Ear and Hearing耳听.ppt

Inservice Review Quinton Gopen, M.D. UCLA Medical Center Feb 27th, 2013 75 y.o. gentleman with vertigo when lays on right side. Counterclockwise nystagmus seen with right side down. Which semicircular canal is responsible? Left posterior Left superior Right lateral Right posterior Answer: Right posterior canal Which nerve is responsible for gustatory sweating ? choices: Glossopharyngeal Facial Chordae Lingual Vidian nerve discussion: the glossopharyngeal nerve innervates the parotid gland via the following pathway: inferior salvatory nucleus (medulla) - glossophayryngeal nerve (Jacobsens nerve) - lesser superficial petrosal nerve - otic ganglion (now postganglionic fibers) - auriculotemporal nerve (CNV3) - partoid gland After the parotid gland is cut out, the parasympathetic fibers aberently regenerate into the sweat glands which leads to Freys syndrome, also known as gustatory sweating answer: glossopharyngeal Tumor at fundus with intact hearing what would be best approach ? choices: Middle fossa Suboccipital Retrosigmoid Translabyrinthine Infracochlear discussion: There are three main types of approach to CP angle tumors: translab, retrosigmoid and middle fossa. The translab can get out any size tumor but has the down side of destroying any residual hearing. The middle fossa and retrosigmoid approaches spare hearing but can only be used in certain instances: middle fossa is best for small tumors at the fundus (very far lateral just as nerve enters cochlea) whereas retrosigmoid (aka suboccipital) is best for tumor at the meatus (very far medially where the nerve exits the brainstem at the CP angle. answer: middle fossa Which pt will do worst with a cochlear implant ? choices: postlingually deaf adult postlingually deaf child prelingually deaf child of short duration sign language before implant congenitally deaf discussion: cochear implants (CI) depend on an intact cochlear nerve which can be stimulated, so the patien