Ent Review Otology And Neurotology Set 1

Front 1

Embyologic Origin
1) Auricle
2) EAC and outer layer of TM
3) Middle fibrous layer of TM
4) Inner layer of TM and middle ear space
5) Malleus Head
6) Incus long process
7) Eustachian tube

Back 1

1) First branchial arch --> Hillocks 1-3, 2nd branchial arch--> HIllocks 4-6
2) First branchial groove (Ectoderm)
3) First arch mesoderm
4) First branchial pouch (Endoderm)
5) First branchial arch: Malleus head and neck, incus body and short process
6) 2nd branchial arch: Malleus manubrium, incus long & lenitcular process, stapes
7) First branchial pouch

Front 2

1/3 and 2/3....EAC and ET

Back 2

EAC = 1/3 cartilage & 2/3 bone
Eustachian = 1/3 bone & 2/3 cartilage (Remember floppy)

Front 3

Fissures of Santorini?

Foramen of Hushke?

Back 3

- lymphatic channels, lateral (carilagenous) EAC --> parotid and TMJ.....spread of infection/tumors

- Same but medial (oseous) EAC
-

Front 4

Connect what two structures, innervation?
- Tensor tympani
- Stapdius muscle

Back 4

- Malleus neck --> cochleariform process (V3)

- Stapes --> Pyrimidal eminance (VII)

Front 5

Predominant dilator of ET, Innervation?
Others, Innervations (3)?

Back 5

- Tensor veli palatini (TVP), V3
- Levator veli palatini (LVP), X
- Tensor tympani, V3
- salpinophyarngeous, X

Front 6

Cochlear aqueduct course?

Vestibular aqueduct courase?

Back 6

- Base of ST (Perilymph) --> Subarachnoid space

- Vestibule (Enodlypmph) --> operculum (PCF)

Front 7

Formation of membranous labrynth?

Ductus Reuniens?

Back 7

Otic placoe --> otic pit --> otocyst--> ML

- Narrowest segment connecting saccule to cochlea

Front 8

Composition of endolymph vs. perilymph

Back 8

Endolymph = intracellular fluid (K>Na)
Perilypmh = extracellular fluid (Na>K)

Front 9

Explain how the HSSC filres?

Back 9

1) Head turns to left
2) Fluid tries to stay still...flows to right toward ampulla
3) Hair cells in crista ampullaris fire

Front 10

Describe different placement of kinocilia in horizontal and vertical canals, effect?

Back 10

HSCC- Kinocilia(K) on vestibule side (V)..... (GRAPHIC- S--ssK--V) , stereocillia(s) displace Kinocillia toward vestibule (Ampullopetal)--> FIRE

SSCC- kinocilia(k) on SCC (S) side (GRAPHIC.... S--Kss--V. Stereocillia displace Kinocilia away from vestibule (Ampullofugal) --> FIRE

Front 11

Utricle detects?

Saccule?

Back 11

U= horizontal linear accellaration (traveling in car)

S= Vertical linear accelleartion (Falling), "the sac drops"

Front 12

Superior vestibular nerve innervates?

Inferior vestibular nerve?

Back 12

S= superior SCC, horizontal SCC, utricle

I= posterior scc adn saccule

Front 13

Area advantage?
Lever Effect?
Tranformer ratio and gain?

Back 13

17:1
1.3:1
22:1, 25-30 dB

Front 14

Alexander's Law

Ewalds 1st and second law

Back 14

Gaze in fast phase direction increases nystagmus (Injury to R side --> Right slow --> Left fast).....so looking away from lesion --> Increase

1) Peripheral nystagmus is in the plan of the SCC being stimulated
2) Canals have a resting excititory tone (50). max excite (300) greater than possible inhibition (0)....stimulating > inhibitory

Front 15

Audiogram axis?

SRT Test, how close to PTA?

SDS score

Back 15

- X = Frequency (Hz)...Y= Hearing level (dB)

- Using spondees (Baseball), volume needed to get 50% right, within 10dB

- Using monosyllabic balanced words, % right 20-40 dB above SRT

Front 16

Interaural attenuation?
- How much for inserts, headphones and bone conduction

-Masking?

