Quiz 2 (ME) Flashcards
(204 cards)
1
Q
infectious inflammation of ME resulting in fluid buildup
A
OME
2
Q
follow AOM
-serous fluid in ME without OM (barotrauma or season allergies)
A
MEE
3
Q
what is treatment for MEE or OME
A
watch and see usually spontaneously resolves
Persistent = myringotomy w/ PE tube
4
Q
GOLD STANDARD FOR OM
A
pneumatic otoscopy
5
Q
Acute onset, ME inflammation & effusion; fever otalgia malaise nausea lack of appetite
A
AOMA
6
Q
What is treatment of AOM
A
observe in older kids & adults
antihistime/decongestants & antibiotics for 7-10 days
f/u tymps in 2-3 wks after antibiotics to allow ME fluid to absorb
7
Q
Condition resolves on its own 7-14 days for _____% of untreated cases and ____% of treated cases; effusion can last for >2-3 wks after antibiotics & resolution of actual infection
A
81
94
8
Q
-™ redness without effusion
-misdiagnosed as OME
form of AOM
A
Acute Myringitis
9
Q
what are diagnostic criteria for chronic OME
A
can be asymptomatic, may have HL, may report “plugged” or “popping” feeling of ears
10
Q
fluid in ME for prolonged periods
-Returns over again with no infection
A
chronic OME
11
Q
OME persisting >/= 3 mos from date of onset or date of diagnosis; has effusion but no fever or otalgia
A
chronic OME
12
Q
can lead to glue ear (ME cavity fills w/ gelatinous debris)
A
chronic ome
13
Q
treatment for chronic OME
A
Watch & wait for 3 mos
Myringotomy if persists followed by PE tube
Tonsil & adenoid removal
14
Q
why should antibiotics not be used in chronic OME
A
due to increase in antibiotic resistance
15
Q
as age increases, prevalence _______ with OME
A
decreases
16
Q
kids outgrow by age 6-8 because
A
ET becomes more slanted
17
Q
what is bacterial reflux
A
caused by colonization of nasopharynx, incompetence of ET and - ME pressure
18
Q
most common pathogen causing OM also found in upper respiratory tract infections
A
bacterial
19
Q
strep throat
A
bacterial
20
Q
most common viral infection of OM
A
respiratory syncytial virus (RSV)
21
Q
what are other causes of OM
A
clef palate
craniofacial disorders like treacher’s & down’s
ciliary dysfunction (cystic fibrosis & karagners
environmental allergies
immune dysfunction (aids, chemotherapy)
ET abnormalities (impaired muscle, shorter tube)
obstruction (feeding tube, tumors)
22
Q
how are ME disorder classified
A
based on duration of disease
based on fluid composition
23
Q
3 criteria by AAP & AAFP for AOM diagnosis:
A
acute onset
ME inflammation
ME effusion
24
Q
short term, self-limiting condition with otalgia & redness of ™ with effusion
A
AOM
25
what is severe AOM
moderate to severe otalgia & temp > 102 deg F
26
what is non severe AOM
mild otalgia & temp < 102 deg F
27
hyperemic stage AOM
red & angry
28
AOM with effusion
may or may not see fluid
loss of clear landmarks
29
AOM suppuratibe stage
fluid & bubbles
30
sub acute OM
3 wks to 3mos
31
recurrent OM
multiple self-limiting w/ symptom-free periods bw flare-ups
3 or more episodes w/in 6 mo period OR 4 or more episodes
32
chronic om
continues >3 mos
usually / fluid but no fever or otalgia
feeling "plugged or popping" of ears
33
management of chronic om
watch & wait for 3 mos, myringotomy followed by PE tube, tonsil removement
34
serous oM
clear
35
mucoid OM
thick & colored (pussy)
36
purulent OM
odorous & thick
37
glue ear
chronic mucoid OM
38
what is glue ear
chronic mucoid OM
me fills with gelatinous debris "glue" that can lead to TM retraction & bone erosion that can lead to cholesteatoma
39
watch & wait for 3 mos, myringotomy followed by PE tube, tonsil removement
MEE
40
can persist for around 40 days
ME effusion
41
high icidence in white kids
MEE
42
What age group do you see more OME?
