Diseases of the Inner Ear

Question 1

A generic term used to describe any number of sensations: ie giddiness, lightheadedness, mental confusion, off balance, etc

Answer 1

Dizziness

Question 2

A sensation of movement, either of oneself or their environment

Answer 2

Vertigo

Question 3

Subjective sound: ringing, roaring, buzzing, blowing, etc

Answer 3

Tinnitus

Question 4

Abnormal sensitivity to sound

Answer 4

Hyperacusis

Question 5

Gold standard for screening for hearing loss is what?

Answer 5

whispered voice test

Question 6

What is the third most common disease in elderly?

Answer 6

Hearing impairment

Question 7

Most cochlear disease results in bilateral what?

Answer 7

bilateral symmetrical SNHL

Question 8

Age-related hearing loss which affects more than half of all adults by age 75 years

Characterized by a progressive, bilateral, symmetric loss of high frequency hearing (SNHL) over many years

Answer 8

presbycusis

Question 9

What is the hallmark of presbycusis?

Answer 9

Characterized by a progressive, bilateral, symmetric loss of high frequency hearing (SNHL) over many years

Question 10

What is the most common cause of sensory hearing loss?

Answer 10

presbycusis

Question 11

In presbycusis, what is the predominantly frequency loss with advancing age?

Answer 11

high frequency

Question 12

What is the second most common cause of sensory hearing loss?

Answer 12

Noise Trauma

Question 13

Sounds greater than what dB for prolonged exposure causes noise trauma?

Answer 13

Sounds > 85 dB

Question 14

In ototoxicity, what system(s) of the ear can be affected?

Answer 14

Both auditory and vestibular systems

Question 15

What are some reversible medications responsible for ototoxicity?

Answer 15

Salicylates

ASA

NSAIDs

Question 16

What are some irreversible medications responsible for ototoxicity?

Answer 16

Aminoglycosides

Loop Diuretics

Antineoplastic agents (Cisplatin very common)

Question 17

Hearing loss that has a rapid onset, occurring over a 72 hour period

May involve one or both ears

Sudden SNHL is a subset of sudden hearing loss that is sensorineural in nature

Answer 17

Sudden Sensory Hearing Loss

Question 18

Approximately how many patients with idiopathic SSNHL will experience recovery – the recovery is often not complete?

Answer 18

two thirds

Question 19

What are the three most common causes of conductive hearing loss in children?

Answer 19

Chronic purulent otorrhea
Mastoiditis
Meningitis

Question 20

Hearing loss is common in kids with what genetic disorder?

Answer 20

Down Syndrome

Question 21

Dizziness is more common in what groups of people?

Answer 21

More common in women and the elderly

Question 22

These diagnostic groups account for >75% of the dizziness etiology

Answer 22

Peripheral vestibular disorders
Psychiatric disorders
Multiple sensory deficits

Question 23

This symptom is a cardinal symptom of vestibular disease

Answer 23

Vertigo

Question 24

Vertigo is classified into what two categories?

Answer 24

Peripheral and Central

Question 25

What type of vertigo is described below? Sudden onset Associated with tinnitus and loss of hearing Horizontal nystagmus may be present Cochlear or retrocochlear Vertigo typically occurs in ISOLATION of brainstem deficits except CN VIII

Answer 25

Peripheral

Question 26

What type of vertigo is described below? Gradual onset No auditory symptoms Typically presents with vertigo in ASSOCIATION with other brainstem deficits (may include CN VIII) Brainstem and cerebellar dysfunction Common in elderly with known cerebrovascular disease

Answer 26

Central

Question 27

When trying to determine if vertigo is peripheral or central, what is important to keep in mind?

Answer 27

Evidence of brainstem involvement rules out peripheral lesion (except advanced acoustic neuroma) Absence of brainstem symptoms DOES NOT rule out a central lesion

Question 28

Evidence of brainstem involvement rules out peripheral lesion in vertigo except what?

Answer 28

advanced acoustic neuroma

Question 29

Vertical, bi-directional or unilateral nystagmus should alert the provider to what vertigo lesion ideology?

Answer 29

central lesion ideology

Question 30

The pattern of recurrent long-standing episodes of vertigo followed by remissions suggests what disease and needs to be worked up?