Masking dilema

Back 16

- Sound intensity needed to cause crossover
- 70 dB, 40 dB and 0dB

-Introducing AC noise to non-test ear to prevent crossover

- Can't mask when bilateral ABG 50-70 dB (Can't give Air conduction to opposite side..won't hear)

Front 17

Stapedial Reflex
- Arc
- Acoustic reflex decay
- Reasons for absent Reflex (3)

Back 17

- Sound --> cochlea --> VIII --> IPSY cochlear nucleus --> trapezoid body --> bilateral superior olives --> Facial nuclei --> VII --> stapes

- 10dB above SRT for 10 seconds....if reflex can't be sustained --> Retrocochlear lesion

-Mild CHL (5-10dB), SNHL (>60dB), facial nerve injured proximal to stapes branch

Front 18

Otoacoustinc Emmissions?
-Types

Back 18

- low intensity sounds in EAC from outer hair cells

Types:
Spontaneous (40-60% of normal ears)
Transiently evoked (broadband tones, neonatal screening)
DPOAE- 2 pure tones frequencies

Front 19

Interpreting OAE
TIP: Easier to look at numbers
- What level of hearing loss --> Abnormal OEA
- What difference between OAE and noise floor(NF) is abnormal?
- What level of hearing loss--> No OAE

Back 19

Source: A guide to OAEs for otolaryngologist...Figure 3
- 15 dB
- <6dB (Example at 2000 Hz)
- Normal: NF = -13, DP = -5 [Difference = 8]
- Abnormal: NF= -13, DP = -10 [Difference = 3]

-30 dB

Front 20

Reasons for Abnormal OAE?

Back 20

- Normal varient
- Poor technique
- Middle or external ear pathology
- Ototoxicity

Front 21

ABR/OAE in auditory neuropathy

Back 21

Normal OAE, abnormal ABR

Front 22

Abnormal ECoG level?
Disease in which it is found

Back 22

SP/AP > 0.45 (0.5)
Meniere's and Syphilis

Front 23

Abnormal Interaural wave V latecny

Back 23

>0.2ms, may not be reliable with tumors <1.0 cm

Front 24

Normal ABR latencies
I-III?
III-V?
I-V?

Back 24

Remember generally just subtract for ballpark
- 2.1
- 1.9
- 4.0

Front 25

Max HL when you can use ABR?
Max HL when you can use ASSR?

Back 25

- 60 dB
- 80 dB

Front 26

Effect of increased vent size?

Back 26

increased vent size --> real ear low frequency output decreaes (Hearing aid low frequency decreased), vent associated resonance frequency increases (Hearing aid present higher Hz)

Increased vent length --> Increase in low frequency gain, vent associate resonance frequency decreases (Adding low Hz)

Front 27

Contraindications for CI

Back 27

1) Acute or chronic infection
2) Retrocochlear disease
3) Michel's deformity

Front 28

Indications for CI
1) Adult
2) Pediatric
- When to implant younger

Back 28

1) <50% HINT score, <20% SDS bilaterally
2) >1 year, HL >90db HL
- Meningitis deafness

Front 29

Pulsatile Tinnitus

Overweight 20-30 y/o female...dx....Trx

Back 29

Pseudotumor cerebri

dx: LP

Trx: Weight loss, diuretics

Front 30

Hyperacusis, autophony, objective tinnitus?

Causes?

Back 30

Patulous ET

- Radiation, weight loss

Front 31

Cuases of clicking sounds in ear

Back 31

Palatal myoclonus
- Rapid clicking caused by contraction of palate muslces on ET
- Trx = Muscle relaxants

- Tensor tympani/Stapedius syndrome
- Spacm or muscle --> fluttering low Hz sound
- Worse with external sound

Front 32

Granulation in EAC and Bony/Cart junction

Back 32

Pathopneumonic for Malignant OE

Front 33

Persistent fluid at 1 month, and 3 months.

Back 33

50% and 10%

Front 34

Painless, odorless otorrhea with LAD, micor-perfs and pale granulation

Back 34

TB OM

Front 35

Strict Indications for BMT

Back 35

1) 3 episodes/6months
2) >4 episodes/1year
3) 3 months effusion

Front 36

MC site of ossicular disruption

Back 36

Incudostapedial joint- necrosis of lenticular process by AVN

Front 37

Hyrtles fissure

Back 37

Tympanomenigial hiatus- connects hypotympanum to subarachnoid space

Front 38

Gradinego's triad?
The other Italian guy?