Peak bw 6-11 mos of age
43
what are risk factors for OME
age, ET dysfunction, craniofacial abnormalities, formula babies, day care, respiratory infections, allergies, smoking, family hx, male, low birth weight. low SES
44
who is more sucseptible to OME
6-11 mos, common in asian & blacks, peaks bw october & april, higher in males
45
risk of child has upper respiratory infection why does it risk OME?
because ET is opened to the nasopharynx and is surrounded by soft muscles and with inflammation of upper respiratory, these muscles swell and it closes off opening of ET, hard for it to
46
signs & symptoms of OME
Quick onset
otalgia
fever
redness of tm
effusion in me
irritability/fussiness
may not eat
no response to sounds
delayed S/L development
reduced attention span
47
what would you see in otoscopy for OME
tm discolored: red, opaque, yellowish, pink
partial/complete bulging of tm or retraction
normal, hypo-mobile, retracted tm
perf, discharge, cholesteatoma, retraction pockets, fluid lines/bubbles in ME
48
what would you see on immittance for OME
tymps: type b (effusion) or type b with HV (perf), type c (et & abnormal gradient/width)
ARTs: abnormal or absent
49
unilateral OM would present with what ART
only ipsi ART is present on the unaffected side
contra is abs/elevated
50
bilateral OM would present with what art
ipsi & contra abnormal in both ears
51
why are ARTs abnormal i OM
not enough sound to move the system: even as low as 10-15 dB gap
52
what would we see for pure tones for OM
WNL or fluctuating: CHL, mixed, SNHL
may have abg
CHL doesn't exceed 60-65 dB (max CHL)
53
what would speech audiometry show for OM
normal supra threhold tests (WRS)
srt matches pta (matches hearing threshold)
54
why is srt consistent with hl but the WRS are not?
srt is a threshold test
wrs is suprathreshold - go 40 above the HL so it is way above the threshold and you can compensate for the attenuation
55
when should you perform head and neck exam
om
56
what is a rising configuration?
abnormal lf and rising to normal or close to normal hf hearing
57
what is a sloping configuration?
normal to near normal lf and hf abnormal hearing
58
what is needed for diagnosis of AOM
can follow URT infection
fever
otalgia
temporary HL
otorrhea
associated systemic symptoms - nausea, general malaise (feeling unwell), lack of appetite
59
what is needed for diagnosis of chronic OM
can be asymptomatic
may have HL
may report “plugged” or “popping” feeling of ears
60
societal complications of OME
$$$, OM is most common visits to the Dr., time off from work & school (lost productivity), development of drug-resistance bacteria, tympanostomy tube placement (2nd most common surgical procedure in kids)
61
comlications of OME
infection of mastoid bone, ossicle erosion, HF SNHL, facial nerve paralysis (rare), meningitis, brain abscess
62
sequelae of OM
permanent/temporary CHL,
damage to ME structures- leads to ossicular destruction & CHL , common with “glue ear”
cholesteatoma - happens with chronic or untreated OME or chronic - ME pressure
HF SNHL - innear ear structures become affected by toxins entering through the round window into the inner ear resulting in permanent SNHL
higher order auditory fxns
63
long term sequelae of oM
attention deficit in adulthood - learned inattention, s/l delays, academic failure, behavior problems, CAPD
64
structural changes of OME
altered ABR after OME resolution, larger tymp width, shallow static admittance, elevated ARTs
65
what higher auditory functions are affected in OM
auditory deprivations- affects language development
learned inattention
hard to process binaural auditory
issues w/ speech sound discrimination - ta vs da
issues with stops - b vs p
66
Another name for cholesteatoma?
