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1-Absolutely contraindication to cochlear implantation would include

severe Cochlear dysplasia, absence of the cochlear nerve, and severe
ossific labyrinthitis.

2-High-pitched, nonpulsatile binaural tinnitus from presbycusis, noise

Exposure, or accompanied by a highfrequency sensorineural hearing loss
needs no imaging.

3-In the presence of a normal physical exam and CHL, pathologies to

investigate radiologically include a congenital cholesteatoma that cannot
be seen through the tympanic membrane, congenital stapes gusher,
enlarged vestibular aqueduct, congenital middle ear anomaly.

4-Acute labyrinthitis is a self-limited disease usually viral in etiology. It

presents with acute onset of hearing loss or vertigo.

5-Classic petrous apicitis manifests as a deep temporal headache, sixth

nerve palsy, and a draining ear (Gradenigo’s syndrome).

6-X-linked stapes gusher. In this anomaly, the absence of a bony

partition at the fundus of the IAC results in transmission of CSF pressure
to the inner ear structures resulting in “gushing” of endolymph at
stapedectomy.

7-Syndromes that may be associated with EAC atresia include the

Goldenhar and Treacher Collins syndromes, PierreRobin sequence,
Klippel–Feil anomaly, and hemifacial microsomia among others.

8-Prussak’s space is located in the epitympanum and is bounded

laterally by the pars flaccida and a bony spur called the scutum. The
medial wall is formed by the neck and head of the malleus.

9-If an air-bone gap did not exist, the loss was thought to be purely
sensorineural.
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10-Human hearing ranges from the threshold of audibility, around 0 dB

HL, to the threshold of pain, around 140 dB HL. Normal conversational
speech occurs at around 40 to 50 dB HL, and the point of discomfort is
approximately 90 dB HL .

11-Aquino sign is the cessation of pulsation and blanching of the mass

in the middle ear with manual compression of the ipsilateral carotid
artery.

12-Brown sign is the cessation of tumor pulsation and tumor blanching

with positive pressure using the pneumatic otoscope;

13-Vestibular schwannomas (VS) (acoustic neuromas) are nerve sheath

tumors of the superior and inferior vestibular nerves (cranial nerve VIII).

14-Tuning fork tests should always be performed on patients with a

temporal bone fracture.

15-Battle sign, which is a postauricular ecchymosis resulting from

extravasated blood from the postauricular artery or mastoid emissary
vein.

16-The presence of stapedius reflex with low-frequency conductive

hearing loss should prompt radiological imaging of the inner ear to
exclude the possibility of dehiscence of the inner ear.

17-Vestibular neuronitis is the third most common cause of peripheral

vestibular vertigo after BPPV and Meniere disease.

18-A delayed onset of vertigo may be the result of a perilymphatic

fistula, an excessively long prosthesis, or labyrinthitis.in stapedotomy.

19-Fluoride reduces osteoclastic bone resorption and increases

osteoblastic bone formation.
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20-One of the earliest signs of otosclerosis is an abnormal acoustic

reflex pattern often preceding the development of an air-bone gap.

21-The SRT is the lowest intensity level at which a patient can

correctly repeat 50% of common bisyllabic words such as “hotdog” or
“baseball.”

22-The ABR is used routinely to screen hearing of newborns, and for

intraoperative monitoring of hearing function during skull base surgery .

23-EOAEs can be used to assess cochlear function in patients who

present with sudden-onset idiopathic hearing loss.

24-Otoacoustic emissions (OAEs) are sounds generated in the cochlea

and recorded in the ear canal. They can be used to assess the status of
cochlear outer hair cells.

25-Stenger testing is strongly recommended for every patient with a

unilateral or asymmetric hearing loss.

26-Moller and Jannetta’s study also indicates that wave V is associated

primarily with the activation of the lateral lemniscus and not the inferior
colliculus as was previouslyconsidered.

27-It is believed that the presence of hydrops affects the elasticity of

the basilar membrane and contributes to the increased amplitude of the
SP relative to that of the AP. A relatively large SP/AP ratio is considered
diagnostic of endolymphatic hydrops.

28-One of the main clinical applications of ECOG is in the differential

diagnosis of hydropic conditions of the cochlea that may be associated
with Meniere disease or other diseases .

29-frequencies of 500 and 1000 Hz are most often used in acoustic

reflex decay tests.Abnormal reflex decay may be indicative of
retrocochlear disease.

30-Stapedius reflex measurement should be included routinely in the

evaluation of patients with facial paralysis.
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31- Speech discrimination testing is an essential component of testing
to evaluate candidacy for a cochlear implant.
32-Threshold is defined as the lowest signal intensity at which multiple
presentations are detected 50% of the time.
33-Pure-tone bone-conduction thresholds provide auditory threshold
information when the cochlea is stimulated more or less directly, with
stimuli that bypass external- and middle-ear structures.
-Pure-tone air-conduction thresholds measure the function of the total
hearing system, including the external, middle, and inner ear.
34-Treatment for MOE : Ceftazidime given intravenously combined
with oral ciprofloxacin and topical aminoglycoside/steroid drops .
35-Bacterial and fungal cultures should be collected if MOE is
suspected. Erythrocyte sedimentation rate (ESR) is generally the only
laboratory abnormality, and it may be markedly elevated. ESR indicates
a state of inflammation in the body, and it can be used to follow
treatment response and recurrence.
36-MOE:The infection begins in the soft tissues of the EAC and
spreads to the skull base via the fissures of Santorini and to the
stylomastoid foramen and jugular foramen via the tympanomastoid
suture.
37-Malignant O E:Common findings on physical examination include
granulation tissue within the external auditory canal, preauricular and
auricular edema and erythema,tympanic membrane necrosis, and facial
nerve paralysis.
38-All patients with unilateral otitis media should have their
nasopharynx inspected for possible nasopharyngeal masses.
39-Schwabach test compares bone conduction of the patient with that
of the examiner.
40-Midline Weber result is referred to as “negative.” “Weber right” and
“Weber left” refer to the direction to which the sound lateralized.
41-Weber test is performed by placing the vibrating 512-Hz tuning
fork in the center of the patient’s forehead, at the bridge of the nose,
or on the central incisors with the patient’s teeth tightly clenched.
42-Tuning fork tests, usually done with a 512-Hz fork, allow the
otolaryngologist to distinguish between sensorineural and conductive
hearing loss .
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43-Vascular masses should prompt consideration of middle ear glomus

tumor; the clinician may also note a Brown sign, in which the mass
blanches with pneumatic otoscopy.

44-White masses behind an intact tympanic membrane, most often in

the anterosuperior quadrant, are consistent with cholesteatoma.

45- Serous effusions often appear as amber fluid, sometimes with air-
fluid levels or air bubbles. Mucoid effusions will appear to be a dull gray
color,

46-Perforations and middle ear effusions are common causes for

immobile tympanic membranes.

47-Lacerations of EAC may be present in the setting of trauma, which

may include temporal bone fractures.

48-The presence of granulation tissue at the junction of the

cartilaginous and bony canal should raise concern for malignant otitis
externa,

49-Thin, atelectatic membrane draped closely over the under lying

middle ear structures may indicate adhesive otitis media

50-prominent radial blood vessels can indicate a chronic middle ear

effusion.

51-Preoperatively, the platelet count should be greater than 50,000/μL;

at levels below 20,000/μL, spontaneous bleeding may occur.

52-The pars flaccida of the tympanic membrane is critical to examine

for retraction pockets, which may develop into cholesteatomas.

53-Meniere’s disease(idiopathic).Meniere’s syndrome(secondery to

other disease like trauma,ear surgery,viral inf.,syphlis,autoimmune.

54-Remember that a negative Rinne for 256,512 and 1024 Hz indicates

a minimum AB gap of 15, 30, 45 dB respectively.
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55-A negative Rinne indicates a minimum air - bone gap of 15—20 dB .

56-Single frequency sound is called a pure tone.

57-Recurrent episodes of acute otitis media treated by: period of 2–3

months of once daily prophylactic antibiotics, such as amoxicillin and
Grommet insertion

58-Carthart’s notch is an artefactual dip in bone conduction

(BC)/cochlear threshold at 2KHz seen in conductive hearing loss, which
resolves/improves on correction of the conductive defect, but may be
explained as follows. When attempting to test only cochlear function
with BC thresholds, some of the sound inadvertently also travels via the
tympanic membrane and ossicles to the inner ear. The natural
resonance frequency of the ear canal/TM/middle ear/ossicles is around
2KHz meaning this effect is greatest at this frequency.Therefore, if a
conductive hearing loss occurs, this will inadvertently also reduce the
apparent BC threshold across all frequencies but most markedly at
2KHz.

