ENT I Flashcards
(90 cards)
1
Q
what occurs if there’s a mismatch of the bilateral labyrinth system?
A
vertigo
2
Q
semicircular canals - what are they and types?
A
Organ for body movement
-posterior semicircular canal, lateral, superior
3
Q
posterior semicircular canal detects what?
A
when head tilts down towards shoulder
4
Q
lateral semicircular canal detects what?
A
when head shakes side to side, “no”
5
Q
superior semicircular canal detects what?
A
when head nods up and down, “yes”
6
Q
organ for hearing?
A
cochlea
7
Q
what do otolith organs sense? names?
A
gravity and linear acceleration
-motion according to their orientation
names: utricle and saccule
8
Q
utricle
A
otolith organ
- horizontal in head
- registers acceleration in horizontal plane
9
Q
saccule
A
otolith organ
- vertical in head
- registers acceleration in vertical plane
10
Q
what is CN VIII responsible for?
A
vestibulocochlear nerve
-responsible for balance and orientation in space and auditory function
11
Q
where does the Eustachian tube run?
A
anterior wall of middle ear to open in nasopharynx
12
Q
what ends are wider in Eustachian tube?
A
nasopharyngeal and tympanic ends are wider than middle of the tube
13
Q
what is narrowest protein of ET tube?
A
bony isthmus
14
Q
when is the ET tube open and closed?
A
normally closed
-only open during swallowing and yawning
15
Q
what is ET tube most important normal function?
A
equalization of pressure across tympanic membrane
16
Q
types of ET tube dysfunction (HINT: 2)
A
dilatory and patulous
17
Q
what is dilatory ET tube dysfunction?
A
-cartilage portion of tube doesn’t dilate
18
Q
causes of dilatory ET tube dysfunction?
A
- inflammation
- pressure dysregulation
- acquired anatomic abnormalities
19
Q
what is patulous ET tube dysfunction?
A
valve incompetency -> chronic patency
-STUCK OPEN
20
Q
dilatory ET tube dysfunction HALLMARK presentation
A
accompanying symptoms of hearing loss and abnormalities of the tympanic membrane
- retraction
- middle ear effusion
21
Q
what will you see on otoscope exam for dilatory ET tube dysfunction?
A
- effusion
- scarring
- thickening of TM (if chronic)
22
Q
what might TM have on dilatory ET tube dysfxn?
A
- retractions
- effusion
- cholesteatomas
- perforations
- plaques
23
Q
patulous ET tube dysfxn HALLMARK presentation
A
autophony (pt hears own voice amplified) & ear fullness
24
Q
what is patulous ET tube dysfxn worsened by?
A
exercise and prolonged speaking
25
PE findings for patulous ET tube dysfxn?
breathing induced excursions (movements) of TM and sensorineural hearing loss
26
what will weber test reveal for dilatory ET tube dysfxn?
lateralization to affected ear -> conductive hearing loss
27
what are the differences in types of hearing loss for patulous and dilatory ET tube dysfxn?
patulous -> sensorineural
dilatory -> conductive
28
treatment of dilatory ET tube dysfunction?
treat underlying etiology
- antihistamines
- decongestants (Zyrtec)
- nasal steroids
- vaslsalva
29
treatment of patulous ET tube dysfxn?
- treat if severe symptoms >6 weeks
- ventilation tubes in severe cases (equalize pressure)
- hydration and mucous thickening agent
30
what do you do for both patulous and dilatory ET tube dysfunction?
REFER TO ENT
- nasal endoscopy
- CT or MRI w/contrast if >3 months of unilateral sx's or middle ear effusion
- surgery if mass found
- balloon dilation
31
is vertigo a symptom or diagnosis?