pseudotumor
67
why are cholesteatomas called pseudotumors
highly aggressive & erosive and have tumor like characteristics by destructing bone & tissue
68
how do cholesteatomas grow
form keratinized epithelial layer & fibrous subepithelial layer called a matrix
keratin creates keratoma
keratoma creates inflammation that leads to formation of cholesteatomas
69
what is the etiology of cholesteatomas
congenital & acquired
70
congenital cholesteatomas
present in kids around 5 yrs
usually male
common in anterior-superior quadrant
71
acquired cholesteatomas
more common
chronic/untreated OME or trama leads to this
slow growing & no initial symptoms
presents with HL first
72
what leads to iatrogenic cholesteatomas
blunt knife, surgery procedures
73
what does iatrogenic cholesteatoma lead to
implantation of squamous epithelium in mE
74
what would otoscopy show for cholesteatomax
normal or a perf
75
what would tymps show for cholesteatoma
any type depending on size, location & what is damaged
normal = no damage
type as = stiffness in cavity
type ad = ossicular disarticuation
type b lv = tm perf or filled me
type b hv = tm perf and me not filled
76
what type of tymp would you see with cholesteatomas
depends on size, location & how much it has damaged
77
what would pure tones show
normal
CHL w/ ossicular disarticulation
mixed
78
hos does perf lead to different HLs
depending on how much the ™ is affected, gives you different hl
79
diagnosis of a cholesteatoma (not from audio)
can be visualized on microscopic exam
CT is used to identify damage that is caused
80
what is the management for cholesteatomas
primary = surgical removal
can use antibiotic steroid drops to limit inflammation and bleeding during surgery
81
surgical results for management of cholesteatomas
HL due to ossicles & tm removal
prosthesis laced and tm reconstructed
mastoidectomy if mastoiditis occurred
82
complications of surgery
HL (permanent CHL, mixed or SNHL)
facial paralysis
dizziness
tinnitus
intracranial complications (meningitis or intracranial abscess)
recurrence of it after surgery
83
what are implications as audiologists working as surgical ear
the second bend is widened (can cause blow by)
if you don't have a ™, earmold impression can adhere to the ossicles
PACK THE CANAL
84
normal audio to mixed hl DEPENDING on where it is and stage you pick it up
same with tymp
cholesteatoma
85
what is the configuration of otosclerosis
rising, can have carhart's notch (bone dip at 2000 Hz reducing or losing ABG)
86
what can carhart's notch also be present in
osteogenesis imperfecta & ossicular fixation
87
what is otosclerosis
specific to stapes footplate to oval window, disease of remodeling of otic capsule
88
Fixation of other ossicles to each other is NOT otosclerosis, instead it is called
ossicular ossification
89
fixation occurs at the
fissula ante fenestram (anterior to oval window and stapes fixation)
90
full footplate involvement =
flat CHL
91
can audio testing differentiate bw otosclerosis & obliterated otosclerosis
NO
92
laying down new bone while also absorbing old bone - to make a spongy bone
pathogenesis
93
sites of OTSC
obliterated in round window
cochlear
histologic
94
cochlear site of OTSC
causes progressive irreversible SNHL
95
genetic etiology of otosclerosis
unclear, presents as AD
incomplete penetrance
varying degree of expressivity
96
recent hypothesis of OTSC
may be related to persistent measles virus infection in the otic capsule
97
some cases of OTSC come from expression of
COL1A1 gene
98
COL1A1 gene is also associatef with
osteogenesis imperfecta type 1
99
approx. 50% of PT w/ type 1 develop HL indistinguishable from OTSC
true
100
can OTSC have blue sclera?
yes
101
histopathology of temporal bones is identical in both
osteo & OTSC
102
how are osteogenesis imperfecta type 1 & OTSC similar
AD, same audio findings, same temporal bone histopathology, & some blue sclera
103
what population is most affected by OTSC
white young females bw 15-45 yrs
104
are most OTSC unilateral
no 70% bilateral
105
in 50% of females, HL occurs during/immediately after pregnancy
OTSC
106
what does otoscopy reveal in OTSC
almost always normal tm
schwartze sign
107
what is schwartze sign we see in OTSC
increased vascularity of bone growing near oval window
reddish/blue glow of the TM
108
pure tone results of OTSC
early stage = normal or mild CHL w/ rising configuration
mid stage: conductive/mixed HL w/ rising or flat configuration
late stage: flattening of previous rising HL
109
if OTSC is purely conductive will it exceed 60-65 dB HL
NO
max CHL
110
what does bone conduction show in OTSC
poor at 2 kHz by 15-20 dB that narrows the ABG
carhart's notch
111
only present in <40% of PT’s
OTSC
112
OTSC is the only ME condition with NORMAL TYMPS
TRUE
113
What does tymp show for OTSC
type a or as
114
ART in OTSC
abnormal in most
negative tone decay
115
speech audio results in OTSC
SRT in agreement with PTA
WRS excellent due to suprathreshold testing
116
what are the diagnostic features of OTSC
audio: bilateral conductive/mixed rising hl, tiniitus
case history
high resolution CT scan
117
bigger ABG = better prognosis with surgery
true
118
what is non surgical management of OTSC
amplification
119
why do they do well with amp
becuase it provides enough amp to get through the ME system for understanding
120
Who would surgery not be an option for? they want it but they cannot?
older - 70-80’s, you do not recover as quickly and have other medical issues and may have chronic issues with age
health - dead ear on the opposite side, if you have significant autoimmune conditions, if you already have a chronic infection etc.
