Kj Lee - Set #3

Front 1

What is a "phase lead"?

Back 1

Eye velocity is greater than head velocity

Front 2

When is it normal to have a phase lead?

Back 2

at low frequencies

Front 3

What does an abnormal phase lead at low frequency suggest?

Back 3

Peripheral lesion

Front 4

What does an abnormal phase lead at all frequencies suggest?

Back 4

Central lesion

Front 5

What is "phase lag"?

Back 5

Head velocity is greater than eye velocity

Front 6

What does occulomotor testing evaluate?

Back 6

Eye movement in the absence of vestibular stimulation

Front 7

Three components to occulomotor testing?

Back 7

1. Saccades 2. Smooth pursuit 3. Optikokinetic nystagmus

Front 8

What is posturography?

Back 8

Evaluates: 1. Balance 2. Visual, proprioceptive and vestibular signal processing

Front 9

What are the 6 testing conditions for posturography?

Back 9

1. eyes open, support stable, visual field fixed 2. eyes closed, support stable, visual field fixed 3. eyes open, support stable, visual field sway referenced 4. eyes open, support tilted, visual field fixed 5. eyes closed, support tilted, visual field fixed 6. eyes open, support tilted, visual field sway referenced

Front 10

What does ENG (electronystagmography) incorporate?

Back 10

Nystagmus VOR/HSCC Oculomotor testing

Front 11

What degree of hearing loss seen in external ear atresia?

Back 11

40-65 dB air-bone gap

Front 12

Which precedes first? Microtia repair or atresia repair?

Back 12

Microtia repair - preserve soft tissue and provide a thin envelope free of scar to receive cartilage framework

Front 13

What three syndromes is Atresia associated with?

Back 13

1. Treacher-Collins Syndrome 2. Goldenhar syndrome 3. Hemifacial microsomia

Front 14

What is atresia?

Back 14

Atresia is absence or underdevelopment of the ear canal and middle ear structures.

Front 15

What are two non-surgical options for atresia?

Back 15

BAHA Early amplification for bilateral disease

Front 16

9 Jahrsdoerfer criteria:

Back 16

1. Stapes - 2 2. Oval window open 3. Round window open 4. Middle ear space 5. Pneumatized mastoid 6. Normal CNVII 7. Malleus and incus (minus 1) 8. Incus and stapes 9. External ear 5 or less - poor 6 - marginal 7 - fair 8 - good 9 - very good 10 - excellent

Front 17

What percentage of aural atresia patients are candidates for surgery?

Back 17

0.5

Front 18

For Microtia what are the common demographics?

Back 18

Right > Left Unilateral > Bilateral (4:1) Males > Females (2.5:1)

Front 19

What is one classification scheme for microtia?

Back 19

Type I - mild deformity (lop ear, cup ear) Type II - all structures present, but this is a tissue deficiency Type III - classic microtia - few recognizable landmarks - lobule present often and anteriorly displaced

Front 20

Best time to reconstruct ear microtia?

Back 20

Between 6 and 10

Front 21

At what age does ear reach 85% of adult size?

Back 21

5

Front 22

4 steps of reconstruction for microtia?

Back 22

1. Auricular reconstruction 2. Lobule transposition 3. Ear elevation/formation of postauricular crease 4. Tragal and concha bowl reconstruction

Front 23

Treatment for ear frostbite?

Back 23

Rapidly rewarm what saline soaked gauze (38-42 degrees) No not debride - wait several weeks for demarcation Treat with topical antibiotics, ointment and analgesics

Front 24

What are the most common bacterial and fungal organisms seen with otitis externa?

Back 24

Bacterial: - Staphylococcus aureus - Pseudomonas aeruginosa Fungal: - Aspergillus niger

Front 25

Treatment for bacterial otitis externa (4)

Back 25

1. neomycin 2. polymyxin 3. ciprofloxacin 4. ofloxacin +/- steroids

Front 26

Treatment for otomycosis (6)

Back 26

1. Merthiolate (thimerosal) 2. Acetic Acid 3. Isopropyl alcohol 4. Gentian Violet 5. Nystatin 6. Azole

Front 27

What is MOE? Who gets it?

