otology revision

OTOLOGY REVISION

Dr. Ahmed Yassin Bahgat, MSc, EBE-ORL Assistant lecturer of Otorhinolaryngology, Alexandria University, Egypt.

Fellow of European board of Otolaryngology-Head&Neck surgery. InternaKonal Sleep Disordered Breathing Surgery (SDBS) - Board cerKed.

Member of American Academy of Otolaryngology-Head&Neck surgery (AAO-HNS), InternaKonal Surgical Sleep Society (ISSS), European Rhinologic Society (ERS)

Clinical and research Fellow of University of Pavia (Italy), University of Versailles (France), University of Central Florida UCF & University of South California USC (USA).

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Study from ONE source Do not study the book in its order

Pre-exam advices

Study from ONE source Do not study the book in its order

Study the COMMON topics

Pre-exam advices

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(Localized oSSs externa (frunculosis

Diagnosis.

CausaSve organism.

Management.

Otomycosis

MulSple Exostosis

4 years old child with right otalgia and high fever for the past two days.

The otoscopic picture showed the following:

Diagnosis.

CausaSve organisms.

Management.

Acute O.M.

Safe CSOM ( central perforaKon)

Unsafe CSOM ( Marginal PerforaKon)

Unsafe CSOM (Secondry cholesteatoma)

Unsafe CSOM (aUc perforaKon)

Unsafe CSOM (aUc cholesteatoma)

3 years old child complaining of bilateral hearing loss, by otoscopy the following is seen:

Tympanometry was done.

Diagnosis.

Management.

MenSon the type of prothesis.

MenSon indicaSons.

Otosclerosis

45 years old female complaining of right hearing loss.

Pure tone audiometry showed the following:

Otoscopy showed the following:

Diagnosis.

Treatment.

45 years old female complaining with pulsaSle Snnitus

Otoscopy showing the following:

Diagnosis:

Treatment:

Glomus Tympanicum

Bells palsy

Diagnosis.

Most common cause.

Other causes

Malignant external oKKs: A. Is more common in elderly diabeScs B. Is usually associated with elevated ESR C. Is treated by analgesics and anS-pseudomonal

anSbioSc D. All of the above

Safe chronic suppuraKve oKKs media is usually associated with: A. AXc perforaSon B. Central perforaSon C. No perforaSon D. Marginal perforaSon

In aUco-antral type of CSOM (unsafe) the discharge is usually: A. Profuse and odorless B. Profuse and feSd C. Scanty and feSd D. Scanty and odorless

In a paKent with classic otosclerosis in the leX ear: A. Weber lateralizes to the leY B. Weber lateralizes to the right C. Weber is central D. Weber lateralizes to both ears

Which of the following diseases can cause mixed hearing loss? A. Impacted wax B. Unsafe CSOM C. AcousSc neuroma D. Presbyacusis

Facial nerve paralysis due to a lesion distal to geniculate ganglion may lead to: A. Increased lacrimaSon. B. Decrease lacrimaSon C. Loss of taste sensaSon in the anterior two thirds

of tongue. D. Loss of taste sensaSon in the posterior third of

tongue.

Sudden severe verKgo for days with nausea , vomiKng, nystagmus and normal auditory funcKon indicates A. Benign paroxysmal posiSonal verSgo B. VesSbular neuriSs C. LabyrinthiSs D. EndolymphaSc hydrops

A child with intact retracted drum and conducKve deafness with no otalgia aXer inadequate treatment of acute suppuraKve oKKs media is suering from: A. Chronic tubotympanic oSSs media B. Chronic aXcoantral oSSs media C. OSSs media with eusion D. OSSs externa

A 38 years old gentleman reports a decreased hearing for the last 2 years. On tesKng with tuning fork, the Rinnes test is negaKve on the right ear and posiKve in the leX ear. With the Webers test the tone is perceived louder in the right ear. The paKent most likely has: A. Right sensori-neural hearing loss B. LeY conducSve deafness C. Bilateral sensori-neural hearing loss. D. Right conducSve deafness

