11/21/2013

11/21/2013

Answers:

What is the first line antibiotic for AOM?
A) Vancomycin 
B) Cipro 
C) Amoxicillin 
D) Keflex 
E) Imipenem

Amoxicillin is first line although Augment is often used due to high resistance to Amoxicillin.

What is a Bezold's abscess?

When infection escapes the mastoid tip it can travel down the upper neck along SCM sheath causing a Bezold’s abscess (just deep to SCM).

MC Questions:
Why must suppurative labyrinthitis secondary to AOM be diagnosed and treated quickly?
A) to avoid CHL 
B) to avoid SNHL 
C) to avoid meningitis 
D) to avoid petrositis 
E) to avoid Meniere's disease

Free Response Question:
What is Gradenigo's Triad?

Quick Facts:

Mastoidectomy Surgical Technique
-Postauricular or endaural incision
Facial Nerve
-by careful at posterior superior mesotympanum.
-horizontal facial nerve runs here.
-easiest to identify nerve at antrum and attic just anterior and inferior to horizontal semicircular canal.
Facial Recess and Epitympanum
-adequate exposure of posterio-superior mesotympanum needs dissection of facial recess.
-can do canal-wall-up or canal-wall-down
-If canal-wall-up then facial recess exposure needs to extent into attic be removing the incus buttress and incus itself.
-Epitympanum is best exposed using canal-wall-down.
Canal Wall Considerations
-Up vs. down based on several things.
-surgeon experience
-low tegmen of anterior sigmoid sinus may require canal wall down.
-possibility of recurrence/residual disease.
-canal-wall-down superior exposure but up can provide adequate exposure too.