121
what is looked at pre op for OTSC
bone conduction
conductive compoment at least 25 dB bw 250-1000
- Rinne test at 512
122
describe the rinne test
fork is placed at EAC and when PT cannot her it, moved to mastoid
if tone is heard longer at bone = -, CHL or mixed because bone is better than ear
if tone is heard longer at ear = + suggesting NH or SNHL
123
how does surgery work with bilateral OTSC
poorer ear goes first
second is done a year later if other ear is stable
124
what are contraindications of surgery for OTSC
dead contra ear
active OE/OM or TM perf
large exostosis that affects ME access
125
ABSOLUTE contraindication of surgery in OTSC
OTSC involves the endolymphatic duct resulting in symptoms of Meniere's disease
126
what would be careful considerations prior to surgery
PT w/ vestib function that is important for employment
otologic issues in contra ear threatening hearing over time
SSCD
127
what is a stapedotomy
small hole in stapes footplate during surgery
30-45 min surgery failure rate 1-3%
128
partial stapedectomy
half removal of stapes footplate during surgery
129
total stapedectomy
total removal of stapes footplate during surgery
130
stapedotomy vs ectomy
otomy = laser making hole
ectomy = footplate removal
131
replacement of footplate
Prosthesis or implant used in stapes surgery
132
are current prosthesis safe in low power Mri
yes, in 1.5 tesla
133
what are complications of OTSC surgery
WRS can worsen w/ cochlear involvement
oval window OTSC
round window OTSC
hyperacusis
facial paralysis
chorda tympani nerve
perilymphatic fistula
labyrinthitis
disarticulation of incus
SNHL
immediate CHL
delayed - onset CHL
134
obliterates the oval window and can’t be easily managed or removed with a laser
surgery takes longer and may be difficult to assess length of prosthesis needed
oval window otsc
135
can cause permanent CHL
surgical removal of this type universally results in SNHL and shouldn’t be attempted
usually fix with amplification
round window OTSC
136
increases sensitivity to sounds; usually temporary
hyperacusis
137
due ot VII damage during surgery - rare
surgery may be stopped with CN VII is completely filling oval window niche
facial paralysis
138
may be sacrificed
branch of VII N to anterior ⅔ of tongue
temporarily decreased taste/sensation for 3-6 mos until compensation of opposite nerve and other nerves take over
chorda tympani nerve
139
what is a perilymphatic fistula
pathological communication bw inner and me
140
differential diagnosis for otsc
menier's
osteogenesis imperfecta
SSCD
141
Menier's symptoms related to otsc
vertigo
tinnitus
lf hl - SNHL in menier's
142
osteogenesis imperfecta symptoms related to otsc
blue sclera, noise notch, fragile bones, collagen gene
143
SSCD symptoms related to OTSC
3rd window
LFCHL but SSD has normal ART and not in otsc
distinguished bw two by CT scan
144
if you get ARTs that are normal -
NOT OTOSCLEROSIS
probably SSCD
145
malfunction of prosthesis
failure to see malleus fixation
round window obliteration
immediate CHL
146
what causes labyrinthitis
air or blood entering vestibule
mechanical trauma to utricle because it lies close to the oval window
147
what is etiology of trauma
blows, sports, blasts, vehicle accidents, foreign body insertion
148
trauma with fracture classifications
longitudinal, transverse pediatric and penetrating temporal bone trauma
149
otic capsule sparing fracture
longitudinal fracture
150
otic capsule disrupting fracture
transverse fracture
151
70-90%, parallels long axis passing through EAC, ™ & roof of ME
longitudinal fracture
152
what is a longitudinal fracture
70-90%, parallels long axis passing through EAC, ™ & roof of ME
153
less common
goes through IAC or otic capsule
transverse fraction
154
what is a transverse fraction
less common
goes through IAC or otic capsule
155
what is pediatric trauma
from falls from heights
automobile/pedestrian accidents
156
what are penetrating temporal bone trauma
most common are gushot sounds (50% of time injures cn 7)
157
trauma without fraction classification
otic barotrauma
inner ear decompression sickness (IEDCS)
thermal injuries
compressive injuries
foreign objects
158
what is otic barotrauma
occurs during descent or short shallow dive
injury that happens from failure to equalize pressure