Back 27

Malignant otitis externa Diabetic and immunocompromised patients

Front 28

What bacteria is most likely the source for MOE

Back 28

Pseudomonas aeruginosa

Front 29

How does infection spread to the skull base with MOE?

Back 29

Fissures of Santorini

Front 30

How is MOE diagnosed radiographically? Followed radiographically?

Back 30

Diagnosed: Technetium 99 Followed: Gallium CT can confirm osteomyelitis, but 30-50% of trabecular bone of the mastoid must be destroyed before obviously positive

Front 31

Treatment of MOE?

Back 31

Antipseudomonal antibiotics for 3-4 months and surgical debridement

Front 32

What are exostoses?

Back 32

Broad-based bony lesions (multiple) of EAC secondary to cold water exposure

Front 33

What do you operate on exostoses?

Back 33

CHL or cerumen impaction

Front 34

What is an osteoma?

Back 34

Benign pedunculated bony neoplasm of the anterior EAC

Front 35

What do you operate on an osteoma?

Back 35

CHL or cerumen impaction

Front 36

4 nerve sources of referred otalgia?

Back 36

1. CN V - oral cavity, mandible, TMJ, palate preauricular region 2. CN VII - EAC, post auricular region 3. CN IX - tonsil, tongue base, nasopharynx, eustachian tube, pharynx (via Jacobson nerve) 4. CN X - hypopharynx, larynx, trachea (via Arnold nerve)

Front 37

What is Jacobson's Nerve?

Back 37

Also called tympanic nerve (branch of IX) It arises from the petrous ganglion, and ascends to the tympanic cavity through the fossula petrosa/tympanic canaliculus, on the under surface of the petrous portion of the temporal bone on the ridge which separates the carotid canal from the jugular fossa. In the tympanic cavity it divides into branches which form the tympanic plexus and are contained in grooves upon the surface of the promontory

Front 38

What is Arnold's Nerve?

Back 38

Arises from the jugular ganglion, and is joined soon after its origin by a filament from the petrous ganglion of the glossopharyngeal; it passes behind the internal jugular vein, and enters the mastoid canaliculus on the lateral wall of the jugular fossa. Traversing the substance of the temporal bone, it crosses the facial canal about 4 mm. above the stylomastoid foramen, and here it gives off an ascending branch which joins the facial nerve. The nerve reaches the surface by passing through the tympanomastoid fissure between the mastoid process and the tympanic part of the temporal bone, and divides into two branches: 1. Joins the posterior auricular nerve. 2. Skin of the back of the auricula and to the posterior part of the external acoustic meatus.

Front 39

Components of Jacobson's nerve

Back 39

1. Sensory fibers supply the middle ear. 2. Parasympathetic secretory fibers serve the parotid gland. The secretory fibers enter the otic ganglion. 3. Sympathetic fibers (for the large deep petrosal nerve) through communication with the carotid plexus

Front 40

Where is the most common source for a CSF otorrhea?

Back 40

Mastoid tegmen secondary to meningoencephalocele

Front 41

What % seal spontaneously? Why?

Back 41

90% Middle fossa close fast - rich arachnoid mesh leads to fibrosis Posterior fossa leaks close more slowly - little arachnoid

Front 42

What are the indications for repair of a CSF otorrhea?

Back 42

1. Persistent leak for >2 weeks despite bed rest with head elevation 2. Recurrent meningitis 3. Brain or meningeal herniation 4. Penetration of brain by bony spicule

Front 43

Two types of cholesteotoma?

Back 43

Congenital and Acquired

Front 44

How does a congenital cholesteotoma usual appear?

Back 44

"pearl" in middle ear space

Front 45

Where does a congenital cholesteotoma develop from?

Back 45

Embryonic rest of epithelium in anterior-superior quadrant

Front 46

Where does an acquired cholesteotoma usually develop from?

Back 46

Retraction pocket of pars flaccida into Prussack space (between pars flaccida and malleus neck)

Front 47

What is the most common location for a cholesteotoma?