Back 38

Puss, Palsy (VI) and pain (retro-orbital) form petrous apicitis

Dorrello- canal for VI

Front 39

MC site of labyrinthine fistula

Back 39

HSCC

Front 40

MC intracranial complication of OM

What increaes risk?

Back 40

meningitis: especially <5 years old

Mondini malformation

Front 41

4 stages of brain abscess

Back 41

1) Encephilitis- fever, HA, nuchal rigidity
2) Latency- asympt
3) Expanding- seizures, localizing signs
4) Termination- Rupture --> death

Front 42

Griesinger's sign

Back 42

Sign in lateral sinus thrombosis
- edem and pain over mastoid from occlusion of emissary veins (Backs up)

Front 43

Tobey-Ayer or Queckenstedt's test

Back 43

Compression of affected side IJ --> Nothing

Compression of contra IJ --> Rapid increase in CSF pressure

Front 44

Total CSF volume?

Production per day?

Back 44

140 ml

550 ml per day

Front 45

Patient with chronic papilledema, diplopia, lethargy, VI nerve palsey...Dx?

MRI shows normal ventricles, why?

Treatment?

Back 45

Ottitic Hydorcephalus

B/C CSF pressure increased, ventricles do not change

Lower ICP: Steroids, mannitol, LP
possible surgical exploration

Front 46

Sudden vertigo and permanent hearing loss during OM...Dx?

Back 46

Supparative Labrynthitis

Front 47

Vertigo and nystagmus elicited by loud noise?
Name?
Diagnosis?

Back 47

Tullios sign

Luetic Labrythitis

Front 48

Kerotosis Obturans vs. Keratosis Obliterans

Back 48

Obterans- Debris blocks up EAC (Obturate means to block up as in the barrell of a cannon)
- Bilateral, younger patient
- EAC widened
- Hearing loss no pain
- Treatment: non-surgical

--> NEXT SLIDE

Hint 48

Obliterans (Canal Cholesteatoma)
- Obliterates (Destroys) part of canal
- EAC cholesteatoma blocks canal
- Hearing loss and pain (erosion of EAC)
- Unilateral and Older
- Treatment: Non-surgical plus canalplasty

Front 49

Exostosis vs. Osteoma

Back 49

Exostoses
- Cold water exposure association
- Multiple, unilateral or bilateral
- Medial bony canal

Hint 49

Single
Unilateral
@ bony-cartilagenous junction

Front 50

Painful nodular growth on 70 year old man's helix? Treatment

Back 50

Chondrodermatitis Nodularis Helices

Full-thickness excision

Front 51

Primary vs. Secondary cholesteatoma?

Location of congenital cholesteatoma

Back 51

Primary = Retraction
Secondary = Perforation

Anterior superior pearl

Front 52

Paraganglioma
- Multiple, family, malignant
- Functional
- MC in H&N
- MC in Temporal bone
- Blood supply of GT

Back 52

-10%, 10%, 5%
- 3%
- Carotid body
- GJ
- Asc. Pharyngeal

Front 53

Brown's sign?
Aquino's sign?

Back 53

-blanching of TM with pressure in GT
- Compression of carotid --> decreaed pulsation

Front 54

Glasscock Jackson Staging
Glomus?

Back 54

1) Small- promontory only
2) Middle ear space
3) Into mastoid
4) Mastoid, EAC and carotid artery

Front 55

Glasscock Jackson staging Jugulare

Back 55

1) Small jugular bulb, middle ear and mastoid
2) under IAC with or w/o intracranial
3) into petrous apex w/ or w/o IC
4) clivus and ITF

Front 56

Fisch classification of glomus tumors?