Answer 30

Multiple Sclerosis

Question 31

List some causes that could cause a peripheral vertigo

Answer 31

Menieres disease Acute labyrinthitis Benign paroxysmal positional vertigo (BPPV) Vestibular neuronitis Vascular compression of the vestibular nerve Ototoxicities Acoustic neuroma Vestibular schwannoma Head trauma Perilymphatic fistula Cervical vertigo

Question 32

This condition is most commonly attributed to calcium debris within the posterior semicircular canal – canalithiasis Recurrent episodes of vertigo lasting one minute or less Episodes are provoked by specific head movements

Answer 32

Benign paroxysmal positional vertigo (BPPV)

Question 33

The following nystagmus findings is suggestive of what condition? Nystagmus begins shortly after (typically seconds) maneuver is completed (latency) and resolves within 60 seconds Fast component of the nystagmus has a characteristic mixed torsional and vertical movement

Answer 33

Benign paroxysmal positional vertigo (BPPV)

Question 34

Idiopathic endolymphatic hydrops Episodic vertigo last minutes to hours (can be disabling) Recur in several months or years No history of URI

Answer 34

Meniere’s Disease

Question 35

What is the triad in Meniere's disease?

Answer 35

Hearing loss (SNHL) Tinnitus Vertigo (and ear fullness)

Question 36

Exact etiology is unknown Recent history of viral URI followed by vertigo, tinnitus, and hearing loss Involves the cochlea and labyrinth Acute temporary vertigo, nausea,

Answer 36

Acute Labyrinthitis

Question 37

Acute labyrinthitis without cochlear involvement Single attack of vertigo, no hearing loss, and full clearing Occur in middle-aged and young adults Can last days Unknown etiology

Answer 37

Vestibular Neuronitis

Question 38

More permanent form of positional vertigo Constant positional vertigo and severe nausea “disabling positional vertigo”

Answer 38

Vascular Compression of the Vestibular Nerve

Question 39

Can injure the peripheral

Answer 39

ototoxicity

Question 40

Which two medications are the most injurious to the vestibular portion of CN VIII?

Answer 40

Streptomycin and gentamycin

Question 40

What is the most notable antineoplastic agent that causes ototoxicity?

Answer 40

Cisplatin

Question 40

What is another term for acoustic neuroma?

Answer 40

Vestibular Schwannoma

Question 40

Most worrisome peripheral lesion (retrocochlear location) Dx commonly between 30-60 years old Benign schwannoma of CN VIII Can produce serious brainstem compression Initial symptoms are the same: asymmetric hearing loss, tinnitus, vague vertigo Progressive clinical course

Answer 40

Vestibular Schwannoma

Question 41

What is the most common sign/symptom of vestibular schwannoma?

Answer 41

Unilateral SNHL, frequently accompanied by tinnitus

Question 41

What are some signs/symptoms of a vestibular schwannoma?

Answer 41

Unilateral SNHL, frequently accompanied by tinnitus Facial numbness/weakness Decreased corneal reflex Decline of speech discrimination

Question 42

What is the gold standard in diagnosing a vestibular schwannoma?

Answer 42

MRI with contrast

Question 43

What is the most common cause of vertigo post head injury?

Answer 43

Labrinthine concussion

Question 44

Leakage of perilymphatic fluid (Round or oval window) Vertigo worse with straining and SNHL Seen in divers, blunt head trauma patients, ear trauma, surgery (stapedectomy)

Answer 44

Perilymphatic Fistula

Question 45

Positional receptors Cervical proprioception dysfunction (Neck movements)

Answer 45

Cervical Vertigo

Question 46

What are some causes of central vertigo?

Answer 46

Drugs (most common cause) Multiple sclerosis Vertebrobasilar insufficiency

Question 47

What is the most common cause of central vertigo?

Answer 47

Drugs

Question 48

What are some drugs that can cause central vertigo?

Answer 48

Reticular activating system suppressants: Sedatives Antibiotics Anticonvulsants Analgesics EtOH

Question 49

Demyelination in vestibular pathway Prob. Autoimmune disease Pattern of recurrent long standing episodes followed by remissions suggests this disease

Answer 49

Multiple Sclerosis

Question 50

Usually produces vertigo in conjunction with diplopia, sensory loss, dysarthria, dysphasia, hemiparesis, and other brainstem deficits May begin as only transient vertigo, later episodes almost always include other brainstem symptoms

Answer 50

Vertebrobasilar Insufficiency