[10.31b] Common Ear Diseases (Part 2) V2.pdf

Extracranial and intracranial

What are the two main categories for complications of otitis media?

Intratemporal and extratemporal

What are the two subcategories of extracranial complications?

Inside the temporal bone

What does the term intratemporal mean in the context of ear disease?

Mastoiditis, ossicular erosion, sensorineural hearing loss, facial nerve paralysis, labyrinthine fistula, labyrinthitis, and petrous apicitis

What are the seven intratemporal complications listed in the source?

Toxins from a long standing infection

What can affect the hair cells in the cochlea to cause sensorineural hearing loss?

Middle ear

Where are the intratemporal branches of the facial nerve specifically housed?

Erosion of the endosteal layer of the semicircular canal

What is the cause of a labyrinthine fistula?

Labyrinthitis

Which condition is defined as the entire cochlea being affected?

Petrous apicitis

Which condition is defined as the entire temporal bone being infected?

Outside the temporal bone

What does the term extratemporal mean?

Subperiosteal abscess, zygomatic abscess, Bezold abscess, postauricular fistula, and extra mastoid cholesteatoma

What are the five extratemporal complications listed?

Subperiosteal abscess

Which abscess is usually seen at the back of the ear and presents as a fluctuant area?

Root of the zygoma

Which anatomical structure is in close proximity to the temporal bone and can be infected due to cholesteatoma?

Postauricular fistula

What is the result when an untreated abscess creates a draining opening outside of the skin?

Horizontal canal

Which semicircular canal is in closest proximity to the ossicles?

Horizontal semicircular canal

Aside from the ossicles, what is the first structure affected when cholesteatoma occupies the entire middle ear?

Hearing loss and intense dizziness

What are the two results of erosion causing communication between the endosteum and endolymph?

Fistula test

Which test provides an inkling that a patient might have semicircular canal dehiscence or erosion?

Meningitis, brain abscess, subdural empyema, epidural abscess, sigmoid sinus septic thrombophlebitis, and otitic hydrocephalus

Name the six intracranial complications listed.

Ascending infection

What do meningitis, brain abscesses, and empyemas signify in the context of otitis media?

MRI with gadolinium contrast

What is the best imaging study for intracranial complications?

Sigmoid sinus septic thrombophlebitis

Which complication involves a thrombus formed due to infection that propagates in the sigmoid sinus?

Picket fence fever pattern

What specific fever pattern on top of a draining ear heralds sigmoid sinus septic thrombophlebitis?

Otitic hydrocephalus

Which rare complication involves increased intracranial pressure with focal neurologic tendencies?

Abnormal bone remodeling

What is the definition of otosclerosis?

Caucasian population

In which population is otosclerosis common but not exclusive?

Round window

In otosclerosis, where is the stapes footplate attached that becomes calcified?

Conductive hearing loss

What is the initial manifestation of otosclerosis?

Sensory hearing loss

What can severe otosclerosis progress to?

Measles virus

Which virus is associated by some with the development of otosclerosis?

Autosomal dominant transmission via COL1A1 gene

What is the genetic risk factor for otosclerosis?

Type 1 Osteogenesis Imperfecta

Which bone disorder is a known risk factor for otosclerosis?

Stapes prosthesis surgery

What is the treatment to establish sound conduction in otosclerosis?

Extrapulmonary Tuberculosis

What was the diagnosis for Case #1 involving a 44 year old female with facial paralysis and dizziness?

Silent otorrhea

What is the term for sudden ear discharge in extrapulmonary TB?

GeneXpert or AFB smear

How is middle ear tuberculosis diagnosed since gram staining is not used?

Medical treatment

Is otitis media from TB primarily treated medically or surgically?

Concomitant cholesteatoma or the need for debridement due to osteolysis

When is surgery required for middle ear tuberculosis?

Vertigo

What is the illusion of motion of either self or the environment?

Umiikot or spinning

What Filipino or English terms are used by patients to describe vertigo?

Para akong matutumba

What Filipino phrase identifies dysequilibrium?

Vertigo, disequilibrium, presyncope, and lightheadedness

What are the four main categories of dizziness?

45 to 54 percent

What percentage of dizzy patients fall into the vertigo category?

Disequilibrium

Which category of dizziness is described as feeling off balance or wobbly?

Presyncope

Which category involves the feeling of losing consciousness or blacking out?

Lightheadedness

Which category involves vague symptoms or feeling disconnected from the environment?

