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Disease Processes > Idiopathic > Flashcards

Idiopathic Flashcards

1
Q

What is the definition of sudden sensorineural hearing loss?

A

>20 dB hearing loss over at least three contiguous frequencies occurring within 3 days.

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2
Q

In what percent of these cases can a definite cause be determined?

A

10%.

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3
Q

What percent of patients with unilateral tinnitus have retrocochlear pathology?

A

11%.

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4
Q

What percent of cases of SD are familial?

A

12%.

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5
Q

What causes hemifacial spasm?

A

A vascular loop, most commonly of the anterior or posterior inferior cerebellar artery, impinging on the root of VII.

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6
Q

Voiceless consonant is suggestive of what disorder?

A

Abductor SD.

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7
Q

What are the two types of SD?

A

Adductor and abductor.

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8
Q

Which is more common?

A

Adductor SD.

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9
Q

Which of these is characterized by a harsh, strained voice with inappropriate pitch breaks, breathiness, and glottal fry?

A

Adductor SD.

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10
Q

The inability to sustain vowels during speech is suggestive of what disorder?

A

Adductor SD.

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11
Q

What is tympanophonia?

A

Audition of one’s own breath sounds.

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12
Q

What are the symptoms of patulous eustachian tube?

A

Aural fullness, autophony, tympanophonia that improve when the head is placed down between the legs; onset often occurs with weight loss or after irradiation to the nasopharynx.

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13
Q

What is the initial treatment for hemifacial spasm?

A

Baclofen.

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14
Q

Which has a male predilection?

A

Both.

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15
Q

What are the typical features of abductor SD?

A

Breathy, effortful hypnotic voice with abnormal whispered segments of speech.

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16
Q

What is the preferred method of treatment for SD?

A

Chemical denervation with botulinum toxin.

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17
Q

What are the two common theories on the etiology of idiopathic sudden sensorineural hearing loss (ISSNHL)?

A

Circulatory disturbance and inflammatory reaction (usually viral).

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18
Q

What laboratory studies are useful in the workup?

A

Coagulation profile (CBC, PT, PTT), viral studies, ESR.

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19
Q

What are the two types of bony growths in the external auditory canal?

A

Diffuse exostoses and osteomata.

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20
Q

Which is more common?

A

Exostoses.

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21
Q

Which is more likely to be bilateral?

A

Exostoses.

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22
Q

Which is more likely to be seen in surfers?

A

Exostoses.

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23
Q

What evidence supports the use of carbon dioxide for ISSNHL?

A

Fisch et al. (1983) compared carbogen (95% oxygen and 5% carbon dioxide) inhalation therapy daily for 5 days with papaverine and low-molecular-weight dextran for 5 days and found a statistically significant improvement in hearing levels with carbogen therapy. These findings have not been replicated.

24
Q

What kind of dystonia is spasmodic dysphonia (SD)?

A

Focal.

25
Q

What condition would cause a tense sounding voice, vocal fatigue, and a prolonged closed phase with reduced vibratory and mucosal wave amplitude during videostroboscopy?

A

Glottic hyperabduction dysphonia.

26
Q

What is the most common cause of pulsatile tinnitus in young female patients?

A

Idiopathic intracranial hypertension (IIH) syndrome.

27
Q

What is the most common cause of venous pulsatile tinnitus?

A

Idiopathic intracranial hypertension syndrome (pseudotumor cerebri, benign intracranial hypertension).

28
Q

When is spontaneous recovery of hearing more likely?

A

If patient is without vestibular symptoms and suffers only partial hearing loss, particularly low frequency (better prognosis if apex of the cochlea is involved).

29
Q

When is a middle ear exploration indicated?

A

If the loss occurs in an only-hearing ear-to rule out a fistula.

30
Q

What are the characteristics of focal dystonias?

A

Inappropriate and excessive efferent activity of motor neurons in small areas.

31
Q

What can be done if symptoms persist after complete paralysis of the posterior cricoarytenoid?

A

Inject the contralateral posterior cricoarytenoid muscle with very small increments of toxin or inject the cricothyroid muscle.

32
Q

What are five other venous etiologies of pulsatile tinnitus?

