11/6/2013

11/6/2013

Answers:

Which of the following in a PE finding that may indicate the presence of a perilymphatic fistula?

A) Hennebert SignB) Positive Dix-Hall-Pike Manuever
C) Positive Fukuda Test
D) Hyperkinetic Optokinetic Afternystagmus
E) None of the above
F) All of the above

Hennebert sign is when nystagmus/vertigo is induced when applying positive (or sometimes negative) pressure to the EAC. It is often present in those with perilymphatic fistulas. DixHallPike is used to detect BPPV, Fukuda test is used in assessing vestibular function and hyperkinetic OKAN is seen in "mal de debarquement" syndrome.

In what direction does nystagmus beat when cold caloric testing is performed? In warm caloric testing?

-Cold = cupula moves away from utricle (nystagmus beats towards opposite side)
-Warm = endolymph will rise (nystagmus beats toward side of stimulus)
-A good mnemonic for this is: COWS = cold opposite, warm same

MC Questions:
The facial nerve is --- to the EAC.
A) Posterior 
B) Anterior 
C) Medial 
D) Lateral 
E) Inferior 
F) Superior

Free Response Question:
Is cerumen acidic or alkylitic?

Quick Facts:

Ear Innervation:
-Lat/Inf/ and Post by great auricular nerve.
-Arnold's nerve (from vagus) innervates inf. bony canal/posterosuperior cartilaginous canal and parts of TM/cymba concha.
-Posterosuperior bony EAC innervated by facial nerve.
-Auriculotemporal branch of V3 supplies ant. pinna.
-Glossopharyngeal may have some contribution, but unclear.