Back 47

Around long process of incus and stapes suprastructure

Front 48

What are common areas for residual disease following surgery for a cholesteotoma?

Back 48

1. Sinus tympani 2. Facial recess 3. Anterior epitympanum

Front 49

What is the most common complication of a cholesteotoma?

Back 49

Erosion of horizontal semicircular canal

Front 50

What test should you perform if you suspect semicircular canal fistula?

Back 50

Fistula test

Front 51

What is a positive fistula test?

Back 51

Hennebert sign Positive pressure causes ampulopetal stimulation of the horizontal SCC with horizontal nystagmus to the ipsilateral side With negative pressure nystagmus reverses

Front 52

Which is the most commonly eroded ossicle?

Back 52

long process of the incus

Front 53

Which is the most commonly injured portion of the facial nerve during surgery?

Back 53

Tympanic portion of the facial nerve - confusing anatomy and frequent nerve dehiscence

Front 54

How do you treat an oval or round window fistula?

Back 54

Patched with fascia and packed

Front 55

What are some complications of cholesteotoma? (besides horizontal SCC fistula)

Back 55

1. extradural or perisinus abscess 2. serous or suppurative labyrinthitis 3. Meningitis secondary to tegmen erosion 4. Epidural, subdural or parenchymal absces 5. Sigmoid sinus thrombosis, phlebitis 6. Subperiosteal abscess, Bezold abscess due to erosion of mastoid cortex 7. Recurrence

Front 56

What are the treatment options for cholesteotoma?

Back 56

Canal wall down mastoidectomy Canal wall up mastoidectomy

Front 57

What are the indications for a canal wall down mastoidectomy?

Back 57

1. Only hearing ear 2. Contracted mastoid 3. Labyrinthine fistula 4. EAC erosion

Front 58

What are the reasons for a persistently draining mastoid cavity?

Back 58

1. Inadequate meatoplasty 2. Dependent tip cell 3. High facial ridge 4. Exposed eustachian tube

Front 59

When don't you remove all the cholesteotoma matrix?

Back 59

1. matrix is adherent to dura 2. matrix is adherent to superior semicircular canal 3. matrix is adherent to FN 4. matrix extends into mesotympanum covering the footplate

Front 60

Which muscle opens the eustachian tube?

Back 60

Tensor Veli Palatini

Front 61

What is the Teunissen classification system for ossicular abnormalities?

Back 61

Class I - congenital stapes fixation Class II - stapes ankylosis with ossicular abnormality Class III - ossicular abnormality with mobile foot plate, ossicular discontinuity, or epitympanic fixation Class IV - aplasia or dysplasia of round or oval window +/- crossing facial nerve or persistent stapedial artery

Front 62

What are the most common bacteria that cause acute otitis media?

Back 62

Streptococcus pneumoniae (40%) Haemophilus influenzae (30%) Moraxella catarrhalis (20%)

Front 63

First line antibiotic for acute otitis media?

Back 63

amoxicillin

Front 64

Define recurrent acute otitis media?

Back 64

>3 episodes in 6 months or >4 episodes in 1 year

Front 65

Define chronic otitis media with effusion?

Back 65

(OME) - serous middle ear effusion for at least 3 months

Front 66

What is chronic suppurative otitis media?

Back 66

infected otorrhea through TM perf or typanostomy tubes

Front 67

Organisms that cause chronic suppurative otitis media?

Back 67

Pseudomonas aeruginosa Staphylococcus aureus Proteus

Front 68

Treatment for chronic suppurative otitis media?

Back 68

Antipseudomonal penicillin Cephalosporin Ear gtts and quinolone (adults)

Front 69

Risk factors for acute otitis media?

Back 69

day care tobacco smoke upper respiratory infection lack of breast feeding genetics immunodeficiency birth defects (cleft palate, etc)

Front 70

Most common cause of vertigo in children?

Back 70

Otitis Media

Front 71

What are five complications of otitis media?

Back 71

1. Otorrhea 2. Mastoiditis (subperiosteal abscess, Bezold abscess) 3. Petrous apicitis 4. Facial nerve paralysis 5. Intracranial complications (meningitis, cerebral abscess, sigmoid sinus thrombosis)

Front 72

What is a Bezold abscess?

