Neurotology

Dizziness and Vertigo

1. What is the definition of vertigo?		G7 p.840:78mm
a. sensation of_____	movement (usually spinning)
b. from
i. i_____ e_____ d_____ or	inner ear dysfunction or
ii. v_____ n_____ d_____	vestibular nerve dysfunction
2. True or False. Inner ear dysfunction presenting with vertigo includes the following:		G7 p.840:82mm
a. labyrinthitis	true
b. trauma, i.e., e_______ l_______	true (i.e., endolymphatic leak)
c. drugs, i.e., a_____	true (i.e., aminoglycosides)
d. acoustic neuroma	false (Acoustic neuroma does not cause inner ear dysfunction but may cause vertigo from compression of the vestibular nerve.)
e. vertebrobasilar insufficiency	true (Other causes of vertigo include inner ear causes: Meniere disease, benign/paroxysmal positional vertigo, syphilis.)
3. Complete the following regarding cupulolithiasis:		G7 p.840:90mm
a. What is cupulolithiasis? c_____ c_____ in s_____ c_____	calcium concretions in semicircular canal
b. It is also known as b_____ p_____ v_____.	benign (paroxysmal) positional vertigo
c. Symptoms are made manifest by_____ _____.	head turning
d. Patient is usually in_____.	bed
e. Is it self-limiting?	yes
f. For how long?	usually not for > 1 year
g. Is hearing affected?	no hearing loss
4. Describe indications and complications of selective vestibular neurectomy (SVN).		G7 p.841:40mm
a. Indications
i. M_____ d_____	Meniere disease
ii. p_____ v_____ i_____	partial vestibular injury
b. Rationale?	In disabling cases of vertigo, refractory to medical/nondestructive surgical treatment. SVN preserves hearing; is 90% (Meniere disease) and 80% (vertiginous spells) effective.
c. Complications
i. h_____ l_____	hearing loss (unusual)
ii. o_____	oscillopsia (Dandy syndrome)
iii. l_____ of b_____ in the d_____	loss of balance in the dark with bilateral SVN
5. Answer the following about the vestibular nerve:		G7 p.841:117mm
a. In which half of the eighth nerve complex?	superior
b. What color relative to the cochlear nerve?	more gray
c. To preserve hearing what vessel must be preserved?	artery of the auditory canal
6. True or False. CN VII can be differentiated from CN VIII at the internal auditory canal (IAC) by all of the following:		G7 p.841:122mm
a. direct stimulation/recording	true
b. lies anterior/superior to VIII	true
c. transverse crest and Bill bar	true
d. darker color c/w CN VIII	false (CN VII is paler/whiter than CN VIII)
e. electromyographic (EMG) monitoring of CN VII during manipulation	true

Meniere Disease

7. What is the clinical triad of Meniere disease?		G7 p.842:33mm
a. v_____ v_____ a_____	violent vertigo attacks
b. t_____	tinnitus “escaping steam”
c. h_____ l_____	fluctuating low-frequency hearing loss
8. Meniere disease is also known as e_____ h_____.	endolymphatic hydrops	G7 p.842:46mm
9. True or False. Treatment of Meniere disease includes		G7 p.843:23mm
a. middle ear perfusion with gentamicin	true
b. bilateral vestibular neurectomy	false (Bilateral ablative procedure is to be avoided.)
c. salt restriction	true
d. vestibular suppressants (e.g., Valium)	true
e. endolymphatic shunting	true

