ENT

Question 1

4) Tuning Fork Tests-512 Hz
a) (hold tuning for on top of head)
i) Midline (Normal)
ii) Lateralizes to CHL or to better ear
iii) Will not lateralize more than 30 decibles

Answer 1

Weber

Question 2

4) Tuning Fork Tests-512 Hz
i) AC >BC (Normal)
ii) BC>AC (CHL)
iii) Hold it out by ear, then place on mastoid process

Answer 2

Rinne

Question 3

a) Stimulus in the ear

b) Receive electrical impulse via brain wave scan

Answer 3

9) Auditory Brainstem Response ABR

Question 4

a) Outer Hair Cells emit low intensity sound following acoustic stimulation
b) Newborn Screening Test
c) Testing for kids

Answer 4

8) Otoacoustic Emission Testing

Question 5

a) Autosomal Dominant incomplete penetrance
b) 60 % have family Hx
c) Fluoride prevents
d) Rx: hearing aids or Stapedectomy

Answer 5

12) Otosclerosis

Question 6

a) Head Trauma
b) SSx: Headache, vertigo, SNHL, CHL, facial nerve paralysis, CSF leak via ear canal or nose
c) Rx: Neurosurgical unit observation, sx relief, lumbar drain, audio, possible ossicular reconstruction

Answer 6

14) Temporal Bone Fracture

Question 7

a) Asymmetric SNHL
b) Vertigo
c) Facial nerve paralysis
d) Aural Fullness
e) Trigeminal numbness
f) Diplopia
g) Dx: MRI of IACs with contrast
h) Rx: OBS vs SURG vs XRT

Answer 7

15) Acoustic Neuroma

Question 8

illusion of movement (ie rocking, rotary, ground rolling, since of falling forward/backward), commonly episodic

Answer 8

a) Vertigo

Question 9

sense of poor coordination with erect posture or movement, usually continuous

Answer 9

b) Dysequilibrium

Question 10

implies orthopedic or neuro problem

Answer 10

c) Imbalance

Question 11

all-encompassing term (ie light-headed, orthostatic, hypoglycemic, inability to concentrate)

Answer 11

d) Dizziness

Question 12

a) Most common peripheral vertigo
b) Cause: post trauma, post viral infection
c) SSx: recurrent brief positional vertigo, latency, fatigability
d) Dx: Hx, Dix-Hallpike
e) Ppys: canalithiasis
f) Normal Hearing

Answer 12

20) Benign Paroxysmal Positional Vertigo

Question 13

a) Symptoms
i) Fluctuating SNHL
ii) Tinnitus
iii) Episodic Vertigo (min-hr)
iv) Aural fullness
v) 25-30% bilateral
vi) Progressive
vii) Often totally asymptomatic between spells
b) Management
i) R/o stroke and tumor, infection, trauma, hypothyroid
ii) Salt restriction
iii) Evenly spaced meals H2O
iv) Diuretics
v) Steroids
vi) Vestibular suppressants: meclizine, benzos, scopolamine
vii) Allergy Rx
viii) Surgery

Answer 13

21) Meniere’s Disease

Question 14

a) Viral infection of the vestibular nerve
b) SSx: Vertigo lasts hours to days, No Hearing Loss
c) Prodromal viral URI
d) May last weeks to months
e) Rx: Meclizine, benzos, antiemetics

Answer 14

22) Vestibular Neuronitis

Question 15

a) SSx: Sudden hearing loss and vertigo, tinnitis
b) Infection spreads from middle ear thru round window or oval window
c) Dx: H & P, audiogram (SNHL)
d) Rx: IV antibiotics, vestibular suppressants, surgical management of middle ear infection, steroids

Answer 15

23) Labyrinthitis Viral or Bacterial

Question 16

a) Birth Trauma
b) Mobious Syndrome
c) Herpes Infection
d) Tumors
e) Stroke
f) Iatrogenic Injury
g) Neurologic Disease: Guillain-Barre, Myesthenia Gravis

