Term
| Which inner ear structure does aminoglycoside antibiotics commonly damage? |
|
Definition
OHCs at the basal turn- high frequency SNHL. Tinnitus commonly precedes and rate of HL is 10-15%
IHC damage occurs at later state |
|
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Term
| How do cisplatin and carboplatin cause hearing loss? |
|
Definition
1) Cisplatin: Permanent bilateral, symmetric high-frequency SNHL by damaging basal turn OHCs and stria vascularis (similar to Lasix)
2) Carboplatin damages IHCs |
|
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Term
| how does the typical location of facial nerve injury differ between otic-capsule sparing and transverse temporal bone fractures? |
|
Definition
1) Longitudinal= perigeniculate
2) Transverse= labyrinthine |
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Term
What is the appearance on T1/T2 MRI of the following petrous apex lesions?
1) Cholesterol granuloma
2) Paraganglioma
3) Cholesteatoma
4) Meningioma
5) Acoustic neuroma |
|
Definition
1) Hyperintense on T1 and T2 (similar to endolymphatic sac tumors)
2) Isointense on T1 and T2
3) DWI restriction, hypointense on T1, hyperintense on T2
4) Isointense T1/T2- dural tail
5) Isointense T1/T2, enhance with contrast on T1 |
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Term
| What are the major derivates of the 2nd branchial arch Reichert cartilage? |
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Definition
| Manubrium of malleus, long process of incus, stapes suprastructure, stylohyoid ligament, body and less corneu of the cricoid cartilage |
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Term
| What is the "loss of gain" due to impedence mismatch between the middle and inner ear that must be overcome by the ossicles and tympanic membrane? |
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Definition
30 dB
Surface area advantage is 26dB (tympanic membrane to oval window)
Level advantage is 2dB
Cantelever advantage is 6dB |
|
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Term
| What malformation is described by membranous aplasia of the cochlea and saccule? |
|
Definition
1) Scheibe, most common histopathologic finding in congenital deafness
Differentiated from Michel aplasia, which is complete agenesis of the petrous temporal bone with normal middle and external ear |
|
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Term
| What are the clinical features and treatment of Cogan syndrome? |
|
Definition
Autoimmune disease that causes fluctuation SNHL, peripheral vestibulopathy and interstitial keratitis
Acute treat with steroid and maintain on cyclophosphamide or azathioprine |
|
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Term
| Diagnostic criteria for meniere's |
|
Definition
1) 2 episodes of vertigo 20 min to 24h
2) Defined low-mid frequency hearing loss
3) Fluctuating aural symptoms (tinnitus, fullness) |
|
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Term
| Approximately what increase in dB is responsible to double sound intensity? |
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Definition
|
|
Term
| What are the most common CPA masses in children? |
|
Definition
|
|
Term
| What are the classic 3 findings in Gradenigo syndrome? |
|
Definition
Petrous apicitis
Retrorbital pain (V1), Abducens palsy (CN VI), Otorrhea
Abx-->surgery |
|
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Term
| What syndrome is associated with congenital SNHL, iris pigment abnormalities, hair hypopigmentation |
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Definition
|
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Term
| Most common infectious cause of congenital hearing loss in US |
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Definition
| CMV- look for cerebral calcifications on CT |
|
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Term
| SLC26A4 gene encodes a chloride iodide transporter. What disease is associated with mutations in this? |
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Definition
| Pendred- hearing loss, thyroid goiter, autosomal recessive |
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Term
What do negative Rinne tests with each of the following tuning forks indicate in terms of air-bone gap?
