Wednesday, November 27, 2013

11/27/2013

11/27/2013

Answers:


What region is the most common area for otosclerosis to begin?
A) Anterior border of round window 
B) Fissula Ante Fenestram 
C) Scutum 
D) Posterior border of oval window

Most common region is fissula ante fenestram which is anterior to stapes footplate and the oval window

What is the "paracusis of Willis"?

The ability to hear better in noise. The patient experiences better understanding of speech in a noisy environment. This phenomenon is characteristic of all patients with conductive hearing loss (including otosclerosis); it occurs because people speak louder in noisy surroundings.

MC Questions:
On physical exam, a patient w/ otosclerosis may demonstrate a reddish blush over the promontory and oval window niche. What causes this finding?
A) Due to an effusion in the middle ear space 
B) Due to prominent vascularity associated w/ inflammation 
C) Due to bleeding from a fractured incus 
D)Due to prominent vascularity associated w/ otospongiotic focus

Free Response Question:
Describe the significant finding of this audiogram.

Quick Facts:
Tympanometry
-Early/middle stage otosclerosis have normal (type A) tympanogram
-Progressive stapes fixation causes Type As (A-shallow) tympanogram
Acoustic Reflex (stapedial reflex)
-abnormal acoustic reflex pattern is earliest sign of otosclerosis.
-normal acoustic reflex demonstrates sustained decrease in compliance during stimulus (due to contraction of stapedial muscle)
-In otosclerosis a biphasic “on-off” pattern with a brief increase in compliance at
onset and finish of stimulus is pathognomonic.
-With disease progression a reduction in reflex amplitude is observed followed by
ipsilateral, then contralateral thresholds and finally disappearance of the
response altogether.
-Most common finding at presentation is absent reflex.

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