59-Masking is always through air conduction.never bone conduction.

60-The auditory brainstem implant makes direct contact with the dorsal
cochlear nucleus .

61- Low frequency SNHL more in menire’s dis.,benign intracranial

HT.basilar migraine, syphilis.

62-Sensorineural hearing loss can complicate radiation therapy and

cisplatin treatment for nasopharyngeal carcinoma in up to 30% of
patients.

63-Tinnitus retraining therapy is effective regardless of the etiology of

tinnitus.

64-The prevalence of tinnitus is approximately the same in children as

in adults.

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65-One of the first indicators of age-related hearing loss is loss of

auditory sensitivity at frequencies higher than 8 kHz.

66-Atrophy of the stria vascularis is the predominant lesion of the aging

ear.

67-Vestibular suppressants should be avoided except for management

of acute vertigo.

68-The antigen target in autoimmune inner ear disease is a 68 kD inner

ear protein.

69-The vestibulo-spinal response to fistula testing is more sensitive

than the vestibulo-ocular response.

70-Diffuse gadolinium enhancement of the cochlea on magnetic

resonance imaging in apatient with sudden sensorineural hearing loss
indicates a leaky
blood-brain barrier.

71-The outer hair cells are not primarily transducers of sound.

72-Mutations in Cx26 are responsible for over one half of moderate-to-

profound hearing impairment in many world populations.

73-Mitochondrial hearing loss may be associated with diabetes mellitus.

74-Alport’s syndrome can be inherited as an X-linked or autosomal

disorder.

75-Usher’s syndrome is the most common autosomal recessive

syndromic hearing loss.

76-Goiter may be apparent at birth in Pendred’s syndrome, it typically

presents in midchildhood.

77-A total ossicular replacement prosthesis is used only when the

stapes superstructure is absent..
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78-The most effective treatment for auricular hematoma is adequate

incision and drainage with suture-secured bolsters.

79-Electronystagmography and the rotational chair are primarily

confirmatory for the suspected site of lesion.

80-The most popular hearing aid style used by Children :behind the
ear.

81-Autologous costal cartilage is the gold standard for auricular

reconstruction .

82-The first stage of auricular reconstruction involves harvest of costal

cartilage and creation of an auricular framework. This usually occurs at
6 years of age or later.

83-Similar elevations in the SP/AP ratio have, however, been reported

in perilymph fistula, autoimmune inner ear disease, and superior
semicircular canal dehiscence .

84-Dorsal cochlear nucleus is the stimulation site for an auditory

brainstem.

85-Schuknecht identified four categories of presbycusis based on

clinical and histopathologic changes within the cochlea. They are
sensory, conductive, strial, and neural.

86-If the fistula involves one of the semicircular canals and if the
mastoid is small, a CWD mastoidectomy, leaving the matrix on the
fistula, is appropriate.

87-A prelingual deaf adult with no oral language is a poor cochlear-

implant

88-Vertical downbeating nystagmus suggests a disorder in the

brainstem.

89-BPPV is considered to be the most common cause of dizziness in

the elderly.
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90-Most common ossicular abnormality in congenital aural atresia is

Fused malleus-incus.

91-OAEs are generally not detected in patients with middle ear

pathology .

92-The most significant risk factor for meningitis after temporal bone
fracture is duration of CSF leak.

93-Prediction of hearing levels is not possible by measuring OAEs.

94-Pendred syndrome is associated with abnormal iodine metabolism.

95-B2-transferrin. When present, a CSF leak is confirmed; however, a

negative test result does not exclude a diagnosis of CSF leak.

96-Vestibular evoked myogenic potentials (for diagnosing semicircular

canal dehiscence),

97-Evaluation under Frenzel goggles can include the head-shake test

and Valsalva-, hyperventilation-, or sound-induced nystagmus.

98-Rotary nystagmus may be more common with semicircular

dysfunction, and abnormal sensations of tilt or sudden drop attacks can
be seen with otolith dysfunction.

99-Pendred syndrome (thyroid organification defect and hearing loss,

Alport syndrome (renal disease and hearing loss, Jervell and Lange–
Nielsen syndromes(prolonged QT interval and hearing loss).

100-Cerebrospinal fluid leak (otorrhea with longitudinal fracture,

rhinorrhea with transverse).

101-Acute coalescent mastoiditis is the most common intratemporal

complication of otitis media.
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102-Sudden sensorineural hearing loss is classified as unilateral

hearing loss of at least 30 dB in at least 3 frequencies occurring within
3 days.

103-Distortion product OAE:useful for testing for noise-induced hearing

loss and medication ototoxicity.

104-Internal auditory canal anomalies:Narrow (<3 mm) associated

with absent or hypoplastic CN VIII,, Widened (>10 mm) associated
with stapes gusher.

105-Schiebe (cochleosaccular aplasia), Alexander(cochlear duct

aplasia, especially affecting basal turn) dysplasia.

106- Contraindications CI: narrow IAC, cochlear nerve aplasia, Michel

aplasia.

107-Indications for tympanostomy tube:Recurrent AOM (>3 episodes

in 6 months, >4 episodes in 12 months), Bilateral COME >3 months,
unilateral COME >6 months, severe retraction pocket,

108-von Hippel Lindau syndrome, Associated with endolymphatic sac

tumors.

109-Aural atresia:Jahrsdoerfer grading system: 10-point grading

system, Six favorable for surgical intervention. 2 points for stapes; 1
point mastoid pneumati, OW status, RW status, malleus, incus, FN
course, status of ME, and external ear appearance.

110-Ossicles: adult-sized at birth.

111-Hemangiomas of the temporal bone often involve the geniculate

ganglion and the internal auditory meatus.

112-Epidermoid cysts have imaging characteristics similar to CSF on

MRI (hypointense on T1-weighted imaging and hyperintense on T2-
weighted imaging) and do not enhance with gadolinium contrast.
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113-distinguishing characteristic relative to vestibular schwannomas

and meningiomas is that epidermoid lesions show no enhancement
with intravenous contrast.

114-The vestibular neurectomy may be approached via a

retrosigmoidal or middle fossa approach.

115-Meniere disease is a clinical diagnosis.

116-Nonsyndromic hearing loss , in which hearing loss is the only

clinical abnormality, or syndromic hearing loss , in which hearing loss
is associated with anomalies in other organ systems.

117-Aplasia or hypoplasia of the round window may be associated with

endemic cretinism and mandibulofacial dysostosis.

118-Round window aplasia is commonly associated with stapes

ankylosis and results in unsuccessful stapedectomy.

119-Irrigation with 1 :1 : 1 distilled white vinegar, distilled water, and

70% isopropyl alcohol may keep some cholesteatomas stable if their
opening into the ear canal is sufficiently large.

120-Recurrent or bilateral auricular swelling should prompt a

rheumatologic workup for relapsing polychondritis.

121-The facial nerve is the most common cranialnerve involved, with

paralysis resulting from involvement at the stylomastoid foramen.
inMOE.

122-Most cases of external otitis should be managed with topical

medications.

123-Microbiology of otitis externa:Pseudomonasaeruginosa was the

most common bacteria responsible for infections. Staphylococcus sp
were the next most common pathogens. Fungi wereresponsible for only
2% of cases.

124-The most commonly used technique for correction of an absent

antihelical fold, originally described by Mustarde,
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125-Ideal age for otoplasty is between 5 and 6 years.

126-Prominent ears occurs in approximately 5% of the population .

127-The translabyrinthine approach provides direct exposure of the

CPA through the petrous pyramid, the shortest route from the surface,

128-The middle fossa approach provides exposure to the IAC from

above and limited access to the CPA.

129-The retrosigmoidal approach is a classic means of exposing the

CPA.

130-The most common primary sites of malignant growth that spreads

to the temporal bone are the breasts (25%),

131-Facial nerve schwannomas :intermediate signal intensity on both

T1- and T2-weighted MRI.

132-The typical feeding vessels for a glomus jugulare tumor are the
ascending pharyngeal artery and the stylomastoid branch of the
occipital artery.

133-Aquino sign is the blanching of the mass with manual compression

of the ipsilateral carotid artery.

134-Brown sign is the cessation of tumor pulsation and tumor

blanching with positive pressure using the pneumatic otoscope;

135-Inherited forms of Paget’s disease have been associated with

mutations on chromosome 5 as well as chromosome 10.