Answer 16

24) Facial Nerve Paralysis

Question 17

no external ear development

i) 10% are Syndromic
ii) 30% are bilateral
iii) Associated with ear canal atresia and middle ear abnormalities
iv) Reconstruction or prosthesis
v) Bone Anchored Hearing Aid

Answer 17

a) Anotia

Question 18

i) Ear is slightly smaller than normal
ii) Conchal bowl is cupped
iii) All subunits are present
iv) Surgery usually not needed

Answer 18

b) Microtia Grade I

Question 19

i) Auricle is half sized
ii) All structures are present
iii) Soft tissues are deficient
iv) Surgery is sometimes beneficial

Answer 19

c) Microtia Grade II

Question 20

i) Small cartilage piece in superior remnant
ii) Anterior deflected lobule
iii) Surgical repair at age 5-6 years old
iv) Prostheses look pretty good

Answer 20

d) Microtia Grade III

Question 21

i) Most common external anomaly
ii) Absence of the antihelical fold
iii) Common in certain Royal lineages
iv) Causes grade school ridicule and low self esteem
v) Surgery offered

Answer 21

e) Lop Ear

Question 22

i) Frequently get infected
ii) Rx with antibiotics and incision and drainage
iii) Completely excise when infection has cleared
iv) Frequently bilateral
v) May affect any part of the auricle

Answer 22

f) Preauricular Pits and Fistulas

Question 23

i) Arrested development of fusion of the Hillocks of His
ii) Contains cartilage and skin
iii) Excision is elective
iv) Facial nerve is quite superficial in infants and toddlers

Answer 23

g) Auricular Appendages

Question 24

i) Autoimmune
ii) Looks really red
iii) Episodic & progressive
iv) May involve nose, joints, airway, heart valves
v) ESR and IGg elevation
vi) Rx: steroids and NSAIDS

Answer 24

e) RELAPSING POLYCHONDRITIS

Question 25

i) ∙Very painful ii) ∙Usually in older patients iii) ∙Looks like skin cancer iv) ∙Benign v) ∙Rx: Excisional biopsy

Answer 25

f) NODULARIS CHRONICUS HELICUS

Question 26

i) AVOID PIERCING IN KELOID PRONE PATIENTS ii) EARLY RX STEROIDS iii) LATE RX EXCISION

Answer 26

g) KELOIDS OF THE EAR

Question 27

i) CAUSED BY TRAUMA ii) TREAT WITH INCISION AND DRAINAGE THEN A BOLSTER iii) UNTREATED RESULTS IN CAULIFLOWER EAR

Answer 27

h) AURICULAR HEMATOMA

Question 28

i) SYMPTOMS INCLUDE PAIN, SWELLING, REDNESS, FEVER ii) ORGANISMS: STAPH, STREP, PSEUDOMONAS iii) RX ANTIBIOTICS AND PAIN RELIEF iv) RISK FACTORS DIABETES, FOREIGN BODIES, PIERCINGS, TRAUMA

Answer 28

i) CELLULITIS OF THE PINNA

Question 29

i) BENIGN PROJECTIONS IN CANAL ii) SEEN IN NORWEGIANS iii) MOST PEOPLE THAT HAVE THEM HAD SIG COLD WATER EXPOSURE iv) SURGICAL REMOVAL IS RARELY INDICATED v) LOOKS LIKE CHOLESTEATOMA

Answer 29

g) EAR CANAL OSTEOMAS & EXOSTOSIS

Question 30

i) PAINFUL, BLEEDING SOFT TISSUE MASS IN CANAL ii) NEEDS BIOPSY iii) NEEDS EXCISION AND OR RADIATION THERAPY iv) CAN METASTASIZE v) CAN BE FATAL

Answer 30

h) CARCINOMA OF EAR CANAL

Question 31

i) VERY PAINFUL RED SWOLLEN CANAL WITH PURULENCE ii) SEEN IN SWIMMERS, Q TIP USERS, DIABETICS, IMMUNOSUPRESSION iii) RX ANTIBIOTIC DROPS AND SYSTEMIC ANTIBX iv) TOPICAL SUCTIONING AND DEBRIDEMENT v) PSEUDOMONAS, E COLI, STAPH CORYNEBACTER vi) HEARING MAY BE AFFECTED