Intermi`ent fever with rigors, tenderness and oedema over mastoid process and headache in a paKent with cholesteatma may be due to A. Otogenic meningiSs B. Otogenic brain abscess C. lateral sinus thrombophlebiSs D. Extradural abscess

All of the following statements are true about tubotympanic type of chronic suppuraKve oKKs media except A. Called safe chronic suppuraSve oSSs media and

is unlikely to produce complicaSons. B. Otorrhea is Profuse , Mucopurulent, Odorless

and Intermi]ent C. The pathology could be in the form of

cholesteatoma or chronic osteiSs D. PerforaSon is usually central

All of the following statements are true about furunculosis except A. InfecSon of the hair follicles of the external canal B. It is limited, to the inner bony part of the external canal. C. Staphylococcus aureus is the causaSve organism D. Recurrent Furunculosis should direct the a]enSon to

diabetes mellitus.

The combinaKon of unilateral otorrhoea, severe facial pain and diplopia is known as A. Pierre Robin syndrome B. Gradenigos syndrome C. Kartagner syndrome D. Ramsay Hunt syndrome

In lower motor neuron facial paralysis with Involvement of the eighth cranial nerve, the level of the lesion is: A. In cerebello-ponSne angle B. In the horizontal tympanic part C. In the verScal part above the stapes D. In the stylomastoid foramen

All of the followings are true about malignant external oKKs except : A. Is more common in diabeSc paSents. B. Is usually associated with elevated ESR C. Is caused by pseudomonas infecSon. D. Is a rapidly progressive neoplasSc disease.

Unilateral secretory oKKs media in an adult paKent may seen in: A. Glandular fever B. Parapharyngeal tumour C. Retropharyngeal abscess D. Carcinoma nasopharynx

Otalgia may be due to all of the following diseases EXCEPT: A. OSSs externa B. Acute oSSs media C. LabyrinthiSs D. PerichondriSs

The triad of ear discharge, retro-orbital pain and 6th nerve paralysis is due to: A. MastoidiSs B. CSOM C. PetrosiSs D. Masked mastoidiSs

Ramsay Hunt syndrome includes all of the followings EXCEPT: A. Facial paralysis B. Vesicles in the external ear canal and concha C. SNHL and verSgo D. Pharyngeal paralysis

All of the following statement are true about otosclerosis except : A. Caused by bony xaSon of footplate of the

stapes to oval window B. Common in male than female C. May be managed by hearing aids D. May cause SNHL or verSgo

All of the following are true about Meniere except A. It is endolymphaSc hydrops B. Causes verSgo for few days C. It is characterized by a]acks of verSgo , SNHL,

Snnitus and aural fullness D. Can be treated by intratympanic injecSon of

gentamycin

Which of the following diseases is associated with pulsaKle Knnitus? Menire's disease. Ear wax impacSon. AcousSc neuroma. Glomus tumour

Intermi`ent fever with rigors and headache in a paKent with cholesteatoma may be due to Otogenic meningiSs Otogenic brain abscess lateral sinus thrombophlebiSs Extradural abscess

Malignant oKKs externa is : a truly malignant disease eroding the external canal

is most commonly seen in elderly uncontrolled diabeScs

staphylococcus aureus is the causaSve organism All of the above

Myringotomy is the operaKon of choice for: a. otosclerosis b. Secretory oSSs media c. Meniere's disease d. cholesteatoma

AUco-Antral type of CSOM (unsafe) can be associated with: central perforaSon marginal perforaSon angular perforaSon Subtotal perforaSon

In safe chronic suppuraKve oKKs the discharge is usually: Profuse and odorless Profuse and feSd Scanty and feSd Scanty and odorless

Tympanic membrane in chronic non-acKve otosclerosis in most cases: Slightly congested Flamingo red Yellow Normal

In lower motor neuron facial paralysis with absent lacrimaKon, the level of the lesion is: In the internal auditory canal In the horizontal tympanic part In the verScal part In the stylomastoid foramen

The treatment of Bells palsy includes all of the following EXCEPT: AnSviral drugs Systemic corScosteroids Eye care Vasodilators.