136-Paget’s disease, or osteitis deformans, is a disorder of excessive

bone remodeling, primarily of the axial skeleton.

137-Fibrous dysplasia is perhaps the most common benign

fibroosseous disorder of the temporal bone. has three major
classifications: (1) monostotic, (2) polyostotic, and (3) the McCune–
Albright syndrome.
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138-ABR has a sensitivity >90%and a specificity of 90% in detecting

VS.

139-Hearing loss is present in 95% of patients with VS.

140-Ninety-five percent of VS occur in a sporadic fashion. no gender

bias and the age of presentation is between 40 and 60 y of age.

141-VS make up 80% of CPA tumors and 8% of all intracranial tumors.

142-The only definitive way to make the diagnosis of a perilymphatic

fistula is surgical exploration.

143-Combined middle fossa-transmastoid approach . This approach is

used for facial nerve exploration in patients with normal hearing.

144-β 2 transferrin is a protein found only in CSF. and perilymph.

145-2% incidence of CSF leak in all skull fractures and a 20%

incidence in temporal bone fractures.

146-Immediate facial nerve injury is highly suggestive of facial nerve

transection.

147-Patients with delayed-onset palsy present to the emergency room

with normal facial nerve function.

148-The most common form of ossicular discontinuity after temporal

bone trauma is incudostapedial joint dislocation.

149-Transverse fractures begin from the foramen magnum, run

through the otic capsule bone that surrounds the inner ear, and then
turn anteriorly toward the foramen lacerum..

150-Longitudinal fractures begin at the squamous portion of the

temporal bone, run through the external auditory canal, and then turn
anteriorly toward the foramen lacerum.
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151-Tuning fork tests should always be performed on patients with a

temporal bone fracture.

152-Battle sign, which is a postauricular ecchymosis resulting from

extra vasated blood from the postauricular artery or mastoid emissary
vein.

153-blow to the occipital skull may go through the foramen magnum

and result in a transverse fracture of the temporal bone.

154-Blunt trauma to the lateral surface of the skull (the squamous

portion of the temporal bone) often results in a longitudinal fracture.

155-Ossicular chain dislocation with an intact eardrum manifests as a

maximal (60 dB) conductive hearing loss.

156-No medical or surgical treatments available to reverse the effects

of NIHL, prevention is key.

157-Typically, the left ear has poorer thresholds in right-handed

people.

158-Risk of NIHL is considered to increase significantly with chronic

exposures above 85 dBA for an 8 hour time-weighted average.

159-Stenger test is the classic behavioral test for estimating a

functional unilateral hearing loss.

160-NIHL is thought to result from metabolic depletion of the sensory

epith elium of the cochlea, mainly the outer hair cells and associated
neurons.

161-The stapedius muscle contracts reflexively (acoustic reflex) in

response to noise >90 dB.

162-Noise-induced hearing loss(NIHL) due to chronic overexposure to

hazardous levels of noise in the workplace.
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163-Stapedius reflexes are present in SSCD.

164-Hearing loss is artifactual and mimics otosclerosis(low-frequency

conductive hearing loss); inSSCD.

165-Patients report increased sensitivity to bone-conducted sounds,

hearing their pulse sound, hearing their eye movements, and
autophony.inSSCD.

166-Inner ear conductive hearing loss in SSCD.

167-Purely vertical or purely torsional nystagmus is highly suggestive

of a central disorder.

168-Central nystagmus is not affected by visual fixation and may

change directions with changes in gaze.

169-The primary central cause for acute vertigo lasting days is a

brainstem or cerebellar stroke.

170-Vestibular neuronitis is the third most common cause of peripheral

vestibular vertigo after BPPV and Meniere disease.

171-BPPV:basophilic deposits adherent to the cupula; this finding was

termed cupulolithiasis , free floating debris in the endolymph termed
canalolithiasis.

172-The central compensation for vestibular injury occurs via the

cerebellum.

173-One single gene, GJB2 ( Gap-Junction Beta 2 encoding for

connexin 26), has emerged to be the most common cause of recessive
deafness,

174-Presbycusis is a type of sensorineural hearing loss that is both

progressive (1–2 dB/year) and irreversible.
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175-Nonsyndromic hearing loss , in which hearing loss is the only

clinical abnormality, or syndromic hearing loss , in which hearing loss
is associated with anomalies in other organ systems.

176-Possible causes of early hearing loss post-stapedectomy include

intraoperative trauma, labyrinthitis, postoperative infection, granuloma
formation, and a perilymphatic fistula.

177-High perilymphatic outflow after performing a stapedectomy or

staped otomy is termed as perlymphatic “gusher.” is the result of either
an abnor mally patent cochlear aqueduct or malformation of the lateral
end of the internal auditory canal.

178-BC level of 0–25 dB in the speech range (250–4000 Hz) and an AC

level of 45–65 dB is a suitable candidate for surgery; an air-bone gap of
at least 15 dB and speech discrimination scores of 60% or better are
preferred.in indication for stapedectomy.

179-Sodium fluoride is also thought to inhibit proteolytic enzymes that

are cytotoxic to the cochlea and that may lead to SNHL

180-Fluoride reduces osteoclastic bone resorption and increases

osteoblastic bone formation.

181-The diagnosis of OS is confirmed at the time of surgery or upon

histologic study of the temporal bone.

182-One of the earliest signs of otosclerosis is an abnormal acoustic

reflex pattern, often preceding the development of an air-bone gap.

183-Carhart notch is thought to result from the disruption of normal

ossicular resonance, which is approximately 2000 Hz. It is therefore a
mechanical phenomenon and not a true reflection of cochlear reserve
since it reverses after successful surgery.

184-Halo sign or double ring sign seen on CT as a low-density zone

outlining the basal turn of the cochlea.in cochlear OS.
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185-CT ,initial imaging modality of choice when the OS is in question.

It is valuable in assessing the pathology of the oval window and
footplate, and the extent of otic capsule involvement.

186-Rinne test at 512 Hz usually indicates an air-bone gap of at least

25 dB. In otoseclerosis.OS

187-Cong.cholesteatoma,defined as an embryonic rest of epithelial

tissue in the ear without T.M perforation and without a history of ear
infection.

188-Otitic hydrocephalus typically presents as headaches and lethargy

without evidence of meningeal signs or intracranial abscess. Often
associated with papilledema.

189-Meningitis secondary to AOM should be treated urgently with a

myringotomy.

190-The term “masked mastoiditis” is used to describe granulation

tissue and bony erosion of the mastoid in the absence of otorrhea.

191-Tympanostomy tubes were first introduced in 1954 by Armstrong,

192-Once commonly practiced, tonsillectomy has been shown to

demonstrate little to no benefit on resolution of middle ear effusions.

193-Congenital cholesteatomas recur in approximately 30–55% of

cases after surgical removal.

194-Management of congenital cholesteatoma is timely surgical

removal. Nonoperative intervention or observation may result in
progressive growth of the lesion with progressive erosion of the
ossicles.

195-Congenital cholesteatoma average age at presentation is 2–4

years for anterior lesions and 12 years for posterior lesions.
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196-VEMP:are short latency electromyograms that are evoked by

acoustic stimuli in high intensity and recorded from surface electrodes
over the

197-Bilateral congenital cholesteatoma (3% of cases), male

predilection,

198-Smooth pursuit is the term used to describe eye movement that is

created when the eyes track moving objects.

199-Saccades are rapid eye movements that bring objects in the

periphery of the visual field onto the fovea.

200-OAE:emissions typically are not detected if there is a conductive or

sensorineural hearing loss greater than 25–30 dB HL.

201-Otoacoustic emissions (OAEs) are objective, noninvasive, and

rapid measures (typically less than 2 minutes) used to determine
cochlear outer hair cell function.

202-The amplitude of the summating potential (reflecting activityof the

hair cells) is compared with that of the compound action potential
(reflecting whole nerve activity). If the ratio is larger than normal (0.3–
0.5), it is considered indicative of Meniere disease

203-ECOG :evaluates the electrical activity generated by the cochlea

and the eighth cranial nerve, occurring during the first 2–3 ms
subsequent to a stimulus.

204-ABR:The absolute latencies of all waves are prolonged, but the

interwave latencies are not substantially affected.in conductive hearing
loss.

205- ABR:interaural (between ears) latencies are equal(within 0.2–0.3

ms).in normal hearing.

206-ABR is frequently used for newborn hearing screening, because it

provides accurate information in a relatively short amount of time.
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207-The measurement of acoustic reflex decay may be useful when a

retrocochlear lesion is suspected.