SYMPTOM
32
what are the key to diagnosis of vertigo?
duration of episodes and association with hearing loss
33
what is affected in peripheral vertigo?
semicircular canals, otolith organs
34
what is affected in central vertigo?
cerebellum, CN VIII, brainstem
35
what is the balance center of the brain?
cerebellum
36
why does vertigo occur?
damage to CNS integrate sensory input and asymmetrical signal is sent
37
causes of peripheral vertigo
- Benign paroxysmal positional vertigo
- Vestibular neuritis (AKA labrythitis)
- Meniere’s Disease
- Herpes zoster oticus
- Acoustic neuroma
- Aminoglycoside toxicity
- Superior semicircular dehiscence syndrome
38
causes of central vertigo
- Migraines
- Cerebral tumor on VIII
- Chiari Malformation
- Brain ischemia (cerebellar infarct) - Ie. Vertebrobasilar stroke
- TIA
- MS
39
clinical presentation of peripheral vertigo
- sudden onset
- tinnitus & hearing loss
- +/- nystagmus
40
clinical presentation of central vertigo
gradual onset, no auditory symptoms like in peripheral vertigo
41
what is the most common cause of vertigo?
benign paroxysmal positional vertigo (~50%)
42
what is benign paroxysmal positional vertigo provoked by?
head movements like turning in bed, tilting head backward to look up
43
what is benign paroxysmal positional vertigo caused by?
calcium debris in semicircular canal (posterior canal most common)
-aka Canalithiasis
44
clinical presentation of benign paroxysmal positional vertigo
- rapid onset of dizziness or spinning (vertigo) that lasts seconds to minutes
- nystagmus (classic is clockwise)
- sensation of motion with sudden head movements
- NO ear pain, hearing loss, tinnitus
45
dx of benign paroxysmal positional vertigo
Dix-hallpike positional testing
- Clockwise, rotary nystagmus – fatigable with repetition
- Latency of 5-15 seconds between supine position and onset of nystagmus
- Induced the vertigo and nystagmus
46
further testing for benign paroxysmal positional vertigo (if needed)
- electronystagmogaphy (records eye movements)
- MRI/CT to r/o CVA or bleed
MRI COMES BEFORE CT
47
txt of benign paroxysmal positional vertigo
-txt is symptomatic b/c resolves w/in months
48
what is first line txt for benign paroxysmal positional vertigo?
antihistamines
49
after antihistamines, what do you use to treat benign paroxysmal positional vertigo?
- antiemetics, Benno's, scopolamine
- vestibular rehab
- surgery (only after 6 months)
50
vestibular rehab for benign paroxysmal positional vertigo
- epley maneuver to shift stone around - 3 different positions
- also do gaze stimulation exercises
51
vestibular neuritis (aka labrynthitis)
viral or post-viral inflammatory disorder affecting vestibular portion of CN VIII
-benign and self-limited
52
vestibular neuritis vs labrynthitis
vestibular neuritis: vertigo w/out hearing loss
labrynthitis: vertigo w/unilateral hearing loss on affected side
53
symptoms of vestibular neuritis (aka labrynthitis)
- Rapid onset of severe, persistent vertigo
- Gait instability
- Decreased hearing in 1 ear for labrynthitis
- Horizontal nystagmus
- Positive head thrust
- Nystagmus is suppressed with visual fixation
- If patient falls it is toward the affected side
- +/- unilateral hearing loss
54
imaging for vestibular neuritis (aka labrynthitis)
MRI/MRA for infarct
-MRA looks at blood vessels
CT if MRI/MRA not available
55
when would you do imaging for vestibular neuritis (aka labrynthitis)?
if concern for lesion or stroke in cerebellum causing symptoms
56
txt of vestibular neuritis (aka labrynthitis)
-steroid therapy (may improve recovery)
-antihistamines, antiemetics
, vestibular rehab
57
prognosis of vestibular neuritis (aka labrynthitis)
- self-limiting
- few days-week
- may have nonspecific dizziness and imbalance for months
58
when would you do vestibular rehab for vestibular neuritis (aka labrynthitis)?
After acute symptoms subside with aggressive proprioception and balance exercises
59
Meniere's disease
- Peripheral vestibular disorder attributed to excess endolymphatic fluid pressure
- Causes episodic inner ear dysfunction
60
what is affected in Meniere's disease?
Labyrinth/inner ear
- Cochlea
- Semicircular canals
- Otolithic organs
61
Risks of Meniere's disease
allergy, stress, viral
62
Meniere's clinical presentation
- vertigo
- unilateral sensorineural hearing loss
- unilateral tinnitus
- ear fullness
- disabling imbalance
- horizontal-torsional nystagmus in acute attack
63
unpredictable episodes of Meniere's last how long and followed by what?
may last hours, recurring, followed by fatigue
64
spontaneous episodes of Meniere's disease last how long?
