![]() An X-ray of the lateral neck may reveal the diagnosis with findings of a widened prevertebral soft tissue shadow, the presence of air-fluid level, foreign body, and/or loss of the normal curvature of the cervical spine. Physical examination may demonstrate nuchal rigidity and/or cervical lymphadenopathy. This is primarily a pediatric illness, rarely occurring in adolescents and adults. Definitive treatment consists of surgical drainage performed by an otolaryngologist. Question Ico-delete Highlights After review of the tests, who is the most appropriate consultant to call?Ĭorrect answer: Otolaryngologist Explanation The X-ray of the lateral neck demonstrates a retropharyngeal abscess. Fever, irritability, and nuchal rigidity persisted. Initial treatment consisted of hydration and antibiotics with a presumptive diagnosis of aseptic meningitis. A basic metabolic panel was normal except for a CO2 of 20 and a BUN of 22. Cerebrospinal fluid - 11 white blood cells and 1 red blood cell/mm3, protein 40 mg/dL, glucose 79 mg/dL. Initial laboratory studies provided the following results: CBC - WBC 26,500 with differential 24% polymorphonuclear leukocytes, 60% bands, 11% lymphocytes, 1% eosinophils, and 4% atypical lymphocytes. The remainder of the examination is normal. The chest is clear and without retractions. Shotty bilateral anterior cervical nodes are palpated. There are no oral or pharyngeal lesions visible tonsils appear to be of normal size and without inflammation or exudates. Nasal mucosa appears mildly erythematous with some dried crusted secretions in both nares. Pupils are equal, round, and reactive to light. Physical examination demonstrates decreased hydration of the oral mucosa, increased capillary refill time, and cool extremities. On examination, her temperature is 39.5☌, respiratory rate 48, apical pulse 162, and blood pressure 90/66 mm Hg. She has no active medical problems and her immunizations are up to date. Also noted are pain and difficulty when swallowing and noisy breathing. She has had watery rhinorrhea, an occasional dry cough, and progressive vomiting with 6 episodes in the prior day, but no diarrhea. The loss of otoconia in the otolithic membrane would probably have little effect on auditory responses.Ī 13-month-old girl presents in the urgent care center with a history of fever, increasing lethargy, and decreased appetite for 4 days. This selective hearing loss of high frequency sounds, such as that of a beeping microwave oven, can be associated with hearing disorders during the process of aging.Loss of neurons from the spiral ganglion would be another example of a sensorineural disorder. This is due to a sensorineural disorder which results in the loss of a specific frequency due to inability to transduce or convey the mechanical signal to a neural signal. ![]() Loss of the cochlear hair cells, particularly at the beginning of the basal turn of the cochlea, typically result in the loss of high frequency sounds. Fibrosis of the tympanic membrane, excessive secretion of cerumen in the external auditory meatus or ankylosis (bone deposition) of the stapes at the oval window are all examples of conductive disorders leading to hearing loss.Furthermore, conductive disorders such as these would result in a clinical situation with the loss of sound at all frequencies, rather than only a high frequency or selected frequency. Sensorineural disorders are those that result from the loss of the ability to transduce or convey the mechanical signal into the neural signal. Conductive disorders are those that result from the mechanical impedance of sound waves from reaching the auditory sensory receptors. Auditory disorders may be related to either conductive disorders, or sensorineural disorders. Correct answer: Loss of cochlear hair cells Explanation Hearing loss may be the result of one of two basic problems. ![]()
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