1) 256 Hz
2) 512 Hz
3) 1024 Hz |
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Definition
1) >15 dB
2) >25 dB
3) >35 dB |
|
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Term
| What are the OSHA guidlines? |
|
Definition
| Starts at 16h for 85dB and then for every 5d increase, number of hours reduced by half |
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Term
| What is measured by cVEMP and oVEMP? |
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Definition
eyes over neck
1) oVEMP= SVN, utricle, superior/lateral canal
2) cVEMP: IVN, saccule, posterior SCC |
|
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Term
| What is measured by cVEMP and oVEMP? |
|
Definition
eyes over neck
1) oVEMP= SVN, utricle, superior/lateral canal
2) cVEMP: IVN, saccule, posterior SCC |
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Term
| Most common direction of spread of attic cholesteatoma originating in prussacks space |
|
Definition
Posterior epitympanum
Shallow pocket lies between pars flacida and neck of malleus where cholesteatoma originates and exits posteriorly towards the aditus ad antrum |
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Term
| What are the histological hallmarks of vestibular schwanomma? |
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Definition
| Antoni A areas (spindle-shaped schwann cells) interspersed amongst Antoni B areas (loosely-packed connective tissue). |
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Term
| Why might you see a low-frequency AGB versus a high-frequency ABG? |
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Definition
1) Low frequency= tympanic membrane perforation with intact ossicular chain
2) high-frequency= partial IS joint separation
3) total discontinuity will be across all frequencies |
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Term
| What are the vestibulotoxic aminoglycoside antibiotics? |
|
Definition
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Term
| Describe the main differentiating factors between the Fish type A, B and C approaches to the infratemporal fossa |
|
Definition
All involve mastoidectomy, transposition of facial nerve
1) Type A: anterior facial nerve transposition for access to jugular foramen, vertical ICA, infralabyrinthine regions
2) Type B: removal of zygomatic arch, temporalis muscle, retraction of condyle, dissection of horizontal ICA, exposes sigmoid sinus, petrous apex, foramen ovale
3) Removal of pterygoid plates to expose parasellar region, foramen rotundum, cavernous sinus, nasopharynx |
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Term
| Differentiate between Rollover and Recruitment and what they each indicate |
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Definition
Recruitment: hearing loss at low loudness then normal hearing at higher loudness= cochlear pathology. If ABSENT recruitment, suggests retrocochlear
Rollover: speech recognition decreases with increasing loudness retrocochlear pathology |
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Term
| Describe how headshake test can be used in evaluation of vestibular dysfunction |
|
Definition
- Shake 30 times then stop
- If at least 3 consecutive beats of horizontal nystagmus, then unilateral vestibulopathy
- Slow phase initially directed towards weak side and then reverses (fast phase away from weak side) |
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Term
| How can you differentiate peripheral from central nystagmus? |
|
Definition
1) Peripheral
- Direction fixed and enhance without fixation
- Horizontal
2) Central
- Not direction-fixed, will enhance with fixation
- Vertical |
|
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Term
| True or False: excessive tone decay is characteristic of a retrocochlear lesions? |
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Definition
True
Sound presented to ear with hearing loss until it becomes inaudible. |
|
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Term
| What is the embryologic origin of the eustachian tube and middle ear? |
|
Definition
1) First branchial pouch
First branchial cleft becomes EAC |
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Term
| What is the first-line antibiotic therapy for a patient with acute mastoiditis WITHOUT a history of AOM? |
|
Definition
1) Vancomycin or Linezolid
2) If AOM history, add anti-pseudomonal |
|
|
Term
|
Definition
1-3 first pharyngeal arch
4-6 second pharyngeal arch
1) Tragus
2) Helical crus
3) Helix
4) Anti-helix
5) Anti-tragus
6) Anti-tragus |
|
|
Term
Audiometry by Age
1) 0 to 6 months
2) 6 months to 3 years (36 months)
3) Age 3-5 years
4) >5 years |
|
Definition
1) Behavioral or ABR
2) Visual reinforcement
3) Play audiometry
4) Conventional audiometry |
|
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Term
| Pittsburgh temporal bone SCC staging |
|
Definition
1) EAC without bone erosion or soft tissue
2) Partial bone, limited soft tissue
3) Full thickness bone, middle ear or mastoid
4) Carotid, jugular bulb, medial middle ear, petrous apex, facial nerve |
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Term
| Interaural attenuation for insert headphones for air conduction |
|
Definition
| 70dB, need to mask above this. 40dB for over the ear. |
|
|
Term
| What vascular anomaly is associated with absent foramen spinosum? |
|
Definition
| Absent diminutive middle meningeal artery and persistent stapedial artery |
|
|
Term
| Most part of the facial nerve is most commonly stimulated during hemifacial spasm after cochlear implantation? |
|
Definition
|
|
Term
| What is the 50 dB SL for an individual with a threshold of 20 dB HL at 100Hz |
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Definition
SL is the level of intensity an individual can just perceive a sound in 50% of presentations.
This is different from HL, which uses the average ear as the reference.
70 dB HL.
SL uses the indivudal's threshold as the referent. So the HL for that individual with would 20 + 50= 70. |
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Term
| When is masking necessary for air and bone conduction? |
|
Definition
1) Air= mast nontest ear when air conductive level in test ear exceeds bone conduction level of non test ear by 40dB or 70 dB (in ear).