A

Jugular bulb abnormalities; hydrocephalus associated with stenosis of the Sylvian aqueduct; increased intracranial pressure associated with Arnold-Chiari syndrome; abnormal condylar and mastoid emissary veins; and idiopathic or essential tinnitus.

33
Q

What are the indications for removal of exostoses?

A

Less than 1mm aperture, recurrent otitis externa, and water trapping.

34
Q

What muscles are injected when using botulinum toxin to treat oromandibular dystonia?

A

Masseter, temporalis, and medial and lateral pterygoid muscles.

35
Q

What syndrome is associated with blepharospasm?

A

Meige’s syndrome.

36
Q

What is the procedure of choice for patients with hemifacial spasm?

A

Microvascular decompression.

37
Q

What evidence supports the use of antivirals for ISSNHL?

A

No randomized, prospective studies have demonstrated this therapy to be effective.

38
Q

What effect does adductor laryngeal breathing dystonia have on the voice?

A

None.

39
Q

Which muscles are involved in blepharospasm?

A

Orbicularis oculi, procerus, and corrugator supercilii.

40
Q

Which is usually attached to the tympanosquamous suture line?

A

Osteomata.

41
Q

What is the current standard of care for the workup and treatment of idiopathic sudden sensorineural hearing loss?

A

Otologic exam, audiogram, and rule-out retrocochlear pathology-treatment with steroids, +I- antivirals, +I- diuretics.

42
Q

What is the prognosis ofiSSNHL?

A

Overall recovery to functional hearing levels in 65-69%; no conclusive evidence that outcome is improved by medical treatment.

43
Q

What is adductor laryngeal breathing dystonia?

A

Paradoxical adduction of the vocal folds during inspiration, causing inspiratory stridor that worsens with exertion and disappears during sleep.

44
Q

What factors lead to the best rate of recovery after ISSNHL?

A

Patients treated with steroids and vasodilators, with worse initial PTA and SDS, younger age, and greater number of treatments are most likely to improve.

45
Q

How is injection into the cricothyroid muscle accomplished, and how is proper placement confirmed?

A

Peroral route; confirm by having the patient sing an ascending scale and observing an increase in EMG activity as the pitch increases.

46
Q

Which muscle is responsible for abductor SD?

A

Posterior cricoarytenoid muscle.

47
Q

What are some treatments for patulous eustachian tube?

A

Reassurance, weight gain, SSKI (10 gtt in juice po TID), Premarin nasal spray (25 mg in 30 cc NS, 3 gtt per nose TID), occlusion of the ET, and myringotomy and tympanostomy tube placement.

48
Q

What evidence supports the use of corticosteroids for ISSNHL?

A

Steroid therapy is among the few treatment methods in ISSNHL to have single modality, randomized, prospective studies demonstrating effectiveness.

49
Q

What are the adverse effects of posterior cricoarytenoid injections?

A

Stridor (particularly with exertion), airway compromise, dysphagia, and aspiration.

50
Q

Which muscles are responsible for adductor SD?

A

Thyroarytenoid and lateral cricoarytenoid muscles.

51
Q

What are the two ways to deliver botulinum toxin to the posterior cricoarytenoid muscle?

A

Transcricoid and retrograde (rotating the larynx away from the side of injection).

52
Q

What percent of these cases will turn out to have a vestibular schwannoma?

A

Up to 4%.

53
Q

How can one confirm placement of the needle in the posterior cricoarytenoid muscle?

A

Using EMG guidance, have the patient sniff.

54
Q

What treatments are used to try to optimize cochlear blood flow?

A

Vasodilators (histamine, papaverine, verapamil, carbon dioxide) and blood thinners (defibrinogenation therapy, dextran, papaverine).

55
Q

What is the treatment for IIH?

A

Weight reduction and acetazolamide (250 mg TID) or furosemide (20 mg BID); lumbar-peritoneal shunt for patients with visual deterioration, persistent headaches, or disabling tinnitus.

56
Q

Which muscles are injected when using botulinum toxin to treat hemifacial spasm?

A

Zygomaticus major and minor, levator anguli oris, and risorius.

Disease Processes (9 decks)

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