526 Ears

Question 1

what is secondary otalgia

Answer 1

referred pain
the ear receives pain even though cause is from somewhere else

Question 2

what is the difference between vertigo, syncope and presyncope (or disequilibrium)

Answer 2

vertigo = illusion of movement
syncope = fainting
presynction/disequilibrium = off balance

Question 3

the vestibular system includes what structures

Answer 3

vestibular structures in the ear, vestibular nerve, and vestibular structures in the brain

Question 4

what is the difference between peripheral and centra vertigo

Answer 4

peripheral involves the vestibular structures in the ear or the vestibular nerve
central vertigo is from damage to vestibular structures in brainstem or cerebellum

Question 5

what is the most common cause of peripher vertigo

Answer 5

BPPV

Question 6

what causes BPPV

Answer 6

calcium crystals in semicircular canals

Question 7

what is a cause of vertigo that may occure after an URTI and is it peripheral or central

Answer 7

vestibular neuritis (AKA labrynthitis)
peripheral

Question 8

vestibular neuritis is inflammation of what CN

Answer 8

VIII

Question 9

how is the cause of AOM different from vestiublar neuritis

Answer 9

vestibular neuritis is usually caused by virus, AOM is usually bacterial

Question 10

what causes Menieres disease and what is another name for meniers disease

Answer 10

causes by excess endolymp in the semicurcular canals from impaired reabsorption damaging cochlea
also called endolymphatic hydrops

Question 11

what is an acoustic neuroma and does it cause central or peripheral vertigo

Answer 11

schwannoma of CN VIII (the vestibulocochlear nerve)
peripheral vertigo

Question 12

what condition would cause acoustic neuromas on both vestibulocochlear nerves

Answer 12

neurofibromatosis type 2

Question 13

what medications are toxic to the auditory system and may cause vertigo

Answer 13

aminoglycosides
phenytoin (anticonvulsants)
quinine (antimalarials)

Question 14

what is the most common cause of central veritgo

Answer 14

stroke

Question 15

what are central causes of vertigo

Answer 15

stoke
tumor to brainstem or cerebellum
MS

Question 16

true or false: both central and peripheral vertigo will have nystagmus

Answer 16

true

Question 17

what direction will the nystagmus be in peripheral vertigo?

Answer 17

horizontal
torsional
vertigo

Question 18

what direction will the nystagmus be in central

Answer 18

horizontal or torsional
NEVER vertical

Question 19

how will the results of the dix hallpike differ between central and peripheral vertigo

Answer 19

Central - no lag time, lasts >1min, provokes mild vertigo
peripheral - 2-40 second lag time, lasts <1 min, provokes severe vertigo

Question 20

what is skew deviation and when would you see it

Answer 20

during dix hallpike for a central cause
eyes move upward and rotate counter clockwise

Question 21

what are the 4 D’s of central vertigo

Answer 21

diploplia
dysphagia
dysarthria
dysmetria

Question 22

auditory symptoms like hearing loss or tinnitus are more common in central or peripheral vertigo

Answer 22

peripheral

Question 23

predictable changes in head position causing vertigo that last for less than a minute with or without n/v but without auditory symptoms is suggestive of what disorder

Answer 23

BPPV

Question 24

acute, severe, constant vertigo that lasts several days with no change with head movements, can occur at rest, with or without hearing loss is suggestive of what disorder

Answer 24

vestibular neuronitis

Question 25

what is the triad of symptoms for menieres disease

Answer 25

recurrent episodic vertigo sensorineural hearing loss tinnitus

Question 26

a sense of ear fullness or aural fullness is associated with what vertigo related disease

Answer 26

meniere disease

Question 27

what is oscillopsia and what may cause it

Answer 27

visual disturbances where it looks like environment oscilates from an impaired vestibular-ocular reflex from ear toxic medications

Question 28

what condition would cause auditory symptoms before causing vertigo

Answer 28

acoustic neuroma

Question 29

what finding during the dix hallpike maneuver would confirm BPPV

Answer 29

worsening vertigo or nystagmus on one side

Question 30

how are scwannomas diagnosed

Answer 30

brain MRI with contrast

Question 31

how is vestiublar neuritis diagnosed

Answer 31

primarily through history and physical exam, especially if recent recoverying from URTIh

Question 32

how it meniere diagnosed

Answer 32

primarily throughout history and physical

Question 33

what is the treatment of BPPV

Answer 33

Epley maneuver

Question 34

how often should the epley be done for BPPV

Answer 34

at least 3 times a day until no symptoms for 24 hours

Question 35

how is vestibular neuritis treated

Answer 35

corticosteroids

Question 36

how is lmeiere disease treated

Answer 36

1. limit salt, caffein,e alcohol and nictorine 2. diuretics like hydrochlorothiazide or acetazolamide 3. surgery - labrinthectomy

Question 37

what are the contraindications for ear irrigation (5)

Answer 37

tympanoplasty cant sit upright FB in ear otitis externa TM perforation

Question 38

what is the treatment for otitis externa

Answer 38

NSAIDs or topical anesthetics topical antibiotics (fluroquinolones like oflaxacin or ciprofloxacin Or Aminolgycosides like neumycin