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AUDE 5410 Aud-Vestib Disorders > Final Exam Study Guide (Prev. Material) > Flashcards

Final Exam Study Guide (Prev. Material) Flashcards

1
Q

Failure of canalization
Associated w/ microtia & ME anomalies
-More common in males

A

congenital aural atresia

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2
Q

what is seen in herpes zoster oticus

A

aka ramsay hunt syndrome / shingles

painful rash in ear canal, concha or below/behind auricle
HL & vertigo w/ CN VIII n involvement

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3
Q

what is seen in cerumen impaction

A

-Tymps →volume < .2 = complete obstruction & flat tymp
→volume >.2 = hole somewhere and might get pure tones

-Pure tones→mild CHL (up to 30dB)

-Otalgia

-Vertigo/Dizziness

-Coughing→arnold’s reflex (branch of CN X in EAC)

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4
Q

what is seen in otitis externa

A

Severe pain →swelling due to edema that causes the pain

-CHL

-Whitish, watery otorrhea

-Acute swelling that can close canal

acute: bacterial, swimmers ear, pain
chronic: seborrheic dermatitis, itchy, watery, swelling causing stenosis

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5
Q

what is seen in collapsing canals

A

Normal tymps

-CHL present @ or worse in HF w/ supras

-Thresholds become better w/ inserts or soundfield

Problem for younger children→ cartilage is not fully developed

-Older adults → cartilage is deteriorating

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6
Q

what is seen in otomycosis

A

-HL or a wet feeling

-Blue-black, green, yellow or white colored

-Debris visible

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7
Q

what is seen in necrotizing external otitis

A

-Immunocompromised PT w/ ear pain

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8
Q

what is seen in exostosis

A

Pain/discomfort

-Tinnitus

-Associated OE

-If large enough, can cause CHL

Bony growth that starts unilateral but ends usually bilaterally

irregular and multiple

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9
Q

what is seen in osteomasas

A

same as exostosis
smooth and regular

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10
Q

what is seen in osteoradionecrosis (ORN)

A

-Ear fullness

-Otalgia

-Foul odor

-CHL/SNHL

-Bloody otorrhea

-Tinnitus

-Microscopy→debris & granulation tissue, yellowish colored bone

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11
Q

what can be seen in otitis media

A

-Otoscopy →pneumatic otoscopy*, discolered ™, partial/complete bulging or retracted, perf, discharge, fluid lines/bubbles

-Immittance→ flat type b w/ HV = perf, flat type b NV = effusion, negative type c pressure = ET dysfunction

-ARTs→ abn/abs, unilateral OM = only ispi of unaffected present, bilateral oM = ipsi & contra bilaterally abn/abs

-Pure tones→WNL, CHL, mixed, SNHL, can fluctuate, could have ABG

-Speech→ normal supra threshold test, srt/pta in agreement

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12
Q

what can be seen in cholesteatomas

A

-Presents w/ HL first

-Otoscopy→ normal or perf present

-Tymps→any type depending on size, location & what is damaged
No damage to ™ or ossicles = normal
ME stiffness = As
Ossicular disarticulation=Ad
™ perf/ME full = B w/ LV
™ perf/ME not full = B w/ HV

-Audio→ depends based on where it is & stage it is picked up (norma→ just perf no ODl, CHL→ ossicular disartic, mixed

can recur even after surgery

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13
Q

what can be seen in OTSC

A

Otoscopy→normal or schwarze sign (reddish glow)
Tymps→type A or AS, only ME condition w/ normal tymps

-ARTs→ abn in most due to reduced mobility of stapes

-Audio→early =normal/mild CHL w/ rising, middle =CHL/Mixed w/ rising or flat, late=flattening of rising CHL/Mixed
(CHL doesn’t exceed 60-65 dB
Max CHL)
BC→Carhart’s notch (poor @ 2 by 15-20dB & narrows ABG), also associated w/

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14
Q

D/D for OTSC

A

Meniere’s (vertigo, tinnitus, LF SNHL)
Osteogenesis imperfecta (blue sclera, noise notch, fragile bones, collagen gene)
SSCD (3rd window, LF CHL but ARTs normal)