Answer 31

i) OTITIS EXTERNA

Question 32

i) PURULENT ULCERS IN AND AROUND EAR ii) DECREASED HEARING iii) SEVERE PAIN iv) FACIAL NERVE PARALYSIS v) ANTIVIRAL RX AND PAIN RELIEF vi) IMMUNOCOMPROMISE MAJOR RISK FACTOR

Answer 32

j) HERPES ZOSTER OTICUS

Question 33

i) Hx pain, hearing loss, vertigo, trauma, Rx Hx, previous ear surgery, recent infection ii) DDx Otitis media, otitis externa, allergy, trauma, CSF leak iii) Dx culture, GM stain, beta 2 transferrin for csf

Answer 33

k) OTORRHEA ( Ear Drainage)

Question 34

i) Red itchy flakey skin ii) Psoriasis of other areas iii) Rx Topical Steroids, avoid trauma, antibiotics for secondary infection

Answer 34

l) Psoriasis of External Ear Canal

Question 35

i) CAN BE CONGENITAL OR SECONDARY TO TRAUMA OR INFECTION ii) NEEDS CANALPLASTY TO ENLARGE CANAL iii) SMALL AMT WAX PLUGS EAR EASILY

Answer 35

m) EAR CANAL STENOSIS

Question 36

i) ITCHING PAINFUL EAR DRAINAGE DECREASED HEARING ii) COMPLICATION OF PRIOR ANTIBACTERIAL RX iii) ANTIFUNGAL DROPS PILLS PAIN RELIEF iv) DEBRIDEMENT v) ALCOHOL, VINEGAR, H2O

Answer 36

n) OTOMYCOSIS

Question 37

i) Pathophysiolgy: Otitis media, trauma, slag burns, indwelling PE tubes, explosion, diving, water skiing, cerumenectomy, barotrauma, cholesteatoma ii) SSx Hearing loss, otorrhea, tinnitis iii) Rx Keep ear dry consider tympanoplasty for persistent perf iv) NOT All PERFS NEED REPAIR v) Often heal with time vi) Tympanoplasty for large conductive hearing loss or to protect middle and inner ear from water and prevent middle ear infection

Answer 37

a) Tympanic Membrane Perforation

Question 38

i) INFLAMED TM WITH SEROUS BULLAE ii) ASSOC W VIRUS or MYCOPLASMA p URI iii) SSx otalgia, otorrhea hearing loss iv) Rx analgesia, antibiotics decompression of painful vesicles, and steroids for sensorineural hearing loss

Answer 38

b) BULLOUS MYRINGITIS

Question 39

i) White plaques on TM ii) Hyalin or Calcium deposition iii) PPx prior Otitis Media or Trauma (PE Tubes) iv) Normal hearing if limited to the TM v) If middle ear involved there may be conductive hearing loss

Answer 39

c) TYMPANOSCLEROSIS

Question 40

i) SOFT BALL OF KERATIN ii) INVOLVES SKIN iii) CAUSES BONE EROSION iv) SURGERY IS ALMOST ALWAYS INDICATED TO EXCISE TO PREVENT DESTRUCTION OF EAR

Answer 40

d) CHOLESTEATOMA

Question 41

i) Squamous epithelium in middle ear ii) Causes bone and soft tissue destruction of ear structures pressure necrosis, secondary infection and proteolytic enzyme release by cholesteatoma. iii) Dx pearly mass aural fullness, hearing loss, vertigo, chronic otorrhea iv) Rx surgical removal = tympanomastoidectomy