Otalgia may be due to all of the following diseases EXCEPT: OSSs externa Acute oSSs media LabyrinthiSs Post-tonsillectomy

The commonest cause of bilateral sensorineural hearing loss in elderly individuals is Cochlear otosclerosis Presbyacusis Middle ear eusion Ototoxicity

Unilateral high frequency Sensorineural hearing loss can be due to: Presbyacusis VesSbular neuriSs Bilateral wax AcousSc neuroma(vesSbular Schwannoma)

Facial nerve paralysis can be caused by all of the following EXCEPT: Car accidents. Otomycosis. NecroSzing oSSs externa Acute suppuraSve oSSs media

In Gradenigos syndrome , diplopia is due to inammaKon of the following cranial nerve : IV nerve V nerve III Nerve VI nerve

Ear wash is indicated in except: Impacted Wax Impacted foreign body Seborrhic external oSSs Otomycosis

All of he following statements are true about acute mastoidiKs except Sagging of postero-superior wall of bony ear canal is present in acute mastoidiSs

Usually occurs in well pneumaSzed mastoid Is more common in adult Usually occurs due to acute oSSs media

Which of the following diseases can cause mixed hearing loss? Impacted wax Unsafe CSOM AcousSc neuroma Presbyacusis

Impedance audiometry is useful in detecKng: Ossicular disconSnuity Eustachian tube obstrucSon Secretory oSSs media All of the above

Cochlear implant is indicated in: Mixed deafness Bilateral conducSve deafness Total deafness Unilateral sensorineural deafness

Dix-Hallpike test is useful in: AcousSc neuroma LabyrinthiSs Menieres disease BPPV

A adult paSent has been complaining of right conSnuous purulent oensive ear discharge for the last 3 years. A month ago he began to suer from headache, fever and vomiSng .2 weeks ago he started to suer from severe headache and drowsiness. The paSent also noSced diculty going up and down the stairs. A week later, he developed hemianopia and weakness in the leY arm and leY leg , The otoscopic examinaKon showed AXc perforaSon Central perforaSon No perforaSon Antero-inferior perforaSon

The condiKon in the previous case is complicated by MeningiSs MastoidiSs Temporal brain abscess Cerebellar abscess

The causaKve organism in acute necroKzing oKKs media is: Aspergillus niger HemolySc streptococci group A. Staph aureus Pseudomonas Aeuroginosa

All of the following may be seen in the tubotympanic type of chronic suppuraKve oKKs media EXCEPT: a- Intermi]ent mucopurulent otorrhoea b- Central tympanic membrane perforaSon c- High incidence of complicaSons d- Profuse odourless otorrhoea

Myringotomy is indicated in acute suppuraKve oKKs media in the following situaKon: Unilateral cases Impeding rapture of tympanic membrane The presence of hypertrophied adenoids. Presence of tender jugulodigastric lymph nodes

Treatment of Menieres disease with non serviceable hearing is : labyrinthectomy EndolymphaSc sac operaSons SelecSve vesSbular nerve secSon All of the above

The treatment of Bells palsy include all of the following EXCEPT: AnSviral drugs Systemic corScosteroids Eye care AnSbioSc therapy.

In a case of cholesteatoma, fever , neck sKness and posiKve Brudzniski sign indicate : MastoidiSs labyrinthiSs MeningiSs PetrosiSs

In a 45 years old female paKent presenKng with pulsaKng Knnitus and red mass behind the drum, all of the following are true except : Glomus tumour is a possible diagnosis More assessment is needed by CT scan or MRI Angiography conrm the diagnosis Biopsy is essenSal to verify the pathological nature.

Wri)en exam

Previous wri]en quesSons 4 signs of secretory oSSs media ? 4 cranial complicaSons of oSSs media ? 4 intracranial complicaSons of oSSs media ? 4 indicaSons of ear wash ? 4 ContraindicaSons of ear wash ? 4 types of mastoid abscess ? 4 diagnosSc signs of malignant oSSs externa ? 4 causes of CHL in children ? 3 causes of purulent otorrhea ?