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15
Q

Normal ARTs with CHL

A

SSCD not OTSC

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16
Q

What is seen in ossicular disarticulation

A

-Otoscopy→perf, bleeding, rarely normal canal or ™, ME filled w/ blood or CSF

-Immittance→ Ad, ARTs abn

-pure tones→acute/delayed CHL or mixed

-Vestib→ BPPV, perilymphatic fistula/leak

Ice cream cone sign is abnormal on CT

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17
Q

what are s/s of paragangliomas

A

-Otoscopy→red mass in ME
-Immittance→ As or B & pulsating w/ jagged edges
-Audio→CHL & sometimes mixed

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18
Q

what is a type a tymp

A

normal
intact tm
normal ME fxnw

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19
Q

what is a type Ad and when is it seen

A

high admittance

compliant system
ossicular disarticulation or loss of elastic fibers in TM

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20
Q

what is type As tymp and when would you see it

A

reduced admittance

stiff system from thick (scarred) tm or OTSC

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21
Q

what is type b tymp and when would you see it

A

reduced admittance/flat

ME fluid (OM)
TM perf
debris in EAC

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22
Q

when would you see type c tymp and what is it

A

intact TM w/ negative ME pressure
ETD
ME fluid

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23
Q

type b high volume

A

perf or pe tube

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24
Q

in type b tymp will you see any other parameters?