Answer 41

e) MIDDLE EAR CHOLESTEATOMA

Question 42

i) Acute middle ear space infection (

Answer 42

f) ACUTE OTITIS MEDIA

Question 43

i) Fluid in ear ii) Not treated with anything iii) May need tubes

Answer 43

g) SEROUS OTITIS MEDIA

Question 44

h) RISK FACTORS FOR OTITIS MEDIA

Answer 44

i) DAY CARE ATTENDANCE ii) SMOKE EXPOSURE iii) BOTTLE FEEDING iv) ALLERGY TO FOODS v) NASAL ALLERGY vi) RECURRENT URI vii) CRANIOFACIAL/SKULL BASE ANOMALIES viii) ADENOID HYPERTROPHY ix) GASTROESOPHAGEAL REFLUX x) IMMUNOLOGIC DISORDERS (IgA IgG def) xi) Ciliary Dysfunction xii) Nasal Intubation (NT NG) xiii) Nasopharyngeal Tumors xiv) Cholesteatoma xv) Genetics (PPGP)

Question 45

i) SIGNS and SYMPTOMS of AOM

Answer 45

i) Otalgia causing irritability and ear tugging ii) Aural fullness, something is blocking ear iii) Hearing loss iv) Tinnitis v) Fever vi) Red or Creamy Yellow TM that Bulges and is Immobile vii) Remember TM turns red with crying

Question 46

j) Management of AOM

Answer 46

i) The majority of AOM cases will spontaneously resolve in 24 – 72 hours ii) Oral antibiotics iii) Topical antibiotic otic drops if TM perforated iv) Pain relief, decongestants, antipyretics v) Prophylactic antibiotics indicated for recurrent infections vi) Myringotomy for severe otalgia or toxic pts.

Question 47

k) Surgical Management of Otitis Media

Answer 47

i) Myringotomy and Tubes (PE) ii) Adenoidectomy iii) Mastoidectomy

Question 48

i) • Embryology: ii) ▫ Cysts consist of squamous cell epithelium containing epidermal appendages iii) ▫ Epidermal elements are displaced during intramembranous growth phase of nasal bones iv) ▫ Location can be several: Fronto-temporal region, Orbital region, or Nasoglabellar region

Answer 48

g) Dermoid Cyst

Question 49

i) • Extracranial protrusions of meninges, CSF fluid, and neural tissue ii) • Meningoceles present similarly without herniation of brain tissue iii) • May present as external or internal nasal masses iv) • Described by location of dehiscence in the skull base

Answer 49

h) Nasal Encephalocele

Question 50

i) Hypotheses on formation ii) ▫ Develop from extracranial rests of glial tissue iii) ▫ Abnormal closure of fonticulus nasofrontalis iv) ▫ Another theory is that they are possibly encephaloceles which have lost CSF connection

Answer 50

i) Nasal Glioma

Question 51

i) Viral Rhinits ii) Occupational Rhinitis iii) Vasomotor Rhinitis iv) Nonallergic Rhinitis with Eosinophilia (NARES) v) Rhinitis Medicamentosa vi) Rhinitis of Pregnancy vii) Vasculitides, Autoimmunes & Granulomatous Dxs

Answer 51

k) Nonallergic Rhinitis

Question 52

i) IgE-mediated hypersensitivity of the nasal mucosa to foreign substances ii) Affects 20% of the United States population iii) Rarely occurs before 2 years of age, almost always present by 20 years of age iv) Male predominance in children, equalizes in adults v) Atopy: genetic predisposition to respond to environmental allergens with the production of specific IgE antibodies

Answer 52

l) Allergic Rhinitis

Question 53

a) Complex group of disorders with inflammation as the major universal finding b) Affects approximately 15% of the adult population in the United States

Answer 53

31) Sinusitis

Question 54

Sinusitis pathogenesis

Answer 54

i) Bacterial: S aureus, M Cat, H Influ (1) in up 80% of patients undergoing surgery for CRS ii) Fungi (1) Non-invasive colonization—obstruction of sinus ostia (2) Allergic fungal sinusitis—IgE mediated hypersensitivity iii) Allergic Rhinitis iv) Cystic fibrosis carrier state v) Primary ciliary dyskinesia vi) Immunodeficiency vii) Environment irritants: Tobacco smoke, Industrial pollution