Clin Med: Inner Ear

Front 1

-Rinne mastoid tests _____
-Rinne air tests _____

Back 1

-CN 8
-TM and ossicles and how they relay sound to CN 8

Front 2

-Rinne conductive loss presents as
-Rinne sensorihearing loss presents as

Back 2

-BC>AC
-AC>BC but not 2:1

Front 3

-+/- distortion of speech
-Difficult hearing in noisy situation
-Pts voice is loud

Back 3

-Sensorineural hearing loss

Front 4

Weber lateralization to good ear =

Back 4

SHL

Front 5

Rinne BC>AC =

Back 5

CHL

Front 6

Rinne AC> BC 2:1 =

Back 6

Normal

Front 7

Rinna BC>AC not 2:1

Back 7

SHL

Front 8

Weber lateralization to bad ear

Back 8

CHL

Front 9

Ringing in the ear without stimulus

Back 9

Tinnitus

Front 10

Reversible causes of tinnitus (SDM)

Back 10

-Salicylates (aspirin)
-Antidepressants
-Antimalarials

Front 11

Permanent causes of of tinnitus (ACD)

Back 11

-Aminoglycosides
-Chemotherapeutics
-Diuretics

Front 12

-% resolution
-Treatment

Back 12

-50% resolve
-25% gets worse
-25% stay the same
-Remove offender, white noise, avoid loud noise

Front 13

-Progressive, gradual HL
-Loss of heard speech with background noise
-Inability to tolerate loud sound
-Tinnitus

Back 13

-Presbycusis

Front 14

Cause of presbycusis

Back 14

Degenerative changes in inner ear or CN 8 (hair cell, basilar membrane, CN damage ischemial

Front 15

Presbycusis definition

Back 15

Bilateral sensorineural hearing loss associated with aging

Front 16

Sudden onset of significant unilateral sensorineural hearing loss +/-tinnitus

Back 16

Sudden sensorineural hearing loss

Front 17

Causes of sudden SHL

Back 17

Usually idiopathic , possibly autoimmune

Front 18

Treatment of sudden SHL

Back 18

Systemic steroids

Front 19

Resolution of sudden SHL

Back 19

-70% spontaneously w/in 2 weeks
-20% experience partial resolution
-10% permanent hearing loss
0

Front 20

-Bilateral SHL
-High frequency sounds lost first
-Histeroy of aminoglycosides or salicylates, antimalarials or chemo

Back 20

Drug ototoxicity

Front 21

Causes of drug ototoxicity (CASA)

Back 21

1. Aminoglycosides
2. Salicylates
3. Antimalarials
4, Chemo

Front 22

How aminoglycosides are ototoxic

Back 22

Destroy hair cells

Front 23

-Tinnitus
-CHL
-Normal PE except W & R
-Excess bone growth

Back 23

Otosclerosis

Front 24

Otosclerosis definition

Back 24

Disease that causes excess bone growth that eventually fuses stapes to TM, preventing TM from moving
--Prevents sound from traveling from middle to inner ear

Front 25

Cause of otosclerosis; begins when:

Back 25

Genetic metabolic disease; beginning around 3rd decade (possibly teens)

Front 26

Common Location of new bone deposition in otosclerosis

Back 26

Near round or oval window

Front 27

Treatment of otosclerosis (2)

Back 27

-Hearing aids improves CHL dramatically
-Surgery (90% resolution)

Front 28

-Unilateral CHL
-Pulsatile or roaring tinnitus
-Red, pulsatile mass behing TM
-Paralysis of CN (face, pharynx, vocal cords, tongue)

Back 28

Glomus jugulare tumor (glomus tympanicum)

Front 29

Glomus jugulare tumor (glomus tympanicum)

Back 29

Vascular tumor in middle ear cavity

Front 30

Treatment of glomus jugulare tumor (2)

Back 30

Radiation
Surgery

Front 31

Radiation complicaitons

Back 31

-Perivascular fibrosis
-Damage to cochlea
-Iatrogenic radiation induced HL

Front 32

Surgery

Back 32

-Obliteration of middle ear
-Iatrogenic CHL

Front 33

-Hallucination of motion
-Worse in absence of visual stimuli
-Dizziness/N/V/sweating/tachycardia
-Auditory symptoms (tinnitus, pressure, HL)
-Nystagmus

Back 33

Vertigo

Front 34

-Nystagmus
-nature
-occurs naturally when:

Back 34

-Rapid, involuntary small amplitude movements (tremor) of the eyes
-Rhythmic
-When watching fast objects & when drunk

Front 35

Causes of vertigo
1
2

Back 35

1. Peripheral (inner ear) stimulation (inner ear infection)
2. Central (brainstem-cerebellum) stimulation

Front 36

-Acute symptoms of vertigo
-Nystagmus
-NO HL, just dizzy
-Initiated by certain head positions

Back 36

Benign paroxysmal positional vertigo (BPPV)