208-When hearing loss exceeds 70 dB HL, it becomes difficult to

determine whether absent acoustic reflexes are due to a cochlear or a
retrocochlear hearing loss.

209-Speech discrimination testing assesses a patient’s ability to

identify monosyllabic words.

210- The SRT is the lowest intensity level at which a patient can
correctly repeat 50% of common bisyllabic words such as “hotdog” or
“baseball.”

211-Masking is required for AC whenever the difference between the

AC presentation level and the non-test ear BC thresholds exceeds
approximately 40 dB for the lower frequencies and 60 dB for the higher
frequencies.

212-Click” into the ear, a large number of auditory nerve fibers are
excited simultaneously. This is called the compound action potential,
and is Wave 1 of the ABR.

213-displacement of the cupula toward the canal provides an

excitatory response (ampullofugal endolymph flow).

214-displacement of the cupula toward the vestibule provides an

excitatory response (ampullopetal endolymph flow).

215-Hair cells Their name derives from the fact that they have about
100 stereocilia at their apical end.

216-Inner or membranous chamber is filled with a high potassium salt

solution called endolymph , which resembles intracellular fluid.

217-Outer or bony chamber is filled with a sodium salt solution called

perilymph , which resembles cerebrospinal fluid..
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218-The total middle ear gain is between 20 and 35 dB.

219-large surface area of the tympanic membrane, compared with the

small surface area of the stapes (14:1).

220-The retrotympanum includes the sinus tympani and facial recess.

221-the shape of the external ear provides approximately 20 dB of

gain to sounds in the middle frequency range (2–4 kHz).

222-People with normal hearing can tell the difference between two
sounds that differ in frequency by less than 0.5%.

223-Most ear anomalies are inherited as autosomal dominant traits

with incomplete penetrance.

224-ABR.wave V component arises from the lateral lemniscus fibers

just caudal to their arrival at the inferior colliculus.

225-SSCCD hearing not benefit from stapedectomy.

226-Menier’s absolute contraindection for stapedectomy,sacule injuery.

227-The ear generally reaches 85% of its ultimate vertical height, 5

cm, by 3 years of age and is nearly full size,6 cm, by 5 years of age.

228-Inherited mitochondrial susceptibility can experience SNHL with

aminoglycoside whether it is given intravenously or by transtympanic
delivery.

229-Similar elevations in the SP/AP ratio have, however, been reported

in perilymph fistula, autoimmune inner ear disease, and superior
semicircular canal dehiscence.and Meniere disease.

230-Oxaliplatin is a third-generation cisplatin analogue that is not

associated with nephrotoxicity or ototoxicity.

231-Meniere disease is an absolute contraindication for stapedectomy/

stapedotomy.
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232-Pendred syndrome:Mutations in SLC2 6A4 gene.

233-Autoimmune inner ear disease:progressive bilateral SHNL that

responds to immunosuppressant therapy.

234-Aggressive papillary adenocarcinoma of the endolymphatic sac

may erode the posterior face of the petrous bone and may be
associated with von Hippel-Lindau disease and renal cyst or tumors.

235-The most common locations of origin of cholesteatomas in

decreasing frequency are the posterior epitympanum, the posterior
mesotympanum, and the anterior epitympanum.

236-The proper use of ear protection can provide over 20 dB of

protection.

237-NIHL is not accelerating and does not progress once exposure has
been terminated.

238-The auditory brainstem implant makes direct contact with the

dorsal cochlear nucleus .

239-Calcification within the tumor or associated hyperostosis supports

the diagnosis of meningioma.

240-Head-impulse test:Involves rotational head movements.

241-Surgical identification of the endolymphatic sac Posterior and

inferior to the posterior semicircular canal.

242-The facial nerve is dehiscent approximately 50 % of the time just

superior to the oval window in its tympanic segment.

243-In an extensive fistula with a contacted mastoid, a canal-wall-

down (leaving the matrix on the fistula, is appropriate)procedure is
best. matrix can be removed if the defect is small and localized.

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244-A prelingual deaf adult with no oral language is a poor cochlear-

implant candidate.

245-Paget disease affects the otic capsule creating bone remodeling

and causes both sensorineural and conductive hearing loss.

246-Size of middle ear is the most important determinant of surgical

candidacy by CT scan in congenital aural atresia.

247-principle measure is used to determine cochlear-implant

candidacy: Hearing in noise test (HINT).

248-Direction of nystagmus with posterior canal BPPV is up beating

(toward the forehead), geotropic (beating toward the ground), and
torsional.

249-BPPV is considered to be the most common cause of dizziness in

the elderly.

250-In aural atresia cases, the expected finding is a fused and

deformed malleus -incus complex.

251-OAEs are generally not detected in patients with middle-ear

pathology and conductive hearing loss.

252-With bone-conduction stimulation, interaural attenuation is < 1 0

dB.

253-Factors that may contribute to the cochlear amplifier include

motility of outer hair cells and the mechanical properties of the
stereocilia and tectorial membrane.

254-Peripheral vestibular nystagmus is suppressed with visual fixation,

is generally horizontal-rotary, can be more easily detected after
headshaking.

255-Clinically, ECochG may be used to predict postoperative audition

and is sensitive to changes in cochlear blood supply.
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256-low-frequency conductive hearing loss and Stapedial reflexes are

present suggests a third-window disorder.

257-Mondini deformity has a higher likelihood of trauma causing

leakage of CSF and perilymph from the inner to middle ear.

258-The direction of nystagmus with right posterior canal BPPV is

upbeating (toward the forehead), geotropic (beating toward the
ground), and torsional (counterclockwise).

259-arachnoid cyst. This is characterized as being hypointense in Tl

and hyperintense on T2 .

260-Atresia surgery is best delayed until age 6 to 7 years, with use of

a bone-vibrator hearing aid before this age is reached.

261-Prediction of hearing levels is not possible by measuring OAEs.

262-In addition to the ossicular chain, the tympanic membrane is

adult-sized at birth.

263-In children developmentally at 5 to 6 months of age, it is possible

to measure hearing threshold levels using VRA.(visual reinforcement
audiometry).

264-The hearing impairment in Pendred syndrome is associated with

abnormal iodine metabolism, which typically results in a euthyroid
goiter.

265-CO 2 and argon lasers, which have been used for the treatment of
benign paroxysmal positional vertigo (BPPV).

266-All aminoglycosides can cause ototoxicity and nephrotoxicity.

Ototoxicity can be irreversible and is cumulative .Nephrotoxicity is more
common and is frequently reversible.
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267- Auricular reconstruction precedes hearing restoration surgery by

at least 2 months to optimize the blood supply for the autologous rib
graft and complex flaps.

268-The usual distance from the lateral surface of the incus to the
footplate is 4.5 mm. Because the piston prosthesis is usually measured
from the medial surface of the incus, 0.25 mm is subtracted to allow for
this distance (incus - 0.5 mm+ extension into vestibule of 0.25) .The
most common piston size is 4.25 mm.

269-acoustic reflex is the contraction of the middle ear stapedius

muscle, attached to the posterior part of the stapes, in response to
medium to high intensity sounds.

270-A major advantage that the ABR has over other auditoryevoked
potentials is that it is not strongly affected by attention, sleep, or
sedation.

271-Thus, otoacoustic emissions and cochlear microphonics are

preneural phenomena that reflect the integrity of the outer hair cells of
the cochlea,

272-Distortionproduct otoacoustic emissio. are more sensitive than

transient-evokedotoacoustic emissions for the detection of early signs
of ototoxicity.

273-Vestibular aqueduct radiologically wider than 1.5 mm at its

midpoint or wider than 2 mm at the operculum is defined as enlarged.

274-Betahistine, an oral preparation of histamine, is one such

medication. It has proved to be effective in treatment of Meniere’s
disease.

275-The most common type of vertigo after head trauma is benign

paroxysmal position vertigo, which manifests with transient rotatory
nystagmus with the Halpike maneuver.
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276-An enlarged vestibular aqueduct, defined as a diameter larger than

1.5 mm at the vestibular aqueduct midpoint or greater than 2 mm at the
operculum, may lead to sudden and progressive sensorineural hearing
loss in children, particularly after even minor head trauma.

277-The incidence of meningitis following a temporal bone fracture

without a CSF fistula is 1%.

278- Bilateral endolymphatic sac tumor associated with von Hippel-

Lindau disease.VHL.

279-labyrinthine fistula has been reported in 10% of cholesteatomas in

adults and children,

280-Otosclerotic Patients are typically treated with Florical, 8 mg three

times per day, until hearing loss stabilizes.