causes sudden & severe - ME pressure
159
waht is inner ear decompression sickness (IEDCS)
occurs during ascent or surfacing from dive
treatment is different but resembles IE barotrauma
HL & tinnitius & dizziness
160
what PT should rapidly get transported to a hyperbaric chamber for recompression
IEDCS
161
what are thermal injuries
lighting bolt conduction
during welding leadimg to TM perf
162
symptoms of thermal injury
SNHL
dizziness/vertigo
facial paralysis
163
compressive injuries
slap or struck on head
falling on water
blast injuries
164
blast inuries lead to
HF SNHL
165
foreign objects
occurs when PT removes cerumen
HL & vertigo
lacerations, infections, hematomas
166
what conditions can we see ossicular disarticulation
osteoporosis or cholesteatoma or untreated ME infection
167
can trauma to head or face cause ossicular disarticulation
yes
168
common signs of ossicular disarticulation on otoscopy
bleeding from ears, csf, perf
169
immittance results for ossicular disarticulatiomn
AD tymps
abnormal reflexes because ossicles aren't together to make sound pressure needed
170
pure tone results for ossicular disarticulation
conductive/mixed HL
can be acute or delayed
171
signs & symptoms of disarticulation
acute/delayed chl
injured tm
me blood or csf
bleeding from ears
bppv, concussions, perilymphatic leak
172
what should be done for diagnosis of ossicular disarticulatioin
ct scan
173
what is normal appearance of ossicles on axial CT
ice cream cone sign
174
ball of ice cream
malleus head
175
cone
body of incus
176
point of cone
short process ofincus
177
failure of ice cream configuration on ct
suggests ossicular chain disruption (incudomalleolar disarticulation)
178
treatment for hemotympanum
self healing
179
persistent chl treatment
repair ossicles or amplification if surgery not possible
180
BPPV treatment
self healing in 6 mos or epley maneuver
181
irreversible snhl & tinnitus treatment
ha's & tinnitus management
182
which me tumor grows largest
glomus jugulare because there is more space for it to grow
183
another name for glomus tumors?
paragangliomas becuase it comes from paraganglia
184
most common benign soft tissue tumor of ME & second most common benign tumor of temporal bone
paragangliomas
185
describe glomus tympanicum
arises from Jacobson nerve in tympanic cavity
neuroendocrine cells give rise to these
smaller
can surgically remove
early symptoms are pulsatile tinnitus, red tm & chl
186
describe glomus jugulare
arises from dome of internal jugular vein & is under pinna on the neck
common & more extensive with space to grow
can be silent for a long time, damage 7 &11 and grow into me cavity
187
usually unilateral, reddish-purple, highly vasculated & lobulated
glomus tumors
188
both slow progressive growth through least resistance paths
true (temporal bone air cells & ET
189
why are glomus tumors incorrectly named
because they originally thought they came from true glomus complexes
190
heredity of tumors
sporadic or AD w/ 100% penetrance
191
who is more affected with tumors with sporadic heredity
females
192
most tumors affect
male and female equally and can be seen in NF1
193
which may have genomic imprinting involved
glomus tumors
194
what is genomic imprinting
when the phenotype varies depending on who passes the gene down
195
who passes the glomus tumors down
father
196
will female offspring have phenotypic expression
usually not until transmission is through a male carrier
197
what is the incidence of glomus tumors
after 5th decade, mostly sporadic, 1/3 to 1/2 associated with NF1, 10 genes linked
198
adrenal gland tumor & causes hormonal problems)
pheochromocytoma
199
signs of glomus tympanicum
smaller & cause early symptoms
pulsatile tinnitus, red tm, chl
if grows medially causes SNHL FN dysfunction or vertigo
200
symptoms of glomus jugulare
remaines silent for years and grows large
HL
otalgia
aural fullness
vertigo
201
if you get a pulsating tymp what should you suspect
glomus tumor
202
audio findings of glomus tumors
red tm or mass in me cavity
chl or mixed
type as or b tymps that show jagged edges w/ PT's pulse
203
treatment for glomus tympanicum
tumor remoal
204
treatment for glomus jugulare
need MRI for definitive diagnosis
surgery/radiation to shrink before removal
