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Final Exam Flashcards

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1
Q

Cholesteatoma

A

Abnormal skin growth behind TM. A cyst that arises from the pars flaccida. can expand into and beyond ME space

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2
Q

How does a cholesteatoma form?

A

in response to repeated infection or trauma, sometimes present at birth. Neg ME pressure causes a perforation or weak spot and skin grows in response which causes a pocket

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3
Q

Tx for cholesteatoma

A

course of antibiotics to reduce any current infection, surgery to remove is final Tx

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4
Q

Tuning Fork Difference Test

A
  • comparison of AC BTW ears
  • tells which ear is most sensitive to that Hz
  • TF held alternatively BTW ears
  • helpful to determine better ear
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5
Q

Weber Test

A

TF placed on center of forehead, midline of skull, nose, chin or upper teeth
- ask Pt where they hear the sound

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6
Q

Rinne Test

A

comparison of TF loudness on mastoid or next to ear

- ask which is louder?

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7
Q

Positive Rinne

A

AC > BC (NH or SNHL)

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8
Q

Negative Rinne

A

AC < BC (CHL)

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9
Q

Equivocal Rinne

A

AC = BC

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10
Q

Rinne Test Interpretation

A

negative rinne = 25 dB CHL

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11
Q

Problems with tuning fork tests

A 
experience:
- poor tech
- improper interpretation 
limitation of fork: 
- test at freq used only
- incorrect interpretation w/ limited results
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12
Q

Sites of possible ossicular discontinuity

A
  • incudo-stapedial joint- most common
  • separation of the incudo-malleal joint
  • dislocation of the incus
  • dislocation of the stapes from the oval window
  • fracture of the stapes
  • fracture of the malleus or incus- common
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13
Q

Etiology of ossicular discontinuity

A
  • blunt head trauma
  • longitudinal temporal bone fracture
  • barotrauma
  • penetrating trauma
  • chronic otitis media
  • chronic OM with cholesteatoma
  • congenital malformation
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14
Q

Effects of ossicular discontinuity on hearing

A
  • mild- mod severe CHL
  • depends on severity of disartic
  • if CHL > 40 dB, suspect disartic
  • large ABG @ high Hz, suspect disartic
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15
Q

Tx for ossicular discontinuity

A
  • partial or total ossicular replacement prostheses (PORP/TORP)
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16
Q

Causes of ossicular discontinuity surgery failure

A
  • on going ME abnormalities
  • recurrent cholesteatoma
  • recurrent OM
  • formation of granulation tissue or adhesions
  • extrusion or absorption of the presthesis and bony anklyosis of prosthesis
  • iatrogenic
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17
Q

Myringoplasty

A

reconstruction of a perforation of TM

- patching of perf that does not reach margin

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18
Q

tympanoplasty

A

reconstruction of the TM, also includes addressing ME pathology

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19
Q

Indications for tympanoplasty

A
  • CHL due to TM perf or ossicular dysfx
  • chronic or recurrent OM secondary to contamination
  • progressive HL due to chronic ME pathology
  • perf or HL persistent > 3 mos. due to trauma, infection, surgery
  • inability to bathe or participate in water sports safely
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20
Q

Goals of tympanoplasty

A
  • establish an intact TM
  • eradicate ME disease and create an air-containing ME space
  • restore hearing by building a secure connection BTW the eardrum and the cochlea
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21
Q