281-CSF leakage occurs through a defect in the lamina cribrosa of the

internal auditory canal in association with a defect in the stapes
footplate.

282-The most common labyrinthine anomaly associated with

spontaneous CSF leak is a Mondini malformation.

283-Paget’s disease, which may be inherited in an autosomal dominant

manner with high penetrance.

284-The incidence of meningitis following a temporal bone fracture

without a CSF fistula is 1%. • The incidence of CSF fistulas with
temporal bone fractures is 17%.

285-The most important landmarks for the facial nerve are the HSCC,
the short process of the incus, and the posterior bony external
auditorycanal; the digastric ridge is also a landmark,

286-Identifying the short process of the incus provides an important

landmark for facial nerve dissection.
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287-The nystagmus with lateral canal BPPV is horizontal and may beat
toward (geotropic) or away from (ageotropic) the downward ear. It
often begins with a shorter latency, increases in magnitude while
maintaining the test position, and is less susceptible to fatigue with
repetitive testing than the vertical torsional nystagmus of posterior
canal BPPV.

288-A relatively large SP/AP ratio is considered diagnostic of

endolymphatic hydrops.

289-giant cholesterol granulomas, but not congenital cholesteatomas,

tend to show capsular enhancement.

290-Facial twitching may occur in the presence of congenital

cholesteatomas and with facial nerve neuromas.

291-Congenital cholesteatomas of the temporal bone may be divided

into four anatomic groups: middle ear, perigeniculate area, petrous
apex, and cerebellopontine angle.

292-The most important landmarks for the facial nerve are the HSCC,
the short process of the incus, and the posterior bony external
auditorycanal;

293-The fistula test results are reported as positive in only 55% to

70%of patients with lateral canal erosion,

294-Hennebert’s sign (a positive fistula test without middle ear

disease) and Tullio’s phenomenon (vertigo or nystagmus on exposure
to high-intensity sound) have been strongly associated with otosyphilis.

295-In otosclerosis we never operate on the only-hearing ear or better

hearing ear.

296-cholesterol granuloma is high signal on T1WI and T2WI from the

methemoglobin.

297-High-resolution T2-weighted MRI is the study of choice for

preoperative evaluation for cochlear implantation.
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298-The Baha was also approved for treatment of unilateral

sensorineural hearing loss or single-sided deafness.

299-Indications for BAHA include a pure tone average bone-conduction

threshold better than or equal to 45 dB.

300-The cochleostomy is made at the anteroinferior aspect of the

round window.

301-Usually, removing the chorda tympani is unnecessary for adequate

visualization of the round window niche area.

302-Superior semicircular canal dehiscence also can be identified

radiographic -ally and has been associated with conductive hearing loss
in children,

303-Mondini dysplasia reflects abnormal development of the cochlea

and is associated with both Pendred’s and branchio-oto-renal
syndromes.

304-Pendred’s syndrome represents 10% of the cases of syndromic

hearing loss and is the most common cause of syndromic hearing loss.
It is associated with a dilated vestibular aqueduct on temporal
Ctscanning.

305-Dilated vestibular aqueduct is defined as one with a diameter

greater than 1.5 mm at its middle third or greater than2.0 mm
anywhere along its length.

306-The space between the mastoid segment of the facialnerve and

the chorda tympani is a space through which a posterior tympanotomy
(or facial recess) can be surgically created to access the middle ear.

307-Type II accounts for 10% of cases, and is characterized by

congenital moderate to severe stable hearing loss, normal vestibular
responses, and onset of retinitis pigmentosa in patients 17 to 23 years
old..
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308-Usher’s syndrome type I accounts for 85% of all cases, and is

characterized by profound congenital hearing loss, absent vestibular
response, and the development of retinitis pigmentosa by age 10 years.

309-A major advantage that the ABR has over other auditory evoked
potentials is that it is not strongly affected by attention, sleep, or
sedation.

310-ECoG:ratio between the two (SP/AP ratio) greater than 0.4 and an
AP duration longer than 3 msec are indicative of endolymphatic hydrops

311-Audiometric evaluation must always precede the ABR test to

ascertain that the level of stimuli used to elicit the ABR is within the
patient’s auditory dynamic range. It is also possible to record ECoG and
ABR simultaneously..

312-Oral fluoroquinolones have become the treatment of choice in

bacterial MOE with cure rates near 90%. Serial gallium-67 bone scans
may help monitor the response to therapy.

313-Bell’s palsy base their decisions for surgery primarily on the NET or
ENoG, but also require confirmatory EMG.

314-EMG is the recording of spontaneous and voluntary muscle

potentials using needles introduced into the muscle. Its role in the early
phase of Bell’s palsy is limited,

315-Stapedial reflex . particularly useful for differentiation of cochlear

and retrocochlear lesion sites .

316-The saccule is the second most common site affected by hydrops,.

317-The most common pathologic interconnection between the

subarachnoid space and the inner ear is through the fundus of the IAC.

318- Large vestibular equduct:It is seen in isolation, as part of the

Mondini malformation, and in patients with branchio-otorenal syndrome
and Pendred syndrome. It is well shown on high resolution CT imaging
of the temporal bone.
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319-landmarks in the middle fossa are the middle meningeal artery at

the foramen spinosum, the greater superficial petrosal nerve at the
facial hiatus, and the arcuate eminence.

320-The site of injury of the facial nerve in temporal bone fractures is

in the perigeniculate region in 80% to 93% of patients.

321-only patients with complete paralysis of immediate or unknown

onset are considered for surgical exploration in temporal bone trauma
causing VII palsy.

322-type C tympanogram also may be present in the early stages of

otitis media without effusion.

323-A type C tympanogram indicates negative middle ear pressure as

reflected by a negative pressure peak and may indicate eustachian tube
dysfunction.

324-Type B tympanograms may be seen in cases of otitis media with

effusion, space-occupying lesions of the tympanic cavity, and tympanic
membrane perforations.

325-It is believed that the presence of hydrops affects the elasticity of

the basilar membrane and contributes to the increased amplitude of the
SP relative to that of the AP.

326-Relatively large SP/AP ratio is considered diagnostic of

endolymphatic hydrops.

327- vertical crest (Bill's bar) is exposed. This bony projection is a key
surgical landmark, in acoustic neuroma.

328-Cholesteatoma and cholesterol granuloma can be differentiated

from each other by MRI, since in the T1 sequence the cholesterol
granuloma is bright but the cholesteatoma appears less bright because
of a longer T1 relaxation time. in petrous apex.
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329-CT findings are identical to those of a cholesterol granuloma and

mucocele of the petrous apex. Cholesterol granul. are indistinguishable
from congenital cholesteatomas
and mucoceles of the petrous apex.

330-In congenital atresia the absence of any identifiable ear canal in

an atretic ear, drilling should always begin at the level of the linea
temporalis, just posterior to the glenoid fossa.

331-Because the primary goal of surgery for acquired atresia is

improvement in hearing, preoperative audiologic testing will help
confirm the nature and extent of loss in the affected ear.

332-Atelectatic ear is one of the most important indications for

cartilage tympanoplasty.

333-Acoustic reflex decay is superiortest of auditory fetigue and less

time consuming.

334-Tone decay tests useful as a screen for VIII nerve lesion.

335-The varicella zoster virus that causes Ramsay Hunt syndrome is

the same virus that causes chickenpox (varicella) and shingles.

336-Battle sign (ecchymosis of postauricular skin) Raccoon sign

(ecchymosis of periorbital area) .

337-Temporal bone fracture comprises 15-25% of all skull fractures .

338-Contrast-enhanced MRI is the study of choice to detect VS,

whereas air contrast CT cisternography is reserved for patients who are
unable to undergo MRI.

339-CT scanning is insensitive to the detection of vestibular

schwannomas, even when performed with contrast medium..
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340-Type As tympanogram:Otoseclerosis,tympanoseclerosis &malleus

fixation .

341- OHC Contain Actin (contractile protein). OHC Reduce Length with
Depolarization.

342- In G J tumor treatment the most common site of lower cranial

nerve involvement was the pars nervosa of the jugular bulb, and this
involvement was typically multiple.

343-Baha consists of three parts: an implanted titanium flange fixture,

a sound processor, and an external abutment that couples the titanium
fixture to the sound processor .

344- Paraganglioma or glomus tumor is a tumor of the neuroendocrine

system derived from neural crest cells and chemoreceptor cells. The
tumor was termed a chemodectoma by Mulligan in 1950.