A

no because ™ is not moving in order to measure them
all you see is volume

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25
type b low volume
obstruction - cerumen, debris, cholesteatoma
26
type b normal volume
fluid behind ear, cholesteatoma - something not allowing movement of ™ but volume is good
27
what if there is abn gradient/width
cannot include as jerger type
28
sensory portion of ART
afferent VIII CN
29
interneurons of ARTs
ventral cochlear nucleus & SOC
30
motor portion of ART
efferent CN VII
31
Acoustic reflexes are elicited between about
60 to 90 dB SL
32
what is SL in ARTs
is referenced to threshold level if 1000 Hz is 30 dB you can elicit a reflex 60-90 above this and result is dB HL
33
Normal ARTs occur between ~ ______for pure tones
85 to 100 dB HL
34
Reflexes are above the level of cognitive control; they are involuntary/automatic
false below
35
If the ART is measured on the same side to which a loud sound is presented, then it is
ipsi art
36
If the ART is measured on the opposite side to that to which the loud sound is presented, then it is
contra art
37
If tone is presented on the probe side, then it is
ispi
38
If tone is presented on the earphone side
contra
39
A normal ear should yield present ARTs from 500 to 2000 Hz at normal levels 4000 Hz, & occasionally 2000 Hz can normally be absent in older ears
true
40
how will a ME pathology affect art
even with 15 dB ABG can decrease intensity of signal going in ART is abn/abs on same side and opposite equal to amount of ABG
41
a right-sided ME pathology will have
abnormal right ipsilateral and contralateral as well as left contralateral ARTs
42
what will bilateral ME pathology show in ARTs
all four ART patterns are abn
43
For a right cochlear pathology ARTs will show what
pattern of elevated/absent responses on the right side (both ipsilateral and contralateral) and present/normal responses on the left side (both ipsilateral and contralateral)
44
The signal will affect the ARTs once the cochlear hearing loss shows AC thresholds >
50 to 60 dB HL
45
ARTs occur for cochlear loss
at lower SLs (30 to 40 dB SL) probably due to recruitment, a hallmark of cochlear impairment
46
R Cochlear path AC thresholds below 50 to 60 dB HL; reflexes at lower SLs
all normal
47
R Cochlear path AC thresholds above 50 to 60 dB HL
R ipsi & contra abn L both normal
48
R Cochlear path Bilateral Cochlear pathology – AC thresholds above 60 dB HL
all abn
49
Elevated/absent ARTs, which do not agree with the cochlear hearing loss are cause for suspicion of
retrocochlear pathology
50
where is reflex decay done
contralateral at 500 & 1000 Hz because this is the most sensitive for vestib schwannomas
51
what will ARTs show for CN VIII pathology
he side affected (wherever stimuli is delivered) will show abnormal ARTs, like a cochlear loss, only the ARTs will be abnormal at lower thresholds (sound effect)
52
what would a R CN VIII path show for ART
right ipsi and r contra are abn L are normal
53
What is congenital aural atresia? What is a condition associated with it? What is the FDA approved device for it and at what age?
failure of canalization results in this associated with microtia & ME anomalies spontaneous, can occur with Treacher collins, trisomy 22, crouzon’s & hemifacial microsomia FDA approves surgical BAHA for kids with bilateral or unilateral atresia after 5 yrs old under 5 can use BC HA coupled to soft/hard headband
54
Man with bilateral mixed HL from 500-4000 in the high frequencies. What could be the cause?
Collapsing canals
55
What is the external canal condition caused by radiation to the head and neck?
ORN
56
what are the signs of impacted cerumen? Mild CHL tymps <.02 ml Coughing Dizziness
all
57
What is not the sign of impacted cerumen? Otalgia Tymps >.03 ml? Complaints of fullness Mild CHL Dizziness
Tymps >.03 ml?
58
List 2 surgical complications of otosclerosis & discuss one of them
OTSC surgery can result in a perilymphatic fistula and a decrease in WRS. Regarding PLF, if implanted prosthesis gets misplaced after surgery it can puncture a hole into the inner ear space allowing perilymph to escape into the ME cavity Another complication is
59
Cholesteatomas are pseudotumors. Justify this. What are tymps findings of one that caused ossicular chain disarticulation? What is preferred treatment.
they are this because they are not considered tumors but they have same mannerisms like bone erosion, growth, and vasculature. They will take over and invade all structures that they contact, similarly to a tumor. In the R ear, tymps would show a type Ad with high static admittance. Surgery is the preferred treatment and antibiotics can be given beforehand to reduce inflammation and bleeding for surgery.
60
What demographic group is most prone to otosclerosis
white women bw 20-40 yrs
61
What is correct for ossicular disarticulation? only caused by temporal bone fractures typically self correcting condition hemotympanum is never reported with this can be caused by a single exposure to very high intensity sound ARTs are normal if tympanic membrane is intact
can be caused by a single exposure to very high intensity sound
62
Otosclerosis is a focal disease of
otic capsule
63
SSCD is differential diagnosis for otosclerosis. Clinically, they are differentiated by