Facial Nerve Palsy

10. Segments of the facial nerve include		G7 p.844:30mm
Hint: see my little tin man
a. c_____	cisternal
b. m_____	meatal
c. l_____	labyrinthine
d. t_____	tympanic
e. m_____	mastoid
11. Answer the following about supranuclear facial palsy:		G7 p.844:55mm
a. Which part of the face is involved?	lower only
b. Emotional facial expression is _____.	intact
c. The lesion is in the lowest part of the _____ _____.	precentral gyrus
d. Part of the face is spared paralysis because the _____ _____ has _____ _____.	upper face; bilateral representation
12. True or False. The following is correct regarding central facial palsy (supranuclear facial palsy):		G7 p.844:55mm
a. confined to lower face	true
b. spares emotional facial expression	true
c. lesion in most inferior opercular portion of precentral gyrus	true
d. upper face has bilateral representation	true
13. Complete the following regarding nuclear facial palsy:		G7 p.844:80mm
a. It causes paralysis of all _____ _____ _____ muscles.	ipsilateral CN VII innervated
b. It plus sixth nerve palsy constitutes the _____-_____ syndrome.	Millard-Gubler
c. It can be caused by a particular tumor called _____	medulloblastoma
d. especially when it _____ the _____ of the _____ _____.	invades the floor of the fourth ventricular
e. True or False. Nuclear facial palsy is due to damage to the motor nucleus at the pontomedullary junction.	true
14. True or False. Regarding CN VII anatomy:		G7 p.844:100mm
a. enters superior-anterior portion of IAC	true
b. external genu is geniculate ganglion	true
c. GSPN first branch after the ganglion	true
d. exits at stylomastoid foramen	true
15. Complete the following about the seventh nerve:		G7 p.844:100mm
a. It exits the brain stem at the _____ _____.	pontomedullary junction
b. It enters the internal auditory canal at the _____ _____.	superoanterior portion
c. The geniculate ganglion is located in the _____ bone.	temporal
d. The first branch is the _____ _____ _____ _____	greater superficial petrosal nerve
e. which goes to the _____ _____	pterygopalatine ganglion
f. and innervates the _____ _____. lacrimal gland—dry eye and nasal mucosa if injured
g. The next branch goes to the _____.	stapedius muscle—to ear—hyperacusis
h. The next branch is the _____ _____.	chorda tympani—taste
i. It then exits the s_____ f_____	stylomastoid foramen
j. and sends branches to the _____.	face
16. Name the facial nerve branches within the temporal bone and their function.		G7 p.844:115mm
a. g_____	greater superficial petrosal nerve (GSPN) to pterygopalatine ganglion, innervates nasal and palatine mucosa and lacrimal gland
b. s_____	branch to stapedius muscle, volume regulation
c. c_____	chorda tympani, taste sensation from anterior two thirds of tongue
d. fibers to s_____ g_____	salivary glands, submandibular, sublingual
e. The nerve travels on to _____ _____.	facial muscles
17. Name the facial nerve branches to the facial muscles cranial to caudal.		G7 p.844:135mm
a. t_____	temporal
b. z_____	zygomatic
c. b_____	buccal
d. m_____	mandibular
e. c_____	cervical
18. Name the three most common causes of facial nerve palsy.		G7 p.844:155mm
a. B_____	Bell palsy
b. h_____	herpes zoster oticus
c. t_____	trauma/basal skull fracture
19. Study Chart. Provide the differential diagnosis for facial nerve palsy.	facial nerve palsy acoustic tumor Bell—birth congenital diabetes fracture Guillain-Barré herpes zoster Klippel-FeilLyme disease meningioma neoplasm otitis media parotid surgery sarcoid trauma	G7 p.844:155mm
20. Describe seventh nerve palsy.		G7 p.845:80mm
a. The most common cause of facial palsy is _____ _____.	Bell palsy
b. Etiology: _____	unknown
c. Probable etiology: v_____ i_____ d_____ p_____	viral inflammatory demyelinating polyneuritis
d. It is caused by the _____ _____ virus.	herpes simplex
e. It progresses _____ _____ _____.	distally to proximally
f. Meaning
i. first	facial movements weak
ii. then	loss of taste and salivation
iii. and then	hyperacusis
iv. and then	decreased tearing
g. Percent that recover completely is _____%; partially _____%.	75 to 80%; 10%
h. Manage with _____ and _____.	EMG and steroids
21. Answer the following regarding Bell palsy:		G7 p.845115mm
a. What often precedes Bell palsy?	a viral syndrome
b. What is the usual sequence of clinical findings? List in order: #x2460; decreased tearing; hyperacusis; facial muscle weakness; loss of taste	, , ,
c. What treatment is recommended?	steroids
22. What are the considerations for facial nerve injury surgical repair?		G7 p.846:180mm
a. if known to be interrupted _____	reanastomose early
b. if known to be in continuity _____	several months of observation
c. role of electrical testing _____	serial electrical testing after 1 week

Hearing Loss

23. Describe the following about hearing loss:		G7 p.848:40mm
a. conductive
i. speech	normal or low volume
ii. Rinne	air less than bone = negative (i.e., abnormal)
iii. Weber lateralizes to _____ _____ side	poor hearing
b. sensorineural
i. speech	loud
ii. Rinne	air more than bone = positive (i.e., normal)
iii. Weber lateralizes to _____ _____ side	good hearing