345-Glomus tumors represent 0.6% of neoplasms of the head and

neck and 0.03% of all neoplasms; they are the most common tumors
of the inner ear and the second most common tumors of the temporal
bone after schwannomas.

346-Developmental failure of the first branchial groove results in

stenosis or atresia of the external auditory canal.

347-Microtia, anotia, and aberrant positioning of the pinna derive from

abnormal development of the first and second branchial arches.

348- The landmark for opening into the facial recess is the fossa
incudis.

349-Enlarged vestibular aqueduct if it is larger than one millimeter,

roughly the size of the head of a pin.
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350-Prolonged wave V & wave I latency in ABR suggest a conductive

loss.

351-Mondini deformety:autosomal dominant

352-Levenson criteria of congenital cholesteatoma,White mass medial

to normal TM-Normal pars flaccida and tensa-No history of otorrhea or
perforations-No prior otologic procedures-Prior bouts of otitis media not
grounds for exclusion.

353-The presence of an aural polyp in a chronically infected ear should

be considered to be a cholesteatoma until proved otherwise.

354-The diagnosis of aural cholesteatoma is made on otoscopic

examination, including endoscopic and microscopic evaluation or
surgical exploration.

355-Osteoclastic bone resorption in chronic otitis media with or without

cholesteatoma is stimulated by various factors, including inflammation,
local pressure, keratin, specific cytokines, and bacterial toxins.

356-A fistula of the bony labyrinth is the most common complication of

COM and is reported to occur in 4–13 percent of cases.

357-Tympanosclerosis refers to hyaline deposits of acellular material

visible as white plaques in the tympanic membrane and as white
nodular deposits in the submucosal layers of the middle ear on
otoscopy.

358-Frenzel’s glasses are generally worn to prevent ocular fixation and

suppression of nystagmus by vision.

359-The OHCs’ main function is to modify the acoustic information that

reaches the IHCs.

360-The sensory receptor for the auditory nerve is the IHC, which
synapses with type I spiral ganglion..
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361-The preferred method for detection of OHC damage is the

measurement of OAEs.

362-Ototoxic substances enter the cochlear tissues via the vascular

system, the CSF (via either the cochlear aqueduct or the internal
auditory meatus), or via the middle ear, across the round window
membrane.

363-Complication of grommate:purulant otorrhoea,early tube

extrution, granuloma, permanent perforation,tympanosclerosis and
cholesteatoma.

364-SNHL,tinnitus,vertigo and feeling of fullness. is detected in

patients with perilymphatic fistula.surgical grafting is the only definitive
treatment.

365-Chemotherapy does not have a role in treatment of acoustic

neuroma.

366-Unilateral HL. Is the classic presentation of acoustic neuroma.

367-20% of patients with Bell’s palsy are actually suffering from Rams
H S.

368-Vestibular Neuronitis it effect only vestibular n. its has no effect on

hearing.

369-The cause of vestibular neuronitis(VN) is still largely unknown.

F=m.

370-Labyrinthitis follows an URT infection in over 50% of cases.

371-Recruitment is positive in cochlear disorders such as Meniere’s

disease.

372-Argon laser is useful in middle ear surgery such as

stapedectomy,ME adhesions and tympanoplasty.

373-Gold standard to diagnose acoustic neuroma is contrast enhanced

MRI with T1 images .
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374-Donaldson’s line is the landmark of endolymphatic sac.

375-SNHL due to quinine,salicylates and furosemide is reversible.

376-Kanamycin is cochleotoxic and most likely to cause unilateral HL.

377-Hearing aid consists of three parts microphone, amplifier and

receiver.

378-CI:two components external (microphone,speech processor and

coil or transmitter).internal(single or multiple electrodes and coil or
receiver).

379-Heterochromia iridis,two eyes are of different coluor or two

different colours in one eye.

380-Dystopia canthorum is lateral displacement of medial canthi.

differentiating from hypertelorism in which orbits are laterally displaced.

381-Hirschsprung’s disease may be associated with both WS-I and WS-

II.

382-Waardenburg’s syndrome is Autsomal dominant.(WS type I with

dystopia canthorm and type II no such feature)

383-Unilateral SNHL is commonly seen in acoustic neuroma.(20%

SSNHL).

384-Episodic vertigo is seen in only 20% of acoustic neuroma.

385-BPPV(free-floating particles).is the most common cause of

vertigo(20%). Followed by Meniere’s and vestibular neuronitis.

386-Notch at 4kHz both in AC and BC is seen in noise –induce HL.

387-Hitzelberger sign its diminished sensation in posteriosuperior wall

of EAC, due to CN VII sensory fiberes affected by acoustic neuroma..
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388-Otolithic crisis of Tumarkin or drop attacks are seen early or late

Meniere’s.

389-Hennebert’s sign it’s a positive fistula test without presence of

fistula.its seen in cong.syphilis or Meniere’s disease(25%).

390-Tullio phenomenon is loud sounds or noise produce giddiness.its

seen in congenital syphlis.meniere’s and sup.SCCD(three functioning
windows).

391-Carhart’s notch is loss of bone conduction(2kHz) in audiogram in

otosclerosis.can be reversed by stapedectomy.

392-paracusis of Willisi:better hearing in noisy surroundings in

otospongiosis.

393-Schwartze’s sign is reddish hue seen over promontory.its due to

increased vascularity of bone and is seen in early or active
otospongiosis.

394-most common site for otosclerosis is fossula ante-fenestram.

395-Otosclerosisis autosomal dominant disease.

396-Aquino’s sign is blanching of glomus t. on compres. of ipsilateral

carotid

397-Griesinger’s sign is edema over the masoid due to thrombosis of

masoid emissary vein.its seen in lat.sinus thrombosis.

398-Glomus tumor. is five time more common in women.its very slow

growing tumor.

399-petrous apex is pneumatised only in 30% of cases.

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400-cholesteatoma destroy bone by proteolytic enzymes_protease,

hyaluronidase and acid phosphatase.

401-Brown’s sign (pulsation sign) in glomus tumor.when pressure is

raised in the ear canal with siegel’s speculum,tumor first pulsates
vigorously and then blanches.

402-phelps sign is destruction of bone between carotid canal and

jugular foramen in glomus jugulare tumors.

403-nystsgmus of central origin has: appears immediately as soon as

the head is put in critical position without latent period,change
direction,lasts as long as the head position is maintained.is not
fatigable.

404-Dix-Hallpike test used in episodic positional vertigo.

405-Vestibular neuronitis produce nystagmus in opposite side.

406-serous labryrinthitis produce nystagmus in same side.

407-labyrinthectomy produce nystagmus in opposite side.

408-Purulent labyrinthitis produce nystagmus in opposite side.

409-Cogan’s syndrome :episodic vertigo,interstitial keratitis and hearing

loss.

410-Caloric test determines function of lat.SCC.

411-spondee words are used to measure speech reception threshold

(SRT).

412-Phonetically balanced words are used to measure discrimination

score.

413-Tone decay test is positive in acoustic neuroma.

414-A sound of 20 dB is 100-fold increase in sound energy.

.
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415-Recruitment is a feature of cochlear deafness.

416-Vowels are low frequency sounds, consonants are high ferquency

sounds.

417-Speech frequencies include: 500.1000,2000 Hz.

418-Invesigation of choice in assessing hearing loss in neonates is

ABR.

419-Costen’s syndrome is characterised by otalgia, vertigo, tinnitus.

420-Dorello’s canal transmits abducens n.(cn VI ).

421-Lat.SCC.stimulated during caloric test in a sitting position with

head tilted 60” .

422-Jacobson’s n. supplies ME,mastoid,secrtomotor to parotid.

423-Furosemide ototoxicity on stria vascularis.

424-Interpretation of ABR is affected by age of the child.

425-Vancomycin induced augmentation of aminoglycoside ototoxicity.

426-The dominant ototoxic effect of salicylates appears to be the

production of tinnitus as well a reversible mild to moderate symmetric
SNHL.

427-Surgical grafting is the only definitive treatment in perilymphatic

fistula.

428-perilymphatic fistula present with tinnitus,vertigo,hearing loss and

feeling of fullness within the ear its difficult to differentiate fro
meniere’s disease on clinical basis alone.

.
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429-BPPV result in vertigo,but dose not cause hearing loss.

430-unilateral hearing loss is the classic presentaion of acoustic

neuroma.

431-little evidence that viral infection cause vestibular neuronitis is still

largely unknown.

432-Vestibular neuronitis is a self limiting,short term illness.usually

lasts for a few weeks.main symptoms are nausea, vomting and
vertigo.no effect on hearing.