normal ARTs
64
Jerger type Ad can be clinical finding in which disorders
ossicular disarticulation
65
Jerger type b HV can be clinical finding in which disorders
cholesteatoma
66
Glomus jugulare tumor can present with
unilateral CHL unilateral mixed HL tymp with jagged edges corresponding to PT pulse intact but inflamed looking ™
67
FN weakness/paralysis potential complication for what conditions
glomus tympanicum chronic suppurative OM cholesteatoma gunshot wound to temporal bone
68
what is a contraindication for surgery for OTSC
OTSC involvement of endolymphatic duct with meniere’s disease like s/s
69
which infectious disease affect mother that results in congenital HL in fetus
CMV infection rubella (german measles) AIDS
70
17 yr old female has chronic bilateral OM since 6 mos old. Has had plenty of PE tubes but none for the last 3 years. Has significant allergies and frequency neg ME pressure (type c) bilaterally. Last ME infection was reported 3 yrs ago. She noticed hearing in right ear is worse for the last year. Copious foul smelling discharge noted on otoscopy in R ear. Pure tones show mild - moderate CHL in R and normal in L. Type b HV in R and type A tymp in left. She most likely developed which condition due to chronic OM and/or negative ME pressure in R ear what is the best treatment for this?
cholesteatoma surgery
71
incorrect for glomus tumors can arise from paraganglia cells on dome of internal jugular vein, arnold & jacobsons glomus tympanicum can commonly grow to large size and cause hoarseness and dysphagia several genes are associated with thee but most are sporadic involvement of XII N indicates extensive growth of jugulare tumor
glomus tympanicum can commonly grow to large size and cause hoarseness and dysphagi
72
causes profound permanent SNHL visual problems and neurological and motor deficits in affected babies
CMV
73
HL secondary to ____ can result in cochlear ossification
meningitis
74
an incudomalleolar disarticulation appears as an ______ sign on CT scans
broken ice cream cone
75
one pathology/condition that could result in tymp with type b high ECV?
cholesteatoma
76
what do we see with rubella virus
german measles Congenital HL cataracts, cardiovascular cataracts, possibly ID
77
what do we see with CMV
Progressive & profound SNHL by age 3-5 (CI candidates) -Decreased life expectancy, larger spleen & liver, “blueberry muffin” rash, & decreased immunity Neurological deficits, blindness, ID, cardiovascular problems
78
what do we see with AIDS
n all cases of sudden bilateral or unilateral HL→populations at risk should be considered for HIV -OME, otalgia, vertigo, tinnitus, fullness, reduced OAEs, delayed ABR interwaves (from HIV or the drugs), recurrent/chronic OME
79
what do we see with meningitis
high fever, stiff neck, malaise, nausea, vomiting -Untreated→ blindness, paralysis, HL/deafness (acquired SNHL) & vertigo
80
what do we see with perilymphatic fistual
Vertigo w/out HL -HL w/out vertigo -Symptoms not determined from Meneries (SNHL, vertigo, tinnitus, aural fullness) -Audio: presentation of complex symptoms→ case hx, symptoms they present with; dix hallpike to see nystagmus
81
Which nerve is involved in eye movements assessed during vestibular testing?
CN III - Occulomotor
82
Which branch of the FN innervates the outer ⅔ of the tongue & can be sacrificed during ME surgery such as removal of cholesteatoma?
chorda tympani
83
a left FN schwannoma will show an abnormal left ispilateral response and an abnormal _____ contralateral response
right
84
what do we see in NIHL
Both TTS & PTS accompanied by tinnitus -symmetrical -profound SNHL is rare -LF thresholds better than 40 dB HF thresholds rarely better than 75 dB -Presbycusis can flatten noise notch -Noise notch noted from 3-4 sometimes 6 kHz
85
what do we see in acoustic trauma
-Otoscopy→TM perf or hemorrhage -Audio→ similar to NIHL, noise notch at 3-6, HF sloping or flat (more common) configuration, mixed HL (OD) -Tymps→Ad w/ OD -ART→abs w/ OD ™ perf, OD, tinnitus, otalgia, HL and/or vertigo
86
Osteopetrosis (bony dysplasia) is a disorder of aging that results in hardening of the cranial bones
false
87
______ syndrome is a rare congenital disorder with possible multifactorial inheritance resulting in hypoplasia of CNs VI & CN VII
mobius
88
what do we see in osteopetrosis
bony displasia Congenital facial paralysis -Vision & HL
89
what do we see in mobius
congenital hypoplasia of 6 & 7 n -Bilateral facial paralysis -CN VI uni or bilateral paralysis (cross eyed) -ID, deformities of extremities, musculoskeletal deformities
90
In the case of Bell’s palsy, MEAR will be present if the lesion is ______ to the stapedius nerve
distal
91
In the case of Bell’s palsy, MEAR will be present if the lesion is ______ to the stapedius nerve
distal
92
what will we see in bell's palsy
-partial/total unilateral facial paralysis → onset with 48 hr period, fever & stiff neck @ onset, no hl/vertigo, no other cranial neuropathy, eye drying (due to lack of eye closure & lacrimation -W/in 3-6 mos of onset→normal otoscopy, HL rare for pure tones, normal tymps, abnormal ARTs (proximal lesion to stapedius nerve), present ARTs (distal lesion to stapedius nerve)
93
what is D/D for bells palsy