4 signs of secretory oSSs media ? Otologic ExaminaSon Otoscopy: Otoscopic manifestaSons of ME Eusion:

Air bubbles /Froth Air-uid level /Hair-line Opaque TM Retracted TM

Seigliza/on: Restricted mobility of TM Tuning Fork Tests: conducSve HL Audiometry: conducSve HL Tympanometry: Type B /Flat tympanogram + absent reexes

4 cranial complicaSons of OM?

Acute mastoidiSs and mastoid abscess (most common complicaSon).

PetrosiSs. LabyrinthiSs. Facial paralysis. OsteomyeliSs of the temporal bone.

4 intracranial complicaSons of OM?

Extradural abscess (commonest intracranial complicaSon).

MeningiSs. Subdural abscess. Brain abscess: Temporal lobe abscess. Cerebellar abscess. Lateral sinus thrombosis. OSSc hydrocephalus.

4 indicaSons of ear wash ?

Wax plug. Foreign bodies (unless it is Sghtly impacted in the ear canal).

Otomycosis. Seborrheic OSSs externa

4 ContraindicaSons of ear wash ?

Dry perforaSon of the tympanic membrane to avoid infecSon of the middle ear.

Recent trauma to the ear. Impacted foreign bodies (especially vegetables) as they may become more impacted.

Acute external oSSs as ear wash may be very painful in some cases and may even worsen the inammaSon.

4 types of mastoid abscess ? Outer table of mastoid bone giving rise to the classical post-auricular mastoid abscess (commonest form). The abscess may rupture to the outside causing mastoid stula.

Root of zygoma giving rise to zygomaKc abscess. Mastoid Sp giving rise to Bezolds abscess deep to the inserSon of sternomastoid muscle.

Roof the antrum (tegmen antri) causing extradural abscess.

Lateral sinus plate causing perisinus abscess and then lateral sinus thrombosis.

4 diagnosSc signs of malignant oSSs externa ?

Unilateral otalgia in an elderly immunocompromised paSent e.g. diabeSc, RF

A characterisSc early sign of the infecSon is the presence of granulaSon Sssue along the oor of external ear at the juncSon of the carSlaginous and bony parts.

The infecSon starts in the external ear and then spreads to the paroSd region and the bones of the skull base causing facial and other cranial nerves palsies.

Elevated ESR and negaSve biopsy for malignany. Pseudomonal infecSon in Culture of granulaSon Sssue.

4 causes of CHL in children ?

Congenital meatal atresia Impacted wax OSSs media with eusion Otosclerosis or congenital ossicular xaSon

3 causes of purulent otorrhea ?

Bacterial external oSSs. Some cases of unsafe chronic oSSs media. Acute necroSzing oSSs media

2014 Exam case 35 year old female paSent with 5 o springs started recently aYer her last delivery to suer from Snnitus in her leY ear as well as diminuSon of hearing in the

same ear. Otoscopic examinaSon revealed normal tympanic membrane bilaterally. Tunning fork tests revealed bilateral conducSve hearing loss , more on the leY side. What is the clinical diagnosis? ((1 mark ) What will conrm your diagnosis? (1 mark ) What is the result of Rinne test in the leY ear ( mark )

Give 2 lines of treatment (( mark each=1 mark )

2014 Exam case A 5 year old boy was referred to an ENT specialist because of mouth breathing and impairment of hearing of 2 years duraSon. His mother reported that her child has almost constant mucoid nasal discharge that someSmes changes to a mucopurulent one and he snores during his sleep. On examinaSon, the child has nasal speech and obvious mouth breathing. ExaminaSon of the ears showed retracted tympanic membranes. Tympanograms were at type B. What is the possible cause of nasal obstrucSon in such case( mark ) ,

and what invesSgaSon that conrm your diagnosis ( mark )? What is the possible cause of hearing loss in this condiSon (1 mark) What is the type of surgery to relief nasal obstrucSon in such

condiSon? (1 mark ) Give 2 lines of treatment for the ear condiSon (1 mark )

otology revision

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