433-Sever headache, vomiting, dysphagia ,&visual field defects in a

patien with cholesteatoma indicate: temporal lobe abcess.

434-Ottitic barotraumas is charactarised by middle ear effusion .

435-Bilateral cauliflower ear deformity, saddle nose deformity, and

stridor.. ..relapsing polychondritis…Rx- dapsone .

436-most consistent landmark that a surgeon can easily use in

identifying the facial nerve near the skull base is the tympanomastoid
suture.

437-Sensorineural hearing loss can complicate radiation therapy and

cisplatin treatment for nasopharyngeal carcinoma in up to 30% of
patients.

438-The outer cartilage bites of Mustarde sutures are described as 1

cm separated by 2 mm.

439-Most ear anomalies are inherited as autosomal dominant traits

with incomplete penetrance.

440-The auricle is 90 to 95% of adult size by 5 to 6 years of age.

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441-Recent studies have linked the cause of Bell’s palsy to herpes

simplex virus.

442-Fibrillation potentials found on facial EMG indicate intact motor

end plates but no evidence of reinnervation.

443-Adults with prelingual deafness are generally not considered good

candidates for cochlear implantation.

444-Nonauditory centers (the limbic and autonomic nervous systems)

are always involved in clinically significant tinnitus.

445-About 20 to 30% of tinnitus patients have normal hearing.

446-first indicators of age-related hearing loss is loss of auditory

sensitivity at frequencies higher than 8 kHz.

447-atrophy of the stria vascularis is the predominant lesion of the

aging ear.

448-Vestibular neuronitis is characterized by an acute attack of vertigo

that may last for a few days. Some patients may later develop BPPV.

449-The superior vestibular nerve innervates the superior and lateral

semicircular canals and the utricle, whereas the posterior semicircular
canal and the saccule are innervated by the inferior vestibular nerve.

450-A 75% rate of hearing improvement was seen with corticosteroids

in patients with a positive Western blot for a 68 kD antigen.

451-antigen target in autoimmune inner ear disease is a 68 kD inner

ear protein.

452-nystagmic eye movements of Hennebert’s sign sometimes Require

the use of infrared nystagmography.
.
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453-clinical diagnostic criteria for perilymphatic fistula Include triad (1)

positive fistula test (Hennebert’s sign/symptom); (2) constant
dysequilibrium, however mild (eg, eyes closed walking); and (3)
postural nystagmus and/or vertigo.

454-Mumps deafness is usually unilateral.

455-Hearing loss associated with carboplatin treatment of brain tumors

can be prevented by administration of sodium thiosulfate.

456-Cisplatin damages the outer hair cells most frequently, whereas

carboplatin damages the inner hair cells in animal experiments.

457-The outer hair cells of the basal turn of the cochlea are damaged
first following exposure to ototoxic doses of aminoglycoside antibiotics.

458-Aminoglycoside ototoxicity can be prevented in experimental

animals by pretreatment with salicylates.by chelate iron and prevent it
from reacting with the aminoglycoside.

459-Benign paroxysmal positional vertigo occurs in 25% of all head

injuries whether there is a fracture or not.

460-perilymphatic fistula should be suspected,in progressive hearing

loss and episodic vertigo after a temporal bone fracture.

461-most common traumatic ossicular abnormality , incudostapedial

joint disarticulation.

462-percentage of traumatic perforations of the tympanic membrane

heal spontaneously: 80%.

463-Mutations in Cx26 are responsible for over one half of moderate-

to-profound hearing impairment in many world populations.

464-The typical autosomal dominant phenotype is one of postlingual

hearing loss. Autosomal recessive hearing loss is more severe than
autosomal dominant hearing loss.
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465-Mitochondrial hearing loss, It may be associated with diabetes

mellitus.

466-Alport’s syndrome:Hematuria is the most common mode of

presentation.

467-Usher’s syndrome, It is the most common autosomal recessive

syndromic hearing loss.

468-The most reliable means of improving hearing in the patient with

otosclerosis is a hearing aid.

469-The principal objective in stapes surgery is to restore sound

pressure transmission to the inner ear.

470-The most frequent site of first occurrence of otosclerosis is in the

fissula ante fenestram.

471-Otosclerosis is a disease affecting endochondral bone.

472-The radiologic study of choice to diagnose lateral sinus thrombosis

is enhanced magnetic resonance imaging.

473-A total ossicular replacement prosthesis is used only when the

stapes superstructure.

474-The most critical factor in avoiding injury to the facial nerve during
mastoid operations is drilling parallel to the nerve.

475-Exostosis is common in cold-water swimmers.

476-Keratosis obturans is associated with bronchiectasis or sinusitis.

477-The most commonly isolated pathogens in acute diffuse otitis

externa are Pseudomonas aeruginosa and Staphylococcus aureus.

478-Cerumen:forms an acidic coat that aids in the prevention of

external auditory canal infection.

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479-Otoacoustic emissions are produced by the outer hair cell motility.

480-Major anatomic generator of the wave V component of the

auditory brainstem response is the lateral lemniscus.

481- The anterior portion of the Incudomalleal Fold and the Anterior
portion of the TTF are the most superior portion of the Tympanic
Diaphragm.

482-TTF separates the AER from the Supra-Tubal Recess .

483-the size of the AER increases as the angle of the TTF increases .

484-Two openings into the tympanic diaphragm insure the ventilation

of the Epitympanum :Ant. Tympanic Isthmus: Between the tensor
tympani muscle & stapes,: Post. Tympanic Isthmus: Between the
stapedial muscle & the Incus

485- Tympanic diaphragm. Formed by:Ant. Malleal Fold, Lateral Incudo-

Malleal Fold, TTF, Ossicles.

486- Prussack’s space: Vent: PP Von Troltsch + Lower Lateral Attic.

487- Epitympanum divided: Ant. + Post by superior Malleal Fold.

488-Koِrner’s septum, the embryologic junction between petrosal and

squamosal portions of the temporal bone,

489-The tympanic segment is the most common site of congenital

dehiscence of the bony canal, especially above the oval window.

490-The facial nerve is most vulnerable to iatrogenic injury just

proximal to the second genu and in its vertical path.

491-In 55% of cases, however, the facial nerve is partially exposed

because of bony dehiscence.
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492-Supratubal recess. The posterior opening of this recess is marked

by the cochleariformprocess inferiorly and the “cog” superiorly,

493-Shrapnell’s membrane serves as the lateral wall of Prussak’s space.

the cochlear aqueduct can be used as a guide to the lower limits of IAC
dissection.

494-Boyette’s solution is( 4% lidocaine, phenylephrine, and sodium

chloride, with sterile water added to make 200 mL.).

495-The most vulnerable portion of the ossicular chain is the long

process of the incus, which possesses a single nutrient vessel and lacks
collateral circulation.

496-The arcuate eminence is the prominence of the superior

semicircular canal on the middle fossa floor.

497-About 50% of children with otitis media will ultimately be

diagnosed with allergic or infectious sinonasal disease.

498-Referred otalgia with dysphagia is a sinister symptom and poor

prognostic sign

499-Acoustic neuromas originate at the junction of the glial and

Schwann cells, that are bilateral (5%) are seen in(NF2). This is an
autosomal dominant disease due to an aberration on the long arm of
chromosome 22.

500-Prerequisites for Type I tympanoplasty are: 1. Presence of mobile

ossicles 2. Patent eustachean tube 3. Perforated ear drum .

501- Derlacki and Clemis criteria for the diagnosis of congenital

cholesteatoma:
1. The patient should not have previous episodes of middle ear
disease
2. Ear drum must be intact and normal
3. It is purely an incidental finding .
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502-laddergram ABLB test indicates complete recruitment..

Recruitment is common in cochlear deafness. It is not seen in
retrocochlear deafness.

503-osteogenesis imperfecta :characterized by brittle bones, blue

sclera and fixation of foot plate of stapes .

504-drugs cause Microtia . Warfarin, Folic acid antagonists like

methotrexate and aminopterin .

505-Kertosis obturans occur due to faulty epithelial migration of

external canal skin.

506-Glomus jugulare - associated with pulsatile tinnitus, conductive

deafness, positive Brown's sign. CT scan shows eorsion of jugular
foramen.

507-Levenson's criteria for malignant otitis externa:

1. Refractory otitis externa.
2. Severe nocturnal otalgia.
3. Purulent otorrhoea.
4. Granulation tissue in external canal.
5. Growth of pseudomonas aeruginosa.
6. Presence of diabetes mellitus / other immunocom- promised states.