Front 37

Paroxysmal =

Back 37

Sudden attach or violent expression of a particular emotion or activity

Front 38

Cause of BPPV

Back 38

-Positioning vertigo
--Migration of an otolith to posterior semicircular canal --> stimulates the canals

Front 39

Diagnosis of BPPV: ____ test

Back 39

Dix Hallpike Positional Testing

Front 40

Positive Dix-Hallpike

Back 40

Burst of nystagmus & vertigo when pt. lays down with head turned (offending ear down to the ground)

Front 41

Treatment of BPPV (3)

Back 41

-Resolves spontaneously
-Treat symptoms with anitemetics/vertiginous
-Epley's Maneuver

Front 42

-Epley's Maneuver
--Start by:
--Sleep:

Back 42

-Moves otolith out of the sensitive part of ear
--Turning head opposite of affected ear
--Semirecumbent

Front 43

-No HL
-Acute vertigo with just moving the eye
-N/V
-Nystagmus
-Pt. veers toward affected side

Back 43

Vestibular neuronitis

Front 44

-Acute phase
--Symptoms
--Duration
-Convalescent:
--Symptoms
--Duration

Back 44

-Severe vertigo, nystag, N/V, veers; 1-5 days
-Imbalance, motion sickness; days to weeks

Front 45

Incomplete recovery likely in:

Back 45

Elderly, visually impaired, those with poor ambulation

Front 46

Cause of vestibular neuronitis

Back 46

Possibly viral infections (URI)

Front 47

Treatment
-Acute Phase
-COnvalescent

Back 47

-Bed rest, antivertiginous/emetic
-Progressive ambulation, vestibular exercises

Front 48

-Unilateral SHL (distinguishes from ____)
-Vertigo (esp. with rapid head mvmnts)
-Nystagmus/N/V
-Tinnitus

Back 48

Labyrinthitis

Front 49

-Etiology of labyrinthtis
--
--
-Occurs as complication of (3)

Back 49

--Viral (serous fluid)
--Bacterial (purulent fluid)
1. AOM
2. Bacterial meningitis
3. Cholesteatoma

Front 50

Diagnosis of labyrinthitis
(3)

Back 50

-CT of head
-Lumbar puncture if you suspect meningitis
-Blood cultures

Front 51

Treatment of labyrinthitis

Back 51

-IV abx
-Drainage of middle ear
-Mastoidectomy
-Send to ENT

Front 52

If a pt has acute onset hearing loss what should you do?

Back 52

Sent to ENT

Front 53

-Age 40-60
-Clusters of vertigo, tinnitus, aural fullness
-+/- N/V
-+/-drop attacks
-+/- SHL

Back 53

Meniere disease

Front 54

-Meniere disease
--Unilateral or bilateral

Back 54

Disorder of vestibular labyrinth
-Unilateral (65%), bilateral (35%)

Front 55

What frequency of hearing will go first in Meniere's

Back 55

Low frequency

Front 56

Later stage of Meniere's:

Back 56

-Persistent tinnitus
-Low frequency HL

Front 57

-Drop attacks
--AKA

Back 57

-Sudden involuntary drop to the ground w/o warning & w/o loss of consciousness
--Tumarkin crisis

Front 58

Treatment of Meniere
-Acute
-Long term

Back 58

Acute
-Best rest
-Anitemetic/vertiginous
Long term
-Medical: Low salt diet, ototoxic meds to destroy vestibular organ
-Surgical: Vestibular neurectomy or labyrnthectomy

Front 59

Possible complication of Menieres

Back 59

May recur in opposite ear after treatment

Front 60

-Unilateral SHL (distinguishes from _____)
-+/- dizziness, no vertigo
-Possible facial n. palsy/trigem sensory deficit
-Slow onset

Back 60

-Acoustic neuroma
--Unilateral: Differentiated from presbycusis

Front 61

-Treatment of acoustic neuroma
--Complication

Back 61

-Surgical excision
--Destroy tumor, in process destroy hearing

Front 62

Causes of SHL
1.
2.
LAMPO
--1.
--2.
--3.
--4.
--5.

Back 62

1. Congential
2. Acquired
--1. Labyrinthitis
--2. Acoustic neuroma
--3. Meniere's
--4. Presbycusis
--5. Ototoxic drugs

Front 63

Causes of CHL
-External Ear (COF)
1.
2.
3.
Middle ear(GASP COB)
(7)

Back 63

1. Cerumen
2. Otitis externa
3. Foreign body
--------------
1. Glomus jugulare
2. AOM
3. SOM
4. Perforation
5. Cholesteatoma
6. Otosclerosis
7. Barotrauma

Front 64

Things causing unilateral SHL

Back 64

-Sudden sensorineural HL
-Labyrnthitis
-Acoustic neuroma

Front 65

Things causing unilateral CHL

Back 65

-Glomus jugulare tumor
-Obstruction