-CPA/skull based tumors -vestib schwannoma -OM -Parotid gland tumors
94
who is most at risk for bells palsy
-Most common cause of acute unilateral facial paralysis -affects both sexes & right more -Pregnancy increases risk 3 fold
95
what would we see with facial neuromas
-Immittance→normal tymps, ARTs abn w/ lesion PROXIMAL to stapedius n & ARTs present w/ lesion DISTAL to stapedius n -Pure tones→ SNHL -ABR→ shows whether its acoustic or facial neuroma - Facial weakness usually gradual (⅔ of all cases), HL (~ 50%, SNHL, CHL, or mixed depending on tumor location - CHL occurs if lesion is on mastoid segment of FN invading ME cavity/ear canal/tympanic portion -Others→tinnitus, otorrhea, ear canal mass, otalgia, vestibular symptoms
96
what are D/D for facial neuromas
-OM w/ CHL (w/ or w/out cholesteatoma), cholesteatoma paragangliomas, meningiomas, acoustic neuroma (vestib schwannoma →because of SNHL that can be present in facial neuroma
97
when should you refer for vestib schwannomas
unexplained unilateral or asymmetric HL 15 dB thresh difference bw ears @ 2 adjacent frequencies for unilateral HL and 20 dB thresh difference bw ears @ 2 adjacent frequencies for bilateral HL unexplained unilateral or asymmetric tinnitus or vertizo/dizziness aural fullness facial paralysis/weakness asymmetric WRS w/ NU-6 lists > 15%? other tests: rollover, ARTs, RDs, ABRs
98
when should you refer for SSNHL
IMMEDIATE referral pure tones → sudden decrease or asymmetry in hearing of at least 30 dB w/ at least 3 consecutive test frequencies onset for over no more than 72 hrs corticosteroid treatment is most effect given w/in 2 wks of onset
99
when should you refer for OM
flat (wide width) w/ normal ECV cloudy ™ and/or air bubbles or air-fluid line or bulging ™ repeat tymp in 6-8 wks to monitor and refer if needed
100
when to refer for PE tubes
flat w/ large ECV → patent tubes (open) asymptomatic PTs w/ patent → follow managing physicians advice on care & f/u symptomatic PTs w/ patent → refer to managing physician symptoms → blood, otorrhea, otalgia, significant CHL flat w/ normal ECV → obstructed tubes, possible O
101
when to refer for perf
flat tymp w/ large ECV → ™ perf can be visualized on otoscopy asymptomatic & undiagnosed PT → follow dry ear precautions and refer to otolaryngologist asymptomatic & diagnosed previously → follow managing physicians treatment symptomatic PTs, whether diagnosed or not → refer to managing physician symptoms→ otorrhea, blood, otalgia, significant CHL
102
when to refer for ossicular discontinuity
Ad, narrow width, high admittance, hyper flaccid significant CHL across audiogram refer for medical eval
103
when to refer for OTSC
A or As, narrow width, normal compliance, unremarkable otoscopy refer for medical eval w/ CHL & BC notch @ 2kHz
104
when to refer for tinnitus
somatic tinnitus→ pulsatile tinnitus, refer mood disorder suicidal ideation w/ it → refer to mental health provider symptoms associated w/ head or neck movement including tinnitus modulation otalgia, otorrhea, dizziness, vertigo
105
when to refer for dizziness
PT w/ atypical findings to BPPV → symptoms not provoked by head position & negative Dix-Hallpike PT w/ BPPV w/ no improvement after 2-3 canalith reposition treatments
106
what does ME path look like on ARTs for L
abn L ispi & contra and abn right contra
107
what does me path for bilateral look like on ARTs
all abn reflexes
108
what is seen in ANSD
disruption of neural synchrony -ECochG & ARTs absent → 8th n involvement -Present OAEs until blood supply compromised -Abs ABR w/ present CM(OHC produced)→no wave 5 latency increase, response reverses based on stim polarity -Poor WRS in noise -Audio can have varying severity & configurations -Contralateral suppression w/ OAEs abs
109
who is at risk for ANSD
-Premature & very low birth weight -Prolonged NICU stay -Anoxia/hypoxia -Hyperbilirubinemia
110
how is ANSD diagnosed
-Present OAEs & reversal ABR, abs ART→anything involving 8th n is abnormal -Actual hearing thresh typically ~10 to 15 dB HL better than ABR thresh
111
what is management of ANSD
*question is not how severe HL is but how severe dys-synchrony is -CI can be either success or not→ neural integrity compromised will not be
112
what is seen in HHL/cochlear synaptopathy
-Loss of connection bw auditory n fibers & hair cells -Adversely affects fine speech structure decoding & speech perception especially seen in noise -Not seen on an audiogram Classic complaint→ “I can hear but I cannot understand what people say"
113
what is seen in presbycusis
Formula→genetics / (age + noise + ototoxic drugs) -Slow, progressive HF sloping SNHL -speech perception especially w/ noise & reverberation -Recruitment
114
what is seen in ABR w/ CHL
absolute latencies are pushed out but relative interwave latencies were retained within normal limits
115
what is seen in ABR w/ SNHL
wave 1 is prolonged (~ 2 ms) wave 5 has normal latency (~ 6 ms) Latency-intensity function shows a wave V not repeatable at 45 dB nHL – a higher hearing threshold
116
whatdoes BS show in ABR
only wave 1 present
117
what does vestib schwan show in ABR
diminished wave I and absent wave III & V

AUDE 5410 Aud-Vestib Disorders (18 decks)

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