Disorders of the Inner Ear

Question 1

What is the oval window?

Answer 1

where the stirrup attaches to the cochlea

Question 2

What are vestibular organs?

Answer 2

organs that sense the position and movement of the head

utricle- lateral
saccule- horizontal
semicircular canals- crista ampullaris- detects rotational acceleration (filled with endolymph)

Question 3

Acoustic Neuroma:

Answer 3

benign tumor of CN VIII;

symptoms: hearing loss, tinnitus, balance problems

Question 4

Dx of Acoustic neuroma:

Answer 4

MRI of head/inner ear w/ gadolinium contrast

Question 5

Tx of Acoustic neuroma:

Answer 5

referral

surgical excision/ gamma knife radiosurgery

Question 6

What is the most common sudden SNHL?

Answer 6

unilateral loss noticed upon waking up

Question 7

Idiopathic Sudden SNHL:

Answer 7

develops over seconds to days
may have tinnitus or ear pressure on affected side
ear exam is normal;

MRI to rule out acoustic neuroma

Question 8

Tx of Sudden SNHL:

Answer 8

35-60% do not need tx;

oral and/or intratympanic injected steroids may improve chances of recovery

Question 9

Tinnitus:

Answer 9

the perception of ringing in the ears

usually due to hearing loss, most often high frequency HL

can be caused by medications

Question 10

Dx for tinnitus:

Answer 10

head and neck PE
Audiogram
Impact on quality of life
Screen for depression

Question 11

Imaging for tinnitus:

Answer 11

if unilateral- MRI;

if pulsatile- MRA or CT of temporal bones (AVM or middle ear tumor)

Question 12

Vertigo:

Answer 12

sensation of spinning or whirling or a sensation of movement in the absence of movement, disequilibrium

Question 13

Dizziness is not oftenly a/w ear disorders

Answer 13

fact, suspicion should increase is there is HL too

Question 14

Dx of vertigo:

Answer 14

most dx of vertigo are based on history;

test gait!

Question 15

Benign Postural Vertigo:

Answer 15

most common cause of vertigo in the US;

spinning vertigo that lasts SECONDS and is provoked by head movements

delayed onset, down beating nystagmus, that lasts seconds and is fatigueable

No asymmetry of hearing on audiogram

Question 16

Dx of benign postural vertigo:

Answer 16

dix-hallpike is positive

Question 17

What causes BPV?

Answer 17

free floating debris in the semicircular canals

Question 18

Tx for BPV:

Answer 18

canalith repositioning maneuver

Question 19

Menieres Disease:

Answer 19

SPONTANEOUS EPISODIC attacks of incapacitating, spinning vertigo that lasts 20 min to several hours.

fluctuating SNHL, tinnitus and ear pressure
ear exam is normal

Question 20

Evaluation of Menieres Disease:

Answer 20

audiogram

Question 21

What causes Menieres DZ?

Answer 21

endolymphatic hydrops:
in adequate absorption of fluid by the endolymphatic sac
intermittent ruptures of the membranous labyrinth causes vertigo and HL which resolve when the membrane heals

Question 22

Tx of Menieres DZ:

Answer 22

spontaneous improvement in 60-70%
low salt diet with a diuretic
anti-vetigo meds and anti-emetics
oral and intraympanic steroid injections

Question 23

Bacterial Labyrinthitis:

Answer 23

severe bacterial infection involving fluid of the cochlea and vestibule;

usually a complication of otitis media
PURULENCE NOTED BEHIND TM, OR COMING THROUGH A PERFORATION;

patient feels extremely ill

Question 24

Symptoms of Labyrinthitis:

Answer 24

profound usually permanent SNHL;

profound spinning vertigo for days

Question 25

Tx of Labyrinthitis:

Answer 25

hospitalize with:
tympanostomy tube (if no TM perforation) and IV abx;
anti-emetic and anti-vertigo meds

Question 26

What meds are the most ototoxic?

Answer 26

aminoglycosides and chemotherapeutic agents