Quiz 1: Outer, Middle, Inner Ear

Question 1

The ossicles convert ___ energy into mechanical energy and amplify it, transferring it to the __ window of the cochlea

Answer 1

Sound

Oval

Question 2

The eustachian tube is opened by which muscle?

Answer 2

Tensor veli palantini

Question 3

Endolymph is found in the membranous labyrinth and has a high concentration of _____ and a lower concentration of ______.

Answer 3

Potassium
Sodium
(The only place in the body where this is found)

Question 4

Which cranial nerve innervates the cochlea?

Answer 4

CN VIII

Question 5

Track the structures that convert sound energy into a nerve impulse.

Answer 5

Outer ear –> ear canal –> TM –> ossicles –> cochlea –> endolymph –> organ of corti –> CN VIII –> temporal lobe

Question 6

What is the name of the vascularization system that supplies blood to the inner ear?

Answer 6

Stria vascularis

Question 7

The organ of corti is stimulated by the flow of _____ ions.

Answer 7

Potassium

Question 8

Osteoma most often occurs in individuals with what hx?

BONUS POINT: which homeopathic?

Answer 8

History of cold-water exposure (swimmers or surfers).

Hekla lava.

Question 9

When is AOM worse?

Answer 9

Evening

Question 10

What is a sign in children, especially infants, that they might have AOM?

Answer 10

Anorexia

Question 11

A retracted TM with a yellow to amber color and fluid would suggest _____ rather than _____.

Answer 11

Otitis media with effusion.

Rather than acute otitis media.

Question 12

What is a highly specific finding upon otoscopy with AOM?

Answer 12

Bulging TM.

Spin— Specific rules in. If TM is bulging, very likely AOM.

Question 13

What is a highly sensitive finding upon otoscopy with AOM?

Answer 13

Immobile TM.

Snout— Sensitive rules out. If TM is mobile, very likely not AOM.

Question 14

An immobile TM that is retracted with a history of allergies suggests…

Answer 14

Otitis media with effusion.

Question 15

In otitis media with effusion, Weber lateralizes to the _____ ear and Rinne will be _____>_____. What type of hearing loss is this?

Answer 15

Bad
BC>AC
Conductive

Question 16

OME and AOM will show which type of tympanometry?

Answer 16

B type, a flat line

Question 17

An infant rectal temp above _____, or oral above _____, mild ear fluid, tympanic erythema, might suggest _____. What other PE findings would you look for to rule in or out your dx?

Answer 17

100.4 F
99.5 F
AOM

Bulging ear drum
Immobile TM
Loss of bony landmarks

Question 18

Complications: AOM (4)

Answer 18

Mastoiditis
Meningitis
Perforated TM
Cholesteatoma

Question 19

Which bacteria are associated with suppurative complications?

Answer 19

P. aeruginosa

S. aureus

Question 20

S/sxs: Mastoiditis (5)

Answer 20

Bulging in the canal
Protrusion of the auricle 
Red behind the ear
Mastoid TTP
High fever

Question 21

Use ______, ____, or _____ to soften cerumen.

Answer 21

Debrox
Calendula oil
Olive oil

Question 22

Why should you not irrigate beans and grains to remove them from the ear canal?

Answer 22

They can swell and become more difficult to remove.

Question 23

What is the main contraindication for irrigating the ear canal?

Answer 23

Perforation of the tympanic membrane.

Question 24

Name some risk factors for OM. There are a lot.

Answer 24

Cranial facial bone structure
Allergies
Dairy
Prone sleeping
Second hand smoke
Race: native north american
Vit D deficiency
< 18 months
Season: incidence increases in fall, highest in Feb, decreases in the spring
Weaning from breast milk
Beginning school or day care

Question 25

Supine bottle feeding with snuffles that causes aspiration in to the eustachian tubes is called...

Answer 25

Toynbee phenomena

Question 26

Tx failure in otitis externa correlates most with...

Answer 26

Failure to clean out the canal (aural toilet [also, wtf?]). | Incorrect diagnosis.

Question 27

Benefits of Abx in OM:

Answer 27

Decrease in mastoiditis Decrease in meningitis (Though recent reports suggest that untreated AOSM has similar rates of complications whether an antibiotic are prescribed or withheld) Good tx for < 2yo with bilateral OM

Question 28

The NNT to reduce pain with Abx.