508-Siegle's pneumatic aural speculum:Testing the mobility of the ear

drum, magnification 2.5 times.

509-familial glomus tumors may occur in 20% of patients with glomus

tumors.

510-Glomus tumors of the temporal bone are neoplasms arising from

normally occurring paraganglionic bodies or formations that are located
on the dome of the jugular bulb and along the course of Jacobson's
nerve (ninthcranial nerve) onto the cochlear promontory.

511-The largest concentration of paraganglionic cells is with the

adrenal medulla. The other predominant locations of paraganglionic
tissue are found in the branchiomeric chemoreceptor system of the
aortic arch, carotid bifurcation, and temporal bone.
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512-28 % - 60% of patients with severe Tinnitus are clinically

depressed .

513- Aggravate Tinnitus:Caffeine, Cola, Tea, Smoking.

514- Tinnitus + HL → 63% noise exposure. 80 % of Otosclerosis. 80

% of Accoustic Neuroma. First sign of ototoxicity.

515- Postural Unsteadiness: Tandem Test, Romberg Test.

516- Fast phase is usually away of the lesion side, Slow phase looks to
the lesion side. Hypofunction.

517- Beat to the right when the eyes look to the right, Beat to the
right when the eyes look on central gaze, Beat to the right when the
eyes look to the left: Sign of a Labyrinthine Disorder.

518- beat to the right on Gaze Right , beat to the left on Gaze Left:
Suspect a brain disease.

519- Positionnal Nystagmus: Suppression by visual fixation .

520- Gaze Nystagmus: Never occur with peripheral vestibular lesion.

521- Congenital Nystagmus: When beats on direct forward gaze.

522- First degree nystagmus: beats in one direction of lateral gaze.

523-Second degree nystagmus: nystagmus still present in straight

ahead gaze.

524- Third degree nystagmus: nystagmus present in all 3 directions of

gaze.

525- Induced nystagmus: occurs with caloric or rotationnal tests.

.
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526- Spontaneous nystagmus: occurs without stimulation.

527- Positional nystagmus: nystagmus occurs with certain head or

body position.

528-Gaze-evoked nystagmus: If the nystagmus begins when the

patient look to the left and right or up and down.

529- Progressive SN hearing loss : Acoustic Neuroma.

530- Sudden hearing loss: Labyrinthe or VIII nerve.

531- Tullio Phenomenon:Loud noise may induce VERTIGO.

532- Facial Nerve Neurinoma Commonest site is geniculate region,

20% of cases of recurrent Bell’s.

533- FN paralysis in Malignant otitis externa 40 % , Only 20 % of the

cases show complete recovery after intensive treatment.

534- Mobeius syndrome Partial or complete agenesis of FN nucleus &

nerve roots Usually bilateral Associated with other cranial nerves
affection

535- Lacrimation test (Shirmer’s test): 25% reduction from normal

side.

536- Stapedial reflex text: absent in 1% of normal individuals .

537-The facial recess is, therefore, bounded medially by the facial

nerve and laterally by the tympanic annulus, with the chorda tympani
nerve running obliquely through the wall between the two.

538-The facial recess is, therefore, bounded medially by the facial

nerve and laterally by the tympanic annulus, with the chorda tympani
nerve running obliquely through the wall between the two.
.
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539-oval window Its size naturally varies with the size of the footplate,
but on average it is 3.25 mm long and 1.75 mm wide.

540-EMG -Primary used in acute phase of facial paralysis (Ist 2 wk) is

confirmatory for other tests.

541-THE DISTRACTION TEST:is suitable for babies from 6 to 18

months.

542-Severity of HL not parallel to disease’s severity(discharging ear).

543- The most common germ of otorrhea is pseudomonas aerogenosa.

544- The most common cause of otorrhea is external otitis.

545- Serum IgE: high values in patients with discharging ears.

546- TB otomastoiditis;Multiple perforations, creamy

discharge,Extensive bony destruction of mastoid and Pulmonary T.B

547- Transcanal(Rosen incision), Endaural(Lempert incision), Post

auricular (Wildes incision).

548-G.Jug:only 1% to 3% of these tumors actively secrete

norepinephrine. Catecholamines are much more likely to be secreted by
glomus jugulare tumors than by glomus tympanicum tumors.

549-Glomus tumors may secrete vasoactive substances or be

associated with other tumors, such as pheochromocytomas.

550-high jugular bulb is present in about 25% of cases.

551-High-tone sensorineural hearing loss, perhaps secondary to

bacterial toxins migrating across the round window.as a seguelae to
ASOM..
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552-ABR has only a 3% false-negative rate. It demonstrates a

retrocochlear lesion by an increased latency between N1 and N5
waves.in Acoustic N.

553-Acoustic neuroma :The most accurate means of identifying small

intra- canalicular tumours is (MRI) with gadolinium enhancement. used
for screening. CT should only be used when MRI is unavailable.

554-Loss of the corneal reflex is an early sign of trigeminal nerve

impairment. In acoustic neuroma.

555-Acoustic neuroma:. Hypaesthesia of the posterior EAC on the side

of the hearing loss should raise the index of suspicion (Hitselberger
sign).

556-The posterior auricular appears to be the dominant artery and

supplies the medial surface (except the lobule) of the auricle.

557-Role of 55 in the ear :vibrating area of the tympanic memberane

55 sq.mm :wieght of ossiculatar chain 55 mg(incus 27 mg,malleus 25
mg and stapes 3mg)/, TM in obliqe position 55` degree
anteroinferiorlly. In 55% of cases, however, the facial nerve is partially
exposed because of bony dehiscence..

558-One of the major reasons for the failure of a mastoid cavity

to become a dry skin-lined bowl is poor meatoplasty technique.

559-Apert syndrome is a rare autosomal dominant craniosynostosis.

Similar to Crouzon's syndrome, midface hypoplasia is prominent with
relative class III occlusion. The most characteristic features are: ‘tower
skull .

560-Crouzon syndrome is an autosomal dominant craniosynostosis.

The syndrome is characterized by midface hypoplasia with relative
mandibular prognathism with an anterior bite and class III occlusion.
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561-Aural cholesteatomas are epidermal inclusion cysts of the middle

ear or mastoid .

562-presence of granulation tissue at the junction of the cartilaginous

and bony junction. This may signify that a malignant otitis externa is
present, which, as an osteomyelitis of the temporal bone.

563-Marginal perforations with thin keratin migrating laterally from the

edge (trail sign) suggests squamous epithelium or cholesteatoma in the
middle ear

564-The diagnosis of otosclerosis must be considered when there is a

history of slowly progressive hearing loss, bilateral disease is present,
and the family history is positive.

565-Indications for reconstruction of the middle ear and tympanic

membrane are to eliminate recurrent disease, provide a dry ear canal
and middle ear space with an intact tympanic membrane, and maintain
or improve hearing.

566-Failure to close the air-bone gap after surgery(stapedectomy) for

presumed otosclerosis may be due to fixation of the lateral ossicular
chain or dehiscence of the superior semicircular canal.

567- If a floating footplate develops and it sinks into the vestibule,

place a tissue graft over the oval window and reconstruct with a wire or
bucket-handle prosthesis.

568- Palpate the lateral ossicular chain after the incudostapedial joint
has been separated, confirm that the lateral chain is not fixed, and then
check the mobility of the stapes.

569-Almost all middle ear prosthetics in use today are

nonferromagnetic .The Robinson prosthesis is included in the group of
devices that can be safely subjected to MRI.
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570- Most of the pathology occurring in the middle ear and mastoid
results from eustachian tube dysfunction.

571-Cholesterol granuloma is a comprehensive term describing a

loculated cystic or solid foreign body reactive process directed against
cholesterol crystals resulting from the by-products of degraded blood.

572-Laboratory markers for identifying perilymph, such as β2-

transferrin or fluorescein, can be unreliable and their absence
misleading.

573- Patients with sudden hearing loss or dizziness who have a history
of recent barotrauma, physical ear injury, or otologic surgery should be
suspected of
having a.perilymphatic fistula.

574-Cholesteatoma definition:destructive and expanding keratinizing

equamous cell cyst(epidermal inclusion cyst).

575-The absence of OAE can be associated with hearing loss of mild to

moderate degree, and presence does not ensure normal hearing.

576-surgical correction of conductive loss may close the air-bone gap,

a sensorineural component may still require amplification.

577-90% of patients suffering from keratosis obturans also have a past

history of
bronchiectasis or sinusitis.