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Continuing Education Quiz

  1. The main goal of lateral bulla osteotomy is to:
    1. Expose the tympanic cavity for thorough evacuation of the bulla
    2. Remove as much chronically infected tympanic bulla bone as possible
    3. Provide drainage of the tympanic cavity
    4. Completely remove soft tissue from the osseous ear canal
  2. The main reasons some surgeons tend to be less aggressive with lateral bulla osteotomy include:
    1. Risk of hemorrhage particularly ventral to the bulla
    2. Risk of facial nerve damage
    3. Risk of inner ear damage
    4. All the above
  3. The use of which of the following instruments should be avoided or used with extreme care when performing a VBO?
    1. Freer elevators
    2. Kerrison rongeurs
    3. Army-navy retractors
    4. Gelpi retractors
  4. The first aspect of lateral bulla osteotomy following total ear canal resection includes:
    1. Complete stripping of epithelium from the osseous ear canal
    2. Elevation of the facial nerve from the lateral face of the tympanic bulla
    3. Ronguer the ventral aspect of the osseous ear canal
    4. Bluntly dissect soft tissue from ventral to the bulla
  5. Rongeuring and elevating tissue just rostral to the opening of the osseous ear canal increases the risk of injuring the:
    1. Facial nerve
    2. Trigeminal nerve
    3. Maxillary artery
    4. Retroarticular vein
  6. Epithelial remnants are most often found in which area inside the tympanic cavity:
    1. Ventral aspect
    2. Caudal aspect
    3. Dorsal medial aspect
    4. Rostral dorsal aspect
  7. The most common result of incomplete evacuation of the tympanic cavity is:
    1. Chronic, intractable middle ear infcction
    2. Partial facial nerve deficits
    3. Acute wound infection responsive to antibiotics
    4. Inner ear infection and chronic neurological signs
  8. Injury to the internal carotid artery can result from:
    1. Levering soft tissue from the ventral aspect of the bulla
    2. Soft tissue dissection from the rostral aspect of the horizontal ear canal
    3. Curettage of the medial aspect of the tympanic bulla
    4. Curettage of the rostral aspect of the tympanic bulla
  9. Which of the following statements is false about the technical aspects of the tympanic cavity evacuation?
    1. All abnormal epithelium and debris should be excised
    2. The ossicles should be removed since they can form a nidus of infection
    3. Avoid curettage of the dorsal aspect since the promontory could be damaged
    4. Aggressive removal of the ventrolateral aspect dramatically helps in exposing the tympanic cavity for evacuation of debris
  10. Regarding the need for passive drainage after total ear canal ablation and subtotal lateral bulla osteotomy, which of the following statements is false?
    1. A drain is placed if there is heavy contamination, poorly controlled hemostasis, or when the tympanic cavity is difficult to clean out properly.
    2. The Penrose drain is placed with blunt dissection with a forceps and tunnelled ventrolateral to the bulla
    3. When creating the tunnel for the drain, never force the forceps through the soft tissue
    4. The drain exits usually at the ventral aspect of the vertical “T” incision created for total ear canal ablation