Week 3 - Ear Flashcards
0
Q
What are 8 causes of conductive hearing loss?
A
- ) Obstruction of ear canal
- ) Perforated tympanic membrane
- ) Dislocated ossicle
- ) Otitis media
- ) Otitis externa
- ) Otosclerosis
- ) Congential
- ) Cholesteatoma
1
Q
What results from physical or mechanical problems that limit movement of the sound wave through the external and middle ear?
A
Conductive hearing loss
2
Q
What is the result of damage to the hair cells or nerves that sense sound waves; a sensory problem in the inner ear?
A
Sensorineural hearing loss (SNHL)
3
Q
What are 11 causes/associated conditions of SNHL?
A
- ) Acoustic trauma
- ) Barotrauma
- ) Head trauma
- ) Ototoxic drugs (Rx drugs and cocaine)
- ) Infection
- ) Aging
- ) Acoustic neuroma
- ) Sudden SNHL
- ) Meniere SNHL
- ) Vascular disease
- ) Multiple sclerosis
4
Q
What would you call a combination of both conductive and sensorineural loss?
A
Mixed hearing loss
5
Q
What is the perception of sound (e.g. buzzing, ringing, roaring, clicking) in absence of an acoustic stimulus. May be intermittent, continuous, pulsatile; either unilateral or bilateral.
A
Tinnitus
6
Q
What are the 2 types of tinnitus?
A
- ) Subjective
2. ) Objective
7
Q
Which type of tinnitus is audible only to patients, is high frequency, and is due to damage of fine hair cells?
A
Subjective tinnitus
8
Q
What are 9 etiological conditions associated with subjective tinnitus?
A
- ) Acoustic trauma
- ) Barotrauma
- ) Eustacian tube dysfunction
- ) Meniere disease
- ) Drugs
- ) Presbycusis
- ) CNS tumor
- ) Infection (OM, labryinthitis, meningitis)
- ) Ear canal obstruction
9
Q
What disease has hearing loss, vertigo, and tinnitus with gradual onset and often progresses to deafness and severe vertigo?
A
Meniere disese
11
Q
What is unilateral hearing loss over 72hrs. and associated with microvascular event or head trauma?
A
Sudden SNHL (SSNHL)
13
Q
Which type of tinnitus is rare and can be heard by the physician listening directly over the patient’s ear with their stethoscope?
A
Objective tinnitus
14
Q
What do you call a tumor in the auditory nerve?
A
Acoustic neuroma
16
Q
What are 4 etiological conditions associated with objective tinnitus?
A
- ) A-V malformations
- ) Turbulent flow in carotid A or jugular V
- ) Vascular middle ear tumor
- ) Monoclonus
17
Q
What are 14 other types or causes for tinnitus?
A
- ) hyperlipidemia
- ) allergies
- ) diabetes
- ) hypertension
- ) hypotension
- ) syphilis
- ) cardiovascular dx
- ) endocrine dx
- ) metabolic dx
- ) TMJ disorders
- ) cervical injuries
- ) stress
- ) dietary problems
- ) intake of stimulants (nicotine, caffeine)
18
Q
What is a non-specific term of describing a sensation of altered spatial orientation “illusory movement” most often cause by dysfunction of the vestibular, visual, or proprioceptive (posterior column) systems, or by diffuse impairment of blood flow to the brain?
A
Vertigo
19
Q
What are the 2 CLASSIFICATIONS of vertigo?
A
- ) True vertigo
2. ) Non-vertigo
20
Q
Which classification of vertigo is the sensation of movement and is caused by asymmetry in the vestibular system (CN8, inner ear, and cerebellum)?
A
True vertigo
21
Q
Which classification of vertigo has syncope, fainting, or sensation of impending fainting?
A
Non-vertigo
22
Q
What are the 2 FURTHER CLASSIFICATIONS of vertigo?
A
- ) Peripheral
2. ) Central
23
Q
Which further classification of vertigo associated with nystagmus has unidirectional with fast component towards normal ear, with horizontal with rotation?
A
Peripheral vertigo
24
Q
Which further classification of vertigo associated with nystagmus is any direction and sometimes changes direction?
A
Central vertigo
25
Q
Which further classification of vertigo associated with other neuro signs is absent?
A
Peripheral vertigo
26
Q
Which further classification of vertigo associated with other neuro signs is often present (ataxic gait, diplopia, slurred speech, numbness)?
A
Central vertigo
27
Which further classification of vertigo associated with postural instability has unidirectional instability and walking is preserved?
Peripheral vertigo
28
Which further classification of vertigo associated with postural instability has severe instability and patient can fall when walking?
Central vertigo
29
Which further classification of vertigo has a presence of hearing loss/tinnitus?
Peripheral vertigo
30
Which further classification of vertigo has a absence of hearing loss/tinnitus?
Central vertigo
31
What are the 3 types of non-vertigo?
1. ) Lightheadedness
2. ) Disequilibrium
3. ) Miscellaneous
32
"Graying out" of vision, pallor, and a roaring sound in the ears, suggesting hypoperfusion of the brain (global hypoperfusion) is a result of which type of non-vertigo?
Lightheadedness
33
Which type of non-vertigo occurs only when standing or walking (gait impairing), unsteady without any dizziness, and patient indicates the "dizziness is in their feet, not in their head"?
Disequilibrium
34
What are 8 causes of lightheadedness of non-vertigo?
1. ) hypotension
2. ) shock
3. ) drugs
4. ) dehydration
5. ) decreased cardiac output
6. ) severe anemia
7. ) hypoglycemia
8. ) cardiac arrythmias
35
What are 6 problems that cause disequilibrium in non-vertigo?
1. ) cerebellum issue
2. ) frontal lobe tumor
3. ) basal ganglia issue
4. ) stroke
5. ) cervical spondylosis
6. ) motor neuron disease
36
What are 7 causes of miscellaneous non-vertigo?
1. ) chronic hyperventilation syndrome
2. ) frequent deep breaths while relaxed
3. ) new eyewear with diplopia
4. ) phobias
5. ) agoraphobia
6. ) acrophobia
7. ) extra-ocular muscular palsy resulting in diplopia
37
What are 4 RED FLAG concomitants of vertigo?
1. ) Head or neck pain
2. ) Ataxia
3. ) Loss of consciousness
4. ) Focal neurological deficit
38
What are 8 causes of otalgia (earache/ear pain)?
1. ) external ear (impacted cerumen, foreign body, local trauma, or OE)
2. ) middle ear (eustacian tube obstruction, OM, and neoplasms)
3. ) referred pain (TMJ or wisdom teeth)
4. ) local infections (tonsillitis, enlarged adenoids, peritonsillar abscess, atlas/axis subluxation)
5. ) tumor (in pharynx, tonsils, tongue, larynx)
6. ) thyroiditis
7. ) neuralgia (trigeminal, shenopalatine, glossopharyngeal, geniculate)
8. ) colds (allergies or cold wind blowing in the ears)
39
What are 5 RED FLAG concomitants for otalgia (earache/ear pain)?
1. ) diabetes
2. ) immunocompromised
3. ) redness/pain over mastoid
4. ) severe swelling of canal meatus
5. ) chronic pain with head/neck symptoms
40
What are 4 ACUTE causes of otorrhea (ear discharge)?
1. ) Acute OM with TM perforation
2. ) Post-tympanostomy tube
3. ) CSF leak from head trauma
4. ) OE (infection or allergy)
41
What are 5 CHRONIC causes of otorrhea (ear discharge)?
1. ) Cancer of ear canal
2. ) Cholesteatoma
3. ) Chronic purulent OM
4. ) Foreign body (usually kids)
5. ) Mastoiditis
42
What are 6 RED FLAG concomitants of otorrhea (ear discharge)?
1. ) head trauma
2. ) cranial nerve dysfunction
3. ) fever
4. ) erythema of the ear
5. ) diabetes
6. ) immune compromised
43
What are 4 sources of etiology for acute otitis externa (AOE)?
1. ) Infection (strep, staph, E. coli, pseudomonas, aspergillus)
2. ) Swimmer's ear
3. ) Forceful cleaning of ears (use of Q-tips)
4. ) Trauma
44
What are 4 signs and sxs of AOE?
1. ) itching
2. ) pain
3. ) discharge
4. ) loss of hearing (swollen canal or canal filled with purulent debris)
45
What are 2 sources of etiology for chronic otitis externa?
1. ) follows psoriasis, seborrheic dermatitis, eczema
| 2. ) allergy or fungus
46
What are 4 signs and sxs of chronic otitis externa?
1. ) pruritis
2. ) redness
3. ) discharge
4. ) itchiness
47
Trauma, insect bites leading to decreased blood supply to ear cartilage causing avascular necrosis and deformity are characteristics of what condition?
Perichondritis
48
What are 4 concomitants of tumors of the ear?
1. ) sebaceous cysts
2. ) osteomas (bony growths that may occlude ear canal)
3. ) gouty deposits (tophi on outer ear)
4. ) BCC or SCC (hx of sun exposure on external ear)
49
What are 3 causes of acute otitis media (AOM)?
1. ) organism
2. ) anatomic position of Eustachian tube
3. ) immunological factors
50
What are 3 common organisms associated with AOM?
1. ) Streptococcus pneumoniae
2. ) Haemophilus influenza
3. ) Moraxella catarrhalis
51
What are 4 risk factors for AOM?
1. ) daycare exposure
2. ) bottle feeding (specifically when lying on back)
3. ) smokers in household
4. ) AOM in first year of life (risk factor for recurrent AOM)
52
What are 7 signs and sxs of AOM?
1. ) throbbing pain (but potentially no pain)
2. ) fever
3. ) decreased hearing
4. ) moodiness
5. ) irritability
6. ) tugging on ear (in children)
7. ) sleep disruption from pain
53
What are 5 complications of AOM?
1. ) OM with effusion (most common)
2. ) speech delay (if bilateral, hearing loss in children)
3. ) mastoiditis (now rare)
4. ) perforation (rupture) of TM (frequent, but not serious unless peripheral)
5. ) may persist during Abx treatment, or relapse within 1 month
54
In complications of AOM, if the TM is perforated what 2 things can happen?
1. ) discharge
| 2. ) sudden loss of pain
55
In complications of AOM, if the TM is perforated peripherally, what should be check for regularly?
Cholesteatoma
56
Which 2 conditions fall under chronic otitis media (COM)?
1. ) Otitis Media with Effusion (OME) (or sometimes listed as Serous OM)
2. ) Chronic Suppurative Otitis Media (CSOM)
57
Which form of COM has effusion (fluid) in the middle ear, is an incomplete resolution of AOM, or is due to inflammation?
Otitis media with effusion (OME)
58
What are 4 risk factors of OME?
1. ) prior tympanostomy tube placement
2. ) allergy (often food - dairy, oranges, apples; or environmental)
3. ) adenoid hypertrophy
4. ) summer or fall months
59
What are 3 signs and sxs of OME?
1. ) hearing impairment (child may appear inattentive)
2. ) mild otalgia (intermittent - worse at night, ear fullness, or popping)
3. ) overlapping sx of common cold (nasal discharge and sore throat)
60
Which type of COM has chronic inflammation of the middle ear that persists at least 6 weeks with TM perforation and otorrhea?
Chronic suppurative otitis media (CSOM)
61
What are 2 source of etiology for CSOM?
1. ) acute OM resulting in perforation (central perforation leading to conductive hearing loss)
2. ) trauma to ear or head
62
What are 3 signs and sxs of CSOM?
1. ) hearing loss
2. ) chronic purulent discharge
3. ) painless
63
Acute onset AND middle ear effusion (bulging TM), limited or absent mobility air-fluid level behind membrane AND SSx of middle ear inflammation (red TM, otalgia) are all diagnostic criteria for which type of OM?
Acute otitis media (AOM)
64
Persistent features of middle ear infection during antibiotic treatment OR relapse within 1 month of treatment completion is the diagnostic criteria for which type of OM?
Persistent AOM
65
Fluid behind INTACT TM in the absence of features of acute infection are the diagnostic criteria for which type of OM?
Otitis media with effusion (OME)
66
Persistent fluid behind an INTACT TM in the absence of acute infection is the diagnostic criteria for which type of OM?
Chronic OM with effusion (COME)
67
Persistent inflammation of the middle ear or mastoid cavity or recurrent or persistent otorrhea through a PERFORATED TM is the diagnostic criteria for which type of OM?
Chronic Suppurative OM (CSOM)
68
Which condition has inflammation and/or infection of the TM and has Primary or Secondary and Acute or Chronic forms?
Myringitis
69
What are 6 PRIMARY causes of myringitis?
1. ) can accompany Mycoplasma pneumonia URI
2. ) acute bullous myringitis (vesicles on TM from infections like S. pneumoniae or herpes)
3. ) acute hemorrhagic myringitis (bacterial or viral infection)
4. ) fungal and eczematous forms
5. ) myringitis granulosa (unclear cause)
6. ) TM trauma
70
What are 5 signs & sxs of myringitis?
1. ) serosanguinous otorrhea
2. ) otalgia
3. ) hearing impairment
4. ) fever
5. ) If acute: sudden onset of ear pain that lasts 24 to 48 hours
71
What condition has growth of keratinizing squamous epithelium in middle ear and pars tensa can enlarge?
Cholesteatoma
72
What are 5 etiologic conditions of cholesteatoma?
1. ) congenital
2. ) primary acquired
3. ) secondary acquired
4. ) previous perforations
5. ) retraction pocket
73
What are 3 signs and sxs of cholesteatoma?
1. ) painless otorrhea (either unremitting or frequently recurrent)
2. ) conductive hearing loss initially, then can grow into inner ear - causing SNHL
3. ) dizziness (relatively uncommon)
74
What are the 2 TYPES of vertigo?
1. ) Subjective
| 2. ) Objective
75
Which condition is suppurative infection in the mastoid air cells?
Acute mastoiditis
76
What are 7 signs and sxs for acute mastoiditis?
1. ) redness
2. ) swelling
3. ) tenderness behind the ear
4. ) fever
5. ) hearing loss
6. ) profuse creamy ear discharge
7. ) throbbing pain
77
What are 6 complications with acute mastoiditis?
1. ) subperiosteal abscess
2. ) CN 7 palsy
3. ) hearing loss
4. ) osteomyelitis
5. ) meningitis
6. ) venous sinus thrombosis
78
What are 2 screens for acute mastoiditis? How would it be treated?
MRI or CT; treatment with drainage and antibiotics
79
What is a genetic (autosomal dominant) metabolic bone disease affecting the otic canal and ossicles and leads to overgrowth of footplate in stapes with dysfunction?
Otosclerosis
80
In which gender, ethnic group, and age is otosclerosis most commonly seen?
F>M 2:1, caucasian people, and age 15-35 years
81
What is the ssx for otosclerosis?
Progressive bilateral (conductive) hearing loss and tinnitus with occasional vertigo
82
What condition is sclerosis of TM from chronic OM and post T-tube, leading to stiffening of the TM and impaired conductive hearing?
Tympanosclerosis
83
What is the ssx of tympanosclerosis?
Early asymptomatic, but hearing loss is progressive
84
What condition has a URI that precedes the onset of symptoms in up to 50% of cases and shows sudden unilateral hearing loss and severe vertigo, frequently associated with nausea and vomiting.
Viral labyrinthitis
85
What age group does viral labyrinthitis commonly affect?
Adults, 30-60 (rare in children)
86
What is a unique form of viral labryinthitis? What is it caused by?
Herpes Zoster Oticus (Ramsay-Hunt syndrome)
| Caused by reactivation of a latent varicella-zoster virus infection, years after the primary infection.
87
Initial deep, burning, auricular pain followed a few days later by the eruption of a vesicular rash in the external auditory canal and concha followed by vertigo, hearing loss, and facial weakness is the ssx for which condition?
Viral labyrinthitis
88
T/F: Symptoms for viral labyrinthitis typically improves over a few weeks; and hearing can improve over time with no further reduction of caloric responses.
FALSE!!! Symptoms for viral labyrinthitis typically improves over a few weeks; however, patients often suffer permanent hearing loss and persistent reduction of caloric responses
89
Which condition is caused by either direct bacterial invasion or through the passage of bacterial toxins into the inner ear?
Bacterial labyrinthitis
90
Meningitis associated with bacterial labyrinthitis typically affects ears unilaterally or bilaterally?
Bilateral
91
How is bacteria spread in meningitis associated with bacterial labyrinthitis?
Spread through CSF to the membranous labyrinth by way of the internal auditory canal or cochlear aqueduct.
92
T/F: Infections of the middle ear or mastoid most commonly spread to the labyrinth through a dehiscent horizontal semicircular canal. Usually the dehiscence is the result of erosion by a cholesteatoma.
True
93
What are 5 ssx of bacterial labyrinthitis?
1. ) profound hearing loss
2. ) severe vertigo
3. ) ataxia
4. ) nausea
5. ) vomiting
94
Which condition is a benign and temporary disorder of the vestibular nerve and has vertigo NOT associated with hearing loss?
Vestibular neuritis
95
Which gender and age does vestibular neuritis tend to affect?
M=F, 40's-50's
96
T/F: URI often precedes vestibular neuritis
True
97
Which season do people more often suffer with vestibular neuritis? Is it bacterial or viral?
Spring-early summer; commonly viral
98
What is the ssx for vestibular neuritis?
Sudden, acute vertigo without hearing loss in an otherwise healthy patient
99
Which condition has sudden vertigo elicited by provocative positions, triggering nystagmus. The character and direction of the nystagmus are specific to the part of the inner ear affected and the pathophysiology?
Benign paroxysmal positional vertigo (BPPV)
100
What is the location of BPPV?
Semicircular canals (i.e. horizontal, posterior, or superior)
101
What are 2 pathophysiologic conditions of BPPV?
1. ) canalithiasis (particles in canal portion of semicircular canals and are free floating - causing vertigo)
2. ) cupulolithiasis (densities adhered to the cupula of the crista ampullaris)
102
What are 5 risk factors of BPPV?
1. ) inactivity
2. ) alcohol
3. ) caffeine
4. ) major surgery
5. ) CNS disease
103
What are 9 etiologic conditions associated with BPPV?
1. ) idiopathic
2. ) vestibular neuritis
3. ) SSNHL
4. ) head/ear trauma
5. ) Meniere disease
6. ) acoustic neuroma
7. ) otitis media
8. ) otosclerosis
9. ) vertebral basilar insufficiency
104
BPPV is due to what - 90% of the time?
Posterior semicircular canal canalithiasis
105
BPPV is characterized by sudden onset of vertigo under which circumstances?
Trying to sit up suddenly, lying down, rolling over in bed, and looking up
106
BPPV symptoms start very violently, but dissipate within what time frame?
20-30 seconds
107
T/F: Severe "attacks" of dizziness can occur in BPPV and even the slightest head movement can cause nausea and vomiting
True
108
T/F: Patients with BPPV will have continuing symptoms that rarely resolve
FALSE!!! Between episodes, patients usually have few or no symptoms. However, some patients complain of a sense of fogginess. In many patients, the symptoms periodically resolve and then recur.
109
What is the standard clinical test used in BPPV?
Dix-Hallpike maneuver
110
What is considered a positive test and pathognomonic for BPPV?
Classic rotatory nystagmus with delay and limited duration
111
Which condition has a benign, slow-growing tumor derived from Schwann cells of CN VII?
Acoustic neuroma (Vestibular Schwannoma)
112
Which condition has the following ssx:
- unilateral, progressive SN hearing loss
- concomitant vertigo, tinnitus, disequilibrium
- headaches present in 50-60% of patients
- facial numbness in about 25% of patients
Acoustic neuroma (Vestibular Schwannoma)
113
T/F: Consider any bilateral sensorineural hearing loss an acoustic neuroma until proven otherwise
FALSE!!! Consider any UNILATERAL sensorineural hearing loss an acoustic neuroma until proven otherwise
114
Which condition has an increase in volume and pressure of the endolymph in the endolymphatic spaces of the inner ear?
Meniere disease
115
Which time of life and gender is normally affected by Meniere disease?
early to mid adulthood; M=F
116
What is the sign and sxs triad for Meniere disease?
1. ) waxing and waning
2. ) SN hearing loss
3. ) tinnitus and vertigo
117
What is the prodrome for Meniere disease?
Fullness or blocked sensation in one ear
118
Rarely, patients may experience such severe vertigo that they will collapse to the ground. These Meniere-related drop attacks are known as what?
Tumarkin crises
119
What is the main etiology of acute mastoiditis? What is the most common "bug" associated with this condition?
Complication of severe AOM; streptococcus pneumoniae
120
Which type of vertigo is present if the patient has the impression they are "moving in space" (self-motion)?
Subjective
121
What type of vertigo is present if the patient objects to moving around (motion of the environment), is more common in aging and increased incidence of falling in those > 65 years?
Objective
