A child is diagnosed as having a congenital cholesteatoma. What is included in management of this condition? (Select all that apply.)
a. Antibacterial
... [Show More] treatment
b. Insertion of pressure equalizing tubes (PETs)
c. Irrigation of the ear canal
d. Removal of debris from the ear canal
e. Surgery to remove the lesion {{Ans- ANS: A, D, E
Cholesteatoma is treated with antibiotics, removal of debris from the ear canal, and possibly surgery. PETs and irrigation of the ear canal are not part of treatment for cholesteatoma.
A child who has recurrent otitis media fails a hearing screen at school. The provider suspects which type of hearing loss in this child?
a. Central
b. Conductive
c. Mixed type
d. Sensorineural {{Ans- ANS: B
A common cause of conductive loss is fluid in the middle ear as a result of chronic otitis media with effusion. Central hearing loss is related to CNS disorders. Mixed-type hearing loss is related to causes of both conductive and sensorineural hearing loss. Sensorineural hearing loss is caused by damage to the structures in the inner ear, usually caused by infection, barotrauma, or trauma.
A result of screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding?
a. Impedance audiometry
b. Pure tone audiogram
c. Speech reception test
d. Tympanogram {{Ans- ANS: D
A screening tympanogram may be performed by a primary provider to determine tympanic membrane mobility and may help in identifying the presence of infection, fluid, or changes in middle ear pressure. The other tests are performed by audiologists, not primary care providers.
Which are risk factors for developing hearing loss caused by presbycusis? (Select all that apply.)
a. Diabetes
b. GERD
c. High blood pressure
d. Liver disease
e. Smoking {{Ans- ANS: A, C, E
Presbycusis is a gradual degeneration within the cochlea that accompanies aging. Diabetes, high blood pressure, and smoking may hasten these changes. GERD and liver disease are not associated with an increased rate of changes.
A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis?
a. Facial palsy and vertigo
b. Fluctuating hearing loss and tinnitus
c. Spontaneous horizontal nystagmus
d. Vertigo with changes in head position {{Ans- ANS: C
Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary nystagmus, away from the affected ear. Facial palsy with vertigo occurs with Ramsay Hunt syndrome, caused by herpes zoster. Fluctuating hearing loss with tinnitus is common in Meniere's disease. Tinnitus may occur with vestibular neuritis but hearing loss does not occur. Patients with benign paroxysmal positional vertigo will exhibit vertigo associated with changes in head position.
A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial diagnostic workup for this patient?
a. Audiogram
b. Auditory brainstem testing
c. Electrocochleography
d. Vestibular testing {{Ans- ANS: A
An audiogram and magnetic resonance imaging (MRI) are part of basic testing for Meniere's
disease. The other testing may be performed by an otolaryngologist after referral.
1. Which symptoms may occur with vestibular neuritis? (Select all that apply.)
a. Disequilibrium
b. Fever
c. Hearing loss
d. Nausea and vomiting
e. Tinnitus {{Ans- ANS: A, D, E
Vestibular neuritis can cause severe vertigo, disequilibrium, nausea, vomiting, and tinnitus, but not fever or hearing loss.
A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis?
a. Acute otitis externa
b. Acute otitis media
c. Chronic otitis externa
d. Otitis media with effusion {{Ans- ANS: A
This patient's symptoms are classic for acute otitis externa. Chronic otitis externa more commonly presents with itching. Acute otitis media is accompanied by fever and tympanic membrane inflammation, but not external canal inflammation. Otitis media with effusion causes a sense of fullness but not pain. [Show Less]