Answer 28

16 patients (17%)

Question 29

Risk of Abx use in OM.

Answer 29

Increased rate of recurrence. | Increased bacterial resistance.

Question 30

Infectious chondritis ____ the lobe and is usually unilateral, while relapsing polychondritis _____ the lobe and is usually bilateral.

Answer 30

Includes | Spares

Question 31

Risk factors: otitis externa

Answer 31

Change in pH from acid to alkaline Increased temp and humidity Mild trauma, frequent cleaning

Question 32

Hx: otitis externa

Answer 32

Swimming Trauma Dermatitis Q-tip abuse

Question 33

Malignant otitis externa affects immunocompromised patients particularly...

Answer 33

Those with DM, alcoholism, severe malnourishment.

Question 34

What may you see in the ear canal of Malignant OE?

Answer 34

Granulation tissue

Question 35

Complications: Malignant OE

Answer 35

Osteomyelitis, hearing loss, facial nerve paralysis, death.

Question 36

Next steps: Suspected malignant OE in office.

Answer 36

Refer to ENT for MRI or CT.

Question 37

DDx: ear pain with WNL otoscopic exam and no loss of hearing.

Answer 37

``` Referred Pain from: TMJ (most common) Molar Cervical spine pain Malignancies ```

Question 38

Red flag pts with referred ear pain include:

Answer 38

``` Smokers Alcohol abuse >50 yo DM (These pts have a higher risk of a serious occult cause of ear pain) ```

Question 39

Which Abx ear drop is indicated in tx of OE and perforated TM? Why?

Answer 39

Fluoroquinolone due to excellent coverage for Pseudomonas and lack of ototoxicity.

Question 40

Homeopathy: OE

Answer 40

Hepar sulph:

Question 41

Most common bacteria found in AOM:

Answer 41

S. pneumonia

Question 42

Homeo: What do you look at when deciding if AOM sxs are an exacerbation of a chronic state or a true acute?

Answer 42

Physical generals. If it is a new PG then give an acute.

Question 43

Are Abx effective for OME?

Answer 43

No

Question 44

What is a helpful question to ask a pt with a cc of dizziness?

Answer 44

Ask the pt to describe their sxs without using the term dizziness.

Question 45

An internal sense of spinning or the feeling that the room is spinning around oneself is called:

Answer 45

Vertigo

Question 46

Most common cause of vertigo can be found in the _____ ____.

Answer 46

Peripheral labyrinth

Question 47

What are common types/origins of "dizziness" a patient might describe?

Answer 47

Vertigo Syncope or presyncope Disequilibrium Lightheadedness (wastebasket term)

Question 48

What are pre-syncope and syncope, and what organ system should you always think of first with these?

Answer 48

Pre-syncope: lightheadedness, muscular weakness, blurred vision, feeling faint. Syncope: loss of consciousness and posture, described as "fainting" or "passing out." Think CARDIAC first! Most common cause of both is a sudden drop in blood pressure.

Question 49

Peripheral vertigo refers to dysfunction somewhere in the _____ or ____ ear.

Answer 49

Middle | Inner

Question 50

Peripheral vertigo: nystagmus is ______ and _____.

Answer 50

Unidirectional | Horizontal

Question 51

Central vertigo refers to dysfunction of the ____ ___ or _____.

Answer 51

Brainstem | Cerebellum

Question 52

Central vertigo: Nystagmus qualities?

Answer 52

Bidirectional | Downbeat aka true vertical

Question 53

Sxs of central vertigo include:

Answer 53

Weakness, dysarthria, vision changes, paresthesia, altered mental status, ataxia or other motor/sensory

Question 54

What is the most useful physical exam for differentiating peripheral and central vertigos? How to interpret?

Answer 54

Head Impulse Test (test vestibular-ocular reflex). In peripheral vertigo, you will perceive a “catch-up” saccade after when the head thrust is in the direction of the lesion. (Test will be negative in central vertigo).

Question 55

What direction of nystagmus implies BPPV (peripheral vertigo) upon Dix-Hallpike maneuver?

Answer 55

Upbeat | Downbeat implies central vertigo