Tympanoplasty techniques

A
  • overlay technique- lateral grafting, post-aurical approach

- underlay technique- medial grafting, canal approach

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22
Q

Type I tympanoplasty

A

TM is grafted to an intact ossicular chain

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23
Q

Type II tympanoplasty

A
  • malleus is partially eroded

- TM +/- malleus remnant is grafted to incus

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24
Q

Type III tympanoplasty

A
  • malleus and incus are eroded

- TM is grafted to the stapes superstructure

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25
Type IV tympanoplasty
- stapes superstructure is eroded but food plate is mobile | - TM is grafted to a mobile foot plate
26
Type V tympanoplasty
TM is grafted to a fenestration in the horizontal SCC
27
tympanoplasty prognostic indicators
- status of ME - presence of handle of malleus - perf > 50%
28
Otosclerosis
- bony changes that occur are usually a combination of resorption and remodeling of the otic capsule bone - abnormal new bone tissue is formed, starting soft and possibly becoming hardened or sclerotic - first stage of otosclerosis is also known as otospongiosis - later stage- bone growth hardens - can occur anywhere in the otic capsule but most commonly the stapes footplate
29
symptoms of otosclerosis
- gradually progressive HL - tinnitus in 50-60% of patients - often bilateral - sometimes vestibular involvement - schwartz sign- red blush hue behind the TM due to vascularity of otospongiosis
30
Etiology of otosclerosis
- not fully understood - hereditary - endocrine, biochemical, metabolic, vascular - pregnancy- hormonal
31
clinical otosclerosis
involving fixation of stapes footplate
32
histological otosclerosis
- involving portion of otic capsule NOT stapes footplate- remains freely mobile
33
Otosclerosis Audiogram
- initially flat or rising CHL - mass component- high freq HL - max CHL- 60-65 dB - Carhart's Notch - bilat, progressive CHL - word rec normal - can spread to cochlea and cause SNHL or mixed
34
diagnosis of otosclerosis
- audio - impedance mismatch - family Hx - tinnitus - imbalance/vertigo - CT scan - schwartz sign
35
Tx for otosclerosis
- monitoring - amplification - diet- reduce caffeine, alcohol, salt - medical- sodium fluoride, vit D - surgery- stapes mobilization, stapedectomy
36
osteoma
- small tumor of new bone growth that is unilateral and singular - commonly found at the junction of the cartilaginous and bony portion of the EAC
37
Exostosis
- new bone growth in multiple and bilateral - arises from periosteum - removed by grinding - common among cold water swimmers
38
Usher Syndrome
genetic disorder characterized by HL, RP, vestibular probs
39
Retinitis Pigmentosa
- deterioration of the sensory cells of the retina - rods deteriorate first - pattern: night blindness, blind spots, tunnel vision
40
Type I Usher Syndrome
- profound HL from birth - RP progresses early - vestibular areflexia
41
Usher Syndrome Type II
- sloping high Hz HL present at birth that does not progress - RP onset in adolescence - normal vestib Fx
42
Usher Syndrome Type III
- NH and sight at birth - progressive HL - mod HL by teens, severe-prof by middle age - RP begins in teenage yrs - progressive loss of vestib Fx
43
Genetics of Usher Syndrome
- autosomal recessive pattern | - genes encode protein that make up cilia
44
Management of Usher Syndrome
- early Dx important - CI - mobility/balance training - Tx RP - genetic testing
45
Acoustic Neuroma
- benign slow growing tumors | - assoc. with neurofibromatosis
46
Symptoms of AN
- HL- most frequent initial symptom, asymmetric, high Hz, decreased speech discrim - vertigo - dysequilibrium - tinnitus - headache - nystagmus
47
Diagnosis of AN
- history and physical exam - audio - ABR - OAE - vestib testing - MRI
48
AN Tx Options
- observation - surgery - radiotherapy - conventional - stereotactic
49
4 types of presbycusis
- sensory - neural - strial - cochlear conductive
50
Sensory presbycusis
- affecting haircells and supporting cells | - bilat, precipitous HFSNHL w/ excellent SDQ
51
Neural presbycusis
- loss of afferent neurons in cochlea | - same audio as sensory but SDQ poor
52
Strial
- due to atrophy of lateral wall of stria vascularis | - fairly flat SNHL with good SDQ
53
cochlear conductive
- metabolic | - possibly due to thickening of BM
54
NIPTS
- NIHL - HL caused by chronic exposure to noise over a long period of time - characteristic high frequency loss - c/o HL and tinnitus
55
Acoustic Trauma
- HL caused by a single, short latency exposure - sudden HL- greatest in ear facing towards noise - unique audio config
56
Blast trauma
- HL secondary to sudden explosive force | - from change in pressure
57
otologic effects of blast injuries
- ME- TM perf most common, occasional ossicular chain disruption - inner ear- may be damaged at pressures insufficient to rupture TM, initial SNHL
58
auditory symptoms of blast trauma
- HL - SNHL, CHL, mixed, bilat or uni, temporary threshold shift - tinnitus - TM rupture - vertigo - otalgia - bleeding from external canal - FB
59
How are people exposed to solvents and heavy metals?
- inhalation - getting on skin - spills - explosions - water contamination - consumption
60
Symptoms of organic solvent exposure
- disequilibrium - vision problems - HL - abnormal olfaction - neurologic - headaches - memory loss - mood swings - coordination difficulties - delayed reaction time
61
solvent effects on inner ear
- cochlear damage - supporting cells - OHCs - vestib damage - sensory cells - synergistic effect when mixed
62
solvent effects on retrocochlear/central
- VIII nerve damage | - cerebellum/brainstem damage

Medical Audiology (1 decks)

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