Back 56

a) middle ear
b) middle ear and mastoid
c) infralabrynthine region
d) Intracranial extension

Front 57

Histelberger's sign

Back 57

decreased sensation of EAC with Acoustic Neuroma

Front 58

CPA tumor with large enodthelia cells and psomomma bodies

Back 58

Meningioma

Front 59

Match with surgical approach to temporal bone
1) Nonservicable hearing
2) <1 cm, intracanalicular
3) Lowest risk to facial nerve
4) postop HA
5) Higher risk to facial nerve
6) Lowest risk of CSF leak
7) Best hearing preservation
8) Only useful for vestibular nerve sectoin

Back 59

T(translab), RL (Retrolab), MCF(Mid Cranial Fossa), RS (Retrosig)
1) TL
2) MCF
3) TL
4) RS
5) MCF/RS
6) MCF
7) MCF
8)RL

Front 60

MC lesion of petrous apex?
MRI findings?

Back 60

cholesterol granuloma

Hyperintense on T1 and T2

Front 61

MC malignancy of temporal bone?
MC temporal bone malignancy of childhood?
MC metz....women?men?

Back 61

- SCCA
- Rhabdo
- Woman: Breast, Men: lung/prostate

Front 62

Staging Temporal bone cancer

Back 62

T1- EAC w/o bony erosion or soft tissue involvement
T2- Limited EAC erosions, <0.5 cm of soft tissue
T3- full EAC erosion with <0.5 cm soft tissue involvement OR middle ear/mastoid
T4- cochlea, petrous apex etc OR facial paresis

Front 63

MC site for otosclerosis

Back 63

fissula ante fenestrum

Front 64

Success of stapes surgery

Back 64

- 90% closure of ABG < 10 dB

Front 65

Definition of SSNHL

Outcomes: Recovery and profound SNHL

Back 65

3's
35 db, 3 frequencies, 3 days

1/3 recover, 1/3 profound HL

Front 66

Antibodies associated with Autoimmune HL

Back 66

68 kD

Front 67

Auditory Neuropathy
- Audio findings
- Other testing finds
- Problem

Back 67

- SNHL with poor word recognition out of proportion to HL

- Absent/abnormal ABR, normal OAE

- Inner hair cell or VIII problem (Outer hair cell normal)

Front 68

Breakdown of hearing loss, hereditary vs. acquired?

Heridtiary:
-Syndromic vs. non-syndromic
-Autosomal Recessive vs. Dominant

Back 68

- 50/50

- 1/3 syndromic, 2/3 non-syndromic

- 80% AR, 18% AD

Front 69

MC cause of prenatal hearing loss

Back 69

Intrauterine infeciton

Front 70

Pediatric testing and age

Back 70

BVP

<6 months- Behavioral observation, tests better ear only

6 mos - 3 years: Visual Response

3-5 years: Conventional play audiometry

Front 71

Test for syndrome:
Pendred syndrome
ECG
Renal U/S

Back 71

Perchlorate test, TFT
JLN
BOR syndrome, Alpert's

Front 72

Congenital Rubella
- Pathology
- Associations
- Dx

Back 72

- Atrophy of organ of corti, loss of hair cells, stri vascularis thrombosis
- Microcephaly, cardiac, cataracts
- IgM, culture

Front 73

Hutchinson Triad

Back 73

- abnormal notched central incisors
- interstitial keratitis
- deafness

Front 74

Diagnosis of CMV

Back 74

- serum anti-CMV IgM
- intranuclear inlcusions (owl's eyes inclusions in urinary sediment)

Front 75

Common Inner Ear dysmorphologies
- Inheritance of: Michel, Mondini,
- MC cochlear malformation
- Associated with Mondini and Pendred syndrome

Back 75

- AD
- Mondini
- EVA

Front 76

MC inner ear aplasia?
- Defect
- Association

Back 76

- Scheibe
- Abnormal pars inferior (Saccule, cochlea), normal pars superior (utricle and SCC)

Front 77

Inheritance of Alexanders and Scheibe aplasia

Back 77

Autosomal Recessive

Front 78

MC cause of non-syndromic hearing loss

Back 78

Connexin mutations
- 80% connexin 26 (GJB3 gene, locus DFNB1)

Front 79

MC cause of syndromic deafness?

Back 79

Usher syndrome
Type 1: MC, SNHL, vestibular defficiency
2: SNHL, normal vestibular
3: progressive SNHL, progressive vestibular

Front 80

Dx of Usher's

Back 80

electroretinography....retinitis pigmentosa