2) Bone conduction: When there is an ABG of >10dB in the test ear. |
|
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Term
| What are the relative clinical use cases for TEOAES and DPOAES? |
|
Definition
1) TEOAE
2) DPOAE (2F2-F1)
Generally DPOAEs are more useful. Particularly useful in assessing neonatal, ear-specific, hearing. Also used in assessment of Ototoxicity. |
|
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Term
| When are each of the tests for pediatric audiometric assessment appropriate? |
|
Definition
1) <6 months= ABR, OAE, behavior observation
2) 6 months to 30 months= Visual reinforcement
3) 36 months to 5 years- conditioned play
4) >5 years- standard audiometry |
|
|
Term
True or false:
OAEs are unreliable if middle ear disease is present |
|
Definition
|
|
Term
| Describe stenger test for pseudohypacusis |
|
Definition
Good for asymmetric or unilateral hearing loss.
5dB above threshold for good ear and 5dB below threshold for poor ear. Both same frequency.
If they don't respond (they should hear the good ear stimulus), the test is positive. |
|
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Term
| True or false: central vertigo is often milder compared to peripheral. It cannot be suppressed with fixation and smooth pursuit is often abnormal |
|
Definition
|
|
Term
| What is the most common cause of genetic congenital deafness? |
|
Definition
70% nonsyndromic. 80% of this is Autosomal recessive.
Of this category 50% is due to connexin 26 defects (GJB2) that encodes gap junctions |
|
|
Term
| What is an example of non-syndromic autosomal dominant congenital hearing loss? |
|
Definition
70% is nonsyndromic. Only 20% of these are AD.
Think COL11A (DFNA13) for type XI collagen |
|
|
Term
What are the genes responsible for the following causes of AD syndromic congenital hearing loss?
1) Branchio-oto-renal
2) NF-1
3) Osteogenesis imperfecta
4) Otosclerosis
5) Stickler
6) Treacher Collins
7) Waardenberg |
|
Definition
1) EYA on chromosome 8q encodes a transcription factor
2) NF1 on chromosome 17
3) COL1A1 on chromosome 17
4) COL1A1
5) COL2A on chromosome 12
6) TCOF1 on chromosome 5, encodoes treacle
7) PAX3 gene on chromosome 2, defect in neural crest migration |
|
|
Term
| What are the most common autosomal recessive syndromic deafness syndromes? |
|
Definition
1) Jervell and Lange-Nielsen: K+ channel mutations, cardiac arythmia
2) Pendred: euthyroid goiter, iodine metabolism issue, abnormal perchlorate discharge test, mondini malformation and EVA
3) Usher- retinitis pigmentosa, hearing and vestibular |
|
|
Term
| What are the two clinical parameters that predict success with hearing aids? |
|
Definition
1) Word recognition scores >50%
2) Dynamic range- uncomfortable loudness level - SRT |
|
|
Term
| What are the advantages and disadvantages of an implanted hearing aid (Soundbridge, MAXUM)? |
|
Definition
Electromagnetic and Piezoelectric options
1) Better soudn fidelity without occlusion effects and less feedback. Heaaing while bathing, swimming etc.
2) Cost, surgery, lack of insurance coverage, battery replacement, limited MRI compatibility. |
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Term
| When is a bone-anchored hearing device appropriate for single sided deafness? |
|
Definition
PTA in the better ear is 20dB or better.
Also good in conductive or mixed loss.
Can eliminate head shadow, improve speech understanding in noise, but not does not help localization. |
|
|
Term
| What are the vestibular considerations for stapes surgery? |
|
Definition
1) Not in active MD
2) Blind patients may not compensate for minor vestibular complications
3) Care if contralateral peripheral vestibulopathy. |
|
|
Term
| What are the vestibular considerations for stapes surgery? |
|
Definition
1) Not in active MD
2) Blind patients may not compensate for minor vestibular complications
3) Care if contralateral peripheral vestibulopathy. |
|
|
Term
| Where is the facial nerve most vulnerable to injury during mastoid surgery? |
|
Definition
| Posterior and lateral to the lateral semicircular canal |
|
|
Term
| What can you learn from a facial nerve injury where there is facial paralysis, decreased salivation and taste but with normal lacrimation? |
|
Definition
This means the injury is distal to the takeoff of the GSPN but proximal to the stapedius. This would suggest impairment at the level of the geniculate.