10 percent

Approximately what percentage of dizzy patients experience lightheadedness?

Balance system

What system allows us to interact and maintain contact with our surroundings safely?

Gravity

What is the constant factor the balance system considers in different environments?

Visual, vestibular, and somatosensory

Which three organ systems integrate information onto the cortex for balance perception?

Neurologic, hearing, ophthalmologic, and Dix Hallpike

What four assessments are done for patients with chronic dizziness?

Vestibulo Ocular Reflex (VOR)

What is the reflexive eye movement in response to head movement called?

Equal and opposite to head movement

How does eye movement compare to head movement in a functioning VOR?

Stable gaze or clear focused vision during head movement

What does the VOR allow a person to maintain?

Motion Provoked Dysequilibrium or Disorientation

What do patients with a chronic VOR deficit complain of instead of vertigo?

Blurring of the visual field

What results from head movement in a patient with a VOR deficit?

Peripheral vestibular level

At what level is the VOR the most important reflex for balance?

Less than 1 minute

What is the typical timing of a BPPV episode?

Change in head position relative to gravity

What is the trigger for BPPV?

Hours

What is the typical duration of a Meniere disease episode?

Vertigo and unilateral tinnitus

What are the characteristic symptoms of Meniere disease in the timing table?

Salt, caffeine, tobacco, stress, and alcohol

What are the five triggers listed for Meniere disease?

Hours

What is the typical timing for a vestibular migraine?

Chocolate, cheese, red wine, hormonal changes, and bright light

Name five triggers for vestibular migraine.

Hours to days

What is the timing for vestibular neuritis or labyrinthitis?

Prior viral symptoms

What often precedes vestibular neuritis?

Sudden onset persistent symptoms

What is the timing for a cerebellar stroke?

Stroke risk factors

What are the primary triggers for a cerebellar stroke?

Situational

What is the trigger category for anxiety or hyperventilation?

Lightheadedness and paresthesias

What are the symptoms of anxiety related dizziness?

1st Group

Which group of dizzy patients says I am not dizzy now but I get dizzy sometimes?

2nd Group

Which group says I am dizzy now and often presents in the ER?

3rd Group

Which group says I am unsteady, off balance, or afraid of falling?

Fixation suppression, saccade, smooth pursuit, and head impulse

Name four directed physical examination tests for dizziness.

Gaze evoked nystagmus

Which test involves the patient following the physician's finger to check for unstable eye movement?

Test of skew

What is another name for the cover uncover test?

Caloric test

Which test stimulates the endolymph to see if it produces eye movement?

Intact tympanic membrane

What is the physical requirement for a patient to undergo a caloric test?

Frenzel glasses

What equipment is worn by the patient during eye movement examination to prevent fixation?

Cold Opposite Warm Same

What does the COWS mnemonic stand for regarding the caloric test?

Vestibulo ocular, vestibulo spinal, and vestibulo colic

What are the three reflexes found in the peripheral system?

Nystagmus

A disturbed VOR is seen in cases of what specific eye movement?

Utricles

Which part of the bony labyrinth detects horizontal linear acceleration?

Saccules

Which part of the bony labyrinth detects vertical linear acceleration?

Semicircular canals

Which parts detect angular acceleration?

Six

How many total SCCs are there in both ears?

LARP pairing

What is the acronym for the left anterior and right posterior SCC pair?

Right superior and left posterior

What is the pair for the right superior SCC?

Brain and eyes

The bony labyrinth organs have direct connections to which two areas?

Ewald 1st Law

Which law states that SCC stimulation causes eye movement in the plane of that canal?

Medial and lateral rectus

Which muscles receive impulses specifically from the horizontal canal?

Saccades

What refers to a delay of eye movement in relation to head movement?

Central lesion

If head movement to the right causes the eye to move upwards, what type of lesion is suspected?

90 spikes per second

What is the assumed innervation rate for SCCs in a resting normal individual?

Left side

If the right SCC is at 45 spikes and the left is at 90, which side does the brain think is excited?

Delay in eye movement

What happens to the eye in a saccade when SCCs are not equally stimulated?

Benign Paroxysmal Positional Vertigo

What is the most common vestibular disorder in the outpatient clinic?

Barany Society

Which society provides the criteria for BPPV?

Lying down or turning over while supine

What specific positions trigger nystagmus in BPPV?

Torsional nystagmus with upper pole beating toward the lower ear

How is nystagmus described in posterior canal BPPV?