Ear Flashcards
Name some peripheral causes of vertigo?
- Benign paroxsymal positional vertigo (BPPV)
- Vestibular neuritis
- Meniere disease
- Otoscleroris
- Labrynthitis
List some central causes of vertigo?
- MS
- Acoustic neuroma
- Vestibular migraine
- CV disease
- Cerebellopontine angle and posterior fossa meningiomas
How does BPPV present?
-Episodic vertigo • sudden onset • provoked by head turning • last >30 secs • other symptoms rare (NO HEARING LOSS)
How is BPPV diagnosed?
Establish important negatives:
- NOT persistent vertigo
- NO speech, visual, motor or sensory problems
- NO tinnitus, headache, ataxia, facial numbness, dysphagia
Hallpike test +ve
What is the dix hall pike test?
How do you do it?
What is a positive test?
Dix-hallpike test is DIAGNOSTIC for BPPV
- Lower down on coach head turned to 45 degree angle
- Nystagmus=+ve test
What is the Eply manoeuvre?
Eply manoeuvre is TREATMENT for BPPV
-move head 90 degrees (from R>L) then tilt so they are looking at floor
What is an acoustic neuroma?
Usually painless benign subarachnoid tumours that cause problems by local pressure, and then behave as SOL
Rare = 1 / 100,000 / year
Where do acoustic neuromas usually arise?
Superior vestibular Schwann cell layer
Sometimes called vestibular schwannoma
How do acoustic neuromas present?
Acoustic neuroma
-Ipsilateral tinnitus +/- sensorineural deafness
(cochlear nerve vompression)
-Disequilibrium common (wobbly)
-Trigeminal compression may give numb face
-Vertigo rare
What investigations are done for an acoustic neuroma?
What is a key differential?
MRI scan for ALL PATIENTS WITH UNILATERAL TINNITUS/DEAFNESS
Key differential = meningioma
What is the management of an acoustic neuroma?
- Surgery is difficult and not often needed eg if elderly
- Methods of preserving hearing and facial nerve eg stereotactic radiosurgery
What is the symptoms of ototoxicity?
List some ototoxic drugs?
Cause bilateral tinnitis with associated hearing loss
Cisplatin and aminoglycosides (end in mycin) = permanent hearing loss
Aspirin, NSAIDs, quinine, macrolides and loop diuretics are associated with tinnitus and reversible hearing loss
Which ones cause hearing loss? Meniers BPPV Lambrynthitis Vestibular neuritis
- BPPV and Vestibular neuritis DO NOT CAUSE HEARING LOSS
- Meniers and Lambrynthitis DO CAUSE HEARING LOSS
How often is the vertigo? Meniers BPPV Lambrynthitis Vestibular neuritis
BPPV (seconds) and Meniers (minuets) = EPISODIC VERTIGO
Lambrynthitis and Vestibular neuritis = PERSISTANT VERTIGO
What is Meniere’s disease?
Disorder of the endolymph volume (labyrinthine fluid) with progressive distention of the labyrinthe
What are the symptoms of Meniere’s disease?
How long do symptoms last?
Triad of:
- Vertigo (with sickness)
- Tinnitus
- Hearing loss (sensorineural)
-Preceded by AURAL FULLNESS
-+/- nystagmus
Symptoms are episodic, lasting minutes to hours
How can you treat Meniere’s disease? (acute/prophylaxis)
Acute:
Prochlorperazine (buccal for severe sickness)
Prophylaxis:
- Betahistine 16mg/8hr po
- Limit salt intake
Surgical procedures:
Labyrinthectomy (but causes total ipsilateral deafness)
-medical (Instillation of gentamicin via grommets)
What is vestibular neuronitis/labyrinthitis?
Inflamation of inner ear (either labrynth or vestibular nerve)
How does vestibular neuronitis/labyrinthitis present?
-Sudden and severe PERSISTANT vertigo (days) • does not progressively get worse • worsened by head movements -Nausea + vomiting -Nystagmus AWAY from affected side
Neuronitis - VERTIGO with no hearing loss or tinnