Question of the Week - January 2022
January 19th, 2022
A 12-year-old girl presents to the ED with fever, sore throat, and difficulty swallowing and opening her mouth. She also notes change in her voice over the last day. Temperature is 100.8°F, but remaining vitals are stable. Physical exam shows cervical LAD, erythematous tonsils, and swelling of the right tonsillar pillar. The uvula is deviated to the left. What is the most appropriate step in management?
A. Tonsillectomy
B. I&D
C. I&D with IV ampicillin-sulbactam
D. IV dexamethasone
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C (Scala tympani)
The electrode array of the implanted device is typically placed in the scala tympani via the round window or cochleostomy.
January 5th, 2022
A 62-year-old man with bilateral hearing loss and intermittent tinnitus presents to the audiology clinic for a follow-up visit. His recent audiogram is shown here:
Which of the following explanations best fit the patient's current symptoms and test results?
A. Family history of otosclerosis
B. Age-related changes
C. Recent MRI showing 5-mm solid mass in the left internal acoustic meatus
D. Recreational hunting on weekends
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Quiz Answer: D (Noise-induced hearing loss)
The symmetric "noise-notch" in bone-conduction thresholds (at approximately 4 kHz) is a characteristic pattern of noise-induced hearing loss (NIHL). Risk factors for NIHL include recreational use of firearms, hunting, exposure to industrial or military noise, power tools, or loud music.
Image source: Johnson A-C, Morata T. The Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals. 142. Occupational exposure to chemicals and hearing impairment; 2010 May. [Article Link]