Back 72

Abscess in digastric groove of SCM

Front 73

Most common complication of otitis media?

Back 73

mastoiditis

Front 74

What is Gradenigo syndrome?

Back 74

otorrhea, retro-orbital pain, lateral rectus palsy

Front 75

Why do you get a VI palsy with petrous apicitis

Back 75

Irritation to VI within Dorello canal

Front 76

Common bacterial agents associated with meningitis as a complication from otitis media?

Back 76

S. pneumoniae H. influenzae

Front 77

Clinical findings with sigmoid sinus thrombosis

Back 77

1. Picket fence fevers 2. Cannonball chest infiltrates on CXR 3. Edema and tenderness over mastoid cortex (thrombosis of mastoid emissary vein)

Front 78

What is Griesinger sign?

Back 78

Edema and tenderness over mastoid cortex (thrombosis of mastoid emissary vein)

Front 79

What is the likely diagnosis of a patent with Jacksonian epilepsy, hemiplegia and otitis media?

Back 79

subdural abscess

Front 80

Chance of having residual middle ear effusion after treatment of ottis media?

Back 80

70% @ 2 weeks 40% @ 4 weeks 20% @ 2 months 10% @ 3 months

Front 81

Most common cause of conductive hearing loss in people 15 to 50?

Back 81

Otosclerosis

Front 82

Prevalence of otosclerosis?

Back 82

Caucasian>Asian>African American Female>Male (2:1)

Front 83

What elevated antibody is seen in perilymph in otosclerosis

Back 83

anti-measles virus IgG

Front 84

Genetic inheritance of otosclerosis?

Back 84

Autosomal dominant with 40% penetrance

Front 85

What conditions hasten the appearance of otosclerosis?

Back 85

Pregnancy and menopause

Front 86

How often is otosclerosis seen bilaterally?

Back 86

0.85

Front 87

Where does disease begin with otosclerosis?

Back 87

Region anterior to oval window niche (fissula ante fenestrum)

Front 88

What are the "Blue Mantles of Manasse"?

Back 88

Finger-like projections of blue otosclerotic bone around normal vasculature

Front 89

What is Schwartze sign?

Back 89

pinkish hue over promontory and oval window niche (thickened mucosa)

Front 90

Results of acoustic reflex testing in patients with otosclerosis:

Back 90

Early - increased compliance at beginning and end of stimulus Late - decreased or absent

Front 91

What do you see on audiometry in patients with otosclerosis?

Back 91

Air-bone gap (not usually greater than 50 dB) with Carhart notch

Front 92

What can you see on CT in patients with otosclerosis?

Back 92

"double ring" "halo sign"

Front 93

Treatment of otosclerosis?

Back 93

1. Consider hearing aid first 2. Stapedectomy (30-40 db air-bone gap) 3. Amplification if CHL >45 dB and has high frequency sensorineural hearing loss (think cochlear otosclerosis)

Front 94

What findings should make you think of cochlear otosclerosis?

Back 94

CHL >45 dB and has high frequency sensorineural hearing loss

Front 95

Sudden decrease in hearing following an initial good result from stapedectomy?

Back 95

Incus erosion PLF - most common cause of cochlear hearing loss following surgery

Front 96

What causes delayed FN paralysis 5-7 days after stapedectomy? Treatment?

Back 96

Consider vial infection Treat with steroids, antivirals

Front 97

What pathology should you consider if a patient has delayed vertigo following stapedectomy?

Back 97

PLF Labyrinthitis Prosthesis that is too long

Front 98

What are the features of tuberculosis in the middle ear?

Back 98

1, Grey TM with small perforations 2. Mucoid, clear drainage 3. Incus resorption, denuded malleus head 4. SNHL

Front 99

What are 4 vascular anomalies found in the middle ear?

Back 99

1. Dehiscent carotid - pulsatile mass in anteroinferior quadrant 2. High-riding jugular bulb - bluish mass in posterointerior quadrant 3. Persistent stapedial artery 4. Glomus tympanicum