If salivation and taste where in tact this would suggest an extracranial injury. |
|
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Term
| What are the distinguishing features of Neuropraxia, Axonotmesis and Neurotmesis? |
|
Definition
1) Neuropraxia is local compression, electrophysiology will be normal, function recovers after compression relieved.
2) Axonotmesis: Endoneural sheeth preserved. Wallerian degeneration distal to the lesion. Electrophsyiological tests will reveal rapid and complete degeneration 72h after injury, but there will be normal recovery.
3) Neurotmesis, full transection. Can electrophysiologically look like axonotmesis early in course |
|
|
Term
| What is the difference between nerve excitability testing and ENG? |
|
Definition
1) NET compares thresholds required to elicit minimal muscle contraction between sides. Difference of >3.5mA is significant.
2) ENG is more quantitative and measures EMG recording of CAP as opposed to visual inspection in NET. Used 3-14 days after onset and >90% weakness is significant. |
|
|
Term
| Which extratemporal facial nerve injuries are left to recover spontaneously? |
|
Definition
| Those distal tot he lateral canthus and oral facial crease |
|
|
Term
| What is the treatment for facial paralysis related to Lyme disease? |
|
Definition
Usually bilateral.
4 weeks of doxycycline. |
|
|
Term
| What does the combination of fibrillation and polyphasic potentials on EMG tell you about the etiology of a facial nerve paralysis? |
|
Definition
| Simultaneous degeneration and repair, suggesting a tumor |
|
|
Term
| What is the prognosis for traumatic neonatal facial nerve paralysis? |
|
Definition
|
|
Term
| In the case of iatrogenic facial nerve weakness, how should it be managed post-operatively? |
|
Definition
If immediate and incomplete, steroids and watch
If immediate and complete explore
If delayed (partial or complete) observe with steroids |
|
|
Term
| What is the role for surgical decompression in zoster related (Ramsey Hunt) facial nerve paralysis? |
|
Definition
| Minimal, involvement is broad as opposed to labyrinthine segment in bell's |
|
|
Term
| What are the appropriate vaccines for cochlear implantation in children? |
|
Definition
1) 13-valent pneumococcal vaccine 2 weeks prior to implant as well as close contacts.
2) If >24 months, 23 valent vaccine can be given. |
|
|
Term
| What is the most common pathogen found in OM biofilms? |
|
Definition
|
|
Term
| How is the diagnosis of otosyphilis made and treated? |
|
Definition
1) VDRL or RPR for screening, FTA-ABS for confirmation
2) Parenteral PCN G 3 weeks, steroids 2 weeks. 30-50% will have improvement in hearing and balance function |
|
|
Term
| What is the treatment for the viral illness that causes hearing loss and "grains of rice" on red base of oral mucosa? |
|
Definition
Measles (Rubeola): RNA paramyxovirus
Cough, coryza, conjunctivitis, maculopapular rash
Vitamin A can reduce morbidity and mortality |
|
|
Term
| What does a patient with hearing loss and hearing improved in noise suggest? |
|
Definition
| Otosclerosis, paracusis of willis |
|
|
Term
| What can you tell about degree of ABG based on tuning fork frequency? |
|
Definition
256= 15 dB or more
512= 25 dB or more
1024= 35 dB or more |
|
|
Term
| What is the definition of idiopathic sudden SNHL? |
|
Definition
| 30dB loss over 3 frequencies within 3 day period |
|
|
Term
| What should be done to treat functional paragangliomas? |
|
Definition
Most common symptoms are pulsatile tinnitus (80%) and hearing loss (60%)
Urinary VMA and metanephrines
Have to treat secretory function prior to general anesthesia- phentolamine with give alpha adrenergic blockage. |
|
|
Term
| What are the Fisch and Glasscock-Jackson glomus classification systems? |
|
Definition
1) Fisch
- A (middle ear), B (mastoid), C (infralabyrinthine), D (intracranial)
2) Glasscock-Jackson
- for tympanicum 1 (promontory), 2 (filling ME), 3 (mastoid), IV (into EAC) |
|
|
Term
| What is the most common malignancy of the temporal bone in childhood? |
|
Definition
Rhabdomyosarcoma.
Most common is embryonal, vs. alveolar and others
Stains include Desmin, MyoD1, myogenin
MRI: T1 isointense to muscle, T2, hyperintense to muscle
Mainstay of therapy is chemo |
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