20min-24 hours
65
imaging for Meniere's
audiometry - positive low frequency sensorineural hearing loss
electronystagmography - pos unilateral reduced vestibular response
caloric testing - shows loss/impairment of thermally induced nystagmus on affected side
66
is there a specific Meniere's test?
NO!
67
txt for Meniere's does what/
relief of symptoms but doesn't address underlying pathology
68
goals of txt for Meniere's?
- Reduce frequency and severity of vertigo attacks
- Reduce or eliminate hearing loss and tinnitus associated with attacks
- Minimize disability
- Prevent disease progression (mostly hearing loss and imbalance)
69
txt for acute symptoms of Meniere's
- Antihistamines
- Antiemetics
- Benzodiazepines
- Anticholinergics (Scolpolamine)
70
long-term txt for Meniere's
- Lifestyle adjustments
- Salt restriction
- Limit caffeine and nicotine
- Limit alcohol
- If tinnitus, avoid excessive noise
71
non-destructive txt procedures for Meniere's
Surgical: On endolympathic sac and succolotomy
-Can cut a hole in the top and let excess fluid drain out
- Intratympanic steroids
- Positive pressure pulse generator
72
destructive txt procedures for Meniere's
Intratympanic gentamicin injection (Kills everything)
```
Surgical laburinthectomy
(Deafness in that ear results)
```
Vestibular nerve resection
(Cut vestibular portion of CN VIII)
73
semicircular canal dehiscence syndrome
Thinning of the bone that separates the superior semicircular canal from middle cranial fossa
-Allows pressure to be transmitted into inner ear
74
how is vertigo provoked in semicircular canal dehiscence syndrome?
coughing, sneezing, valsalva, loud sounds (Tullio phenomenon)
75
what establishes dx for semicircular canal dehiscence syndrome?
high resolution Ct of the temporal bone
76
tinnitus epidemiology
- children
- increases w/age
- men>women
- smokers
77
will chronic tinnitus remit completely
no, but often becomes less bothersome over time
78
types of tinnitus (HINT: 2)
pulsatile, non-pulsatile
79
pulsatile tinnitus sounds like and seen it what disorders?
- Like listening to own heartbeat
- Vascular disorders
- Arteriovenous shunts
- Venous hums
- Eustachian tube dysfunction
- Arterial bruits (worse in quiet environment)
80
non-pulsatile tinnitus
- Clicking tinnitus (secondary to middle ear spasm)
| - Unilateral
81
causes of tinnitus
- ototoxic meds
- presbycusis
- otosclerosis
- chiari malformations
82
how do ototoxic meds cause tinnitus?
Affects various components of the cochleovestibular end-organ
83
presbycusis and tinnitus
- Sensorineural hearing loss with aging
| - Any acquired high frequency loss commonly associated with tinnitus
84
otosclerosis and tinnitus
Condition of abnormal bone repair of the stapes footplate bone
85
chiari malformations and tinnitus
Occurs when low lying cerebellar tonsils cause tension on the auditory nerve
86
history for diagnosing tinnitus
- get description of tinnitus
- ask about previous ear disease, noise exposure, hearing status, head injury, symptoms suggestive of TMJ
- review all meds and supplements
- review medical conditions
- ask if difficulty hearing or hearing loss
87
medical conditions associated with tinnitus
HTN, atherosclerosis, neurologic illness, prior surgery
88
physical exam for tinnitus
- Complete HEENT
- Cranial nerve exam
- Evaluate tympanic membrane
- Auscultate the neck, periauricular area, temple, orbit, mastoid
- Effects of positioning on vascular compression of the neck on side involved should be noted
89
what to avoid with tinnitus?
excessive noice and ototoxic and other drugs that damage cochlea
90
txt for tinnitus
-Correct identified comorbidities and mitigate their effect of tinnitus
-Treat underlying depression and insomnia
-Cochlear implants in cases of severe sensorineural hearing loss
-Tinnitus retraining therapy
Bio-feedback cognitive therapy as adjunct
