwannoma (Acoustic Neuroma)

Answer 6

Slow-growing, benign tumor of CN 8 Schwann cells

Question 7

Vesticular Schwannoma can grow large enough to:

Answer 7

Compress facial nerve, leading to facial palsy

Question 8

Best Diagnosis tools for Vestibular Schwannoma

Answer 8

-Contrast-Enhanced MRI: Gold standard of Diagnosis
-CT Scan: If MRI is contraindicated

Question 9

Treatment of Vestibular Schwannoma

Answer 9

-Observation: Wait until symptoms are intolerable
-Microsurgical removal or reduction of tumor
-Stereotactic radiation therapy

Question 10

What other ear-related symptoms can hearing loss be accompanied by?

Answer 10

Tinnitus, ear ache or ear pain, dizziness or problems with balance
-Others: Ear discharge, fullness in the ear, nausea

Question 11

Conductive Hearing Loss is caused by:

Answer 11

Anything that interferes with conduction of sound waves from outer ear to oval window

Question 12

Causes of Conductive Hearing Loss

Answer 12

-Middle ear infections (Otitis media)
-Wax or any blockage of outer ear
-Otosclerosis (growth of surrounding bone)
-Cholesteatoma (growth into the middle ear)

Question 13

Sensorineural Hearing Loss is due to:

Answer 13

-Dysfunctional cochlea, acoustic nerve, or brain
-Usually permanent
-Usually affects both ears, but not necessarily equal

Question 14

Possible Causes of Sensorineural Hearing Loss

Answer 14

-Presbycusis: Decline in hearing due to aging
-Acoustic Trauma: Damages hair cells of inner ear
-Drugs: Aspirin, quinine, opiods (ototoxicity)
-Vestibular Schwannoma: A benign tumor

Question 15

Presbycusis

Answer 15

-Age-related sensorineural hearing loss
-Especially affects high frequency sounds: Difficult to hear & understand voices in a crowded situation

Question 16

Diagosis of hearing loss

Answer 16

-Patient history, doctor suspicion
-Screening tests: Rinne, Weber Tests

Question 17

Hearing Tests

Answer 17

-Hearing acuity: Whisper, Finger Rustle
-Hearing Loss: Weber, Rinne

Question 18

Conductive Hearing Loss

Answer 18

-Weber: Vibration sounds heard best in bad ear
-Rinne: Bone and Air conduction are equal

Question 19

Sensorineural Hearing Loss

Answer 19

Weber: Vibration sounds heard more in good ear
-Rinne: Air>Bone Conduction

Question 20

Audiologist Tests for Hearing

Answer 20

-Audiometry
-Tympanometry/Impedance Tests

Question 21

Tx of hearing loss

Answer 21

-Conductive: Removal of wax, cholesteatoma, stapedectomy, and prosthesis…
-Sensoryneural: Hearing aid, removal of vestibular schwannoma

Question 22

Cochlear implants

Answer 22

Hearing device for people with severe sensorineural hearing loss

Question 23

Tinnitus

Answer 23

“Paresthesia of the ear”/Ringing

Question 24

Causes of Tinnitus

Answer 24

-Loud noises
-Underlying disease: HBP, allergies, heart disease..
-Ear infection
-Rupture/Perforation of tympanic membrane
-Earwax
-Injury to the neck or head
-Vestibular schwannoma/other tumors
-Drugs

Question 25

Diagnosis in Tinnitus

Answer 25

-Check hearing: Auditory acuity, Weber, Rinne -Otoscopy: Check canal and tympanic membrane

Question 26

Treatment of tinnitus

Answer 26

-Treat the cause -Adjust: Per PARTS findings in cervical spine/occiput -Muscle work: SCM and suboccipital -Self-help measures

Question 27

Inputs that contribute to our sense of balance, body position, motion

Answer 27

Afferent information from: Ears, proprioceptors, inner ear

Question 28

Labyrinthitis

Answer 28

-Infection/inflammation of the labyrinth

Question 29

Labyrithitis is almost always caused by:

Answer 29

Viral infection

Question 30

Symptoms of Labyrinthitis

Answer 30

-Vertigo, loss of balance (even longer) -Loss of hearing in one ear -Dizziness (lasts for days)

Question 31

Treatment of Labyrinthitis

Answer 31

-Promote self-healing: Rest, fluids, good nutrition, adjust -Take care regarding balance: Avoid quick movements -Seldom recurs

Question 32

Meniere’s Disease

Answer 32

Periods of vertigo lasting for minutes to hours -Unknown etiology

Question 33

Meniere’s Prodromals

Answer 33

-Visual: “Explosions of spots” -Auditory: Tinnitus -Head: “Feels Full” -General: Sweating

Question 34

Treatment of Meniere’s

Answer 34

-No known cure -Chiro adjustments and trigger point work: Neck, schoulder and cervicothoracic regions -Medications to: reduce anxiety -Reduce intake of: Salt, nicotine, alcohol, caffeine

Question 35

Meniere’s: Diet/Supplementation

Answer 35

Manganese, B Complex, Chromium picolinate, Co-Q10, Butchers Broom

Question 36

Benight Paroxysmal Positional Vertigo (BPPV)

Answer 36

Extreme spinning sensation when patient looks up or to one side, or when lying on one side

Question 37

Symptoms of BPPV typically last:

Answer 37

Only about a minute but are recurrent

Question 38

BPPV is typically caused by:

Answer 38

Disruption or malposition of the otoconia/otoliths in the utricle and saccule, especially when head is moved in certain directions -Younger: Head Injury -Adults: Age-Related

Question 39

What test would you perform for BPPV

Answer 39

Dix-Hallpike Test -Others: Elecronystagmography, MRI, Rotating Stool Test

Question 40

Dix-Hallpike Test would be positive for BPPV if:

Answer 40

1. Bursts of Nystagmus: As patient turns head when supine 2. Vertigo

Question 41

Treatment of BPPV

Answer 41

-Canalith repositioning maneuvers: Epley maneuver

Question 42

Cervicogenic vertigo

Answer 42

Vertigo due to abnormal proprioceptive input from the cervical spine

Question 43

What joints/muscles are affected by Cervicogenic Vertigo?

Answer 43

-Joints between occiput and C3 -Muscles of the neck: SCM & suboccipital muscles

Question 44

In cervicogenic vertigo, _____ and ___ are always present and _____ ROM is always found

Answer 44

Neck pain, trigger points and decreased ROM

Question 45

Treatment of certicogenic vertigo

Answer 45

Chiro adjustments, stretches/neck exercises, postural hygiene, medications, surgery

Question 46

Vertigo Supplementation

Answer 46

Niacin, DMG, B Complex, Choline, ginko biloba, zinc, butcher’s broom, ginger

Question 47

Male de Debarkment Syndrome (MdDS)

Answer 47

Rare, usually after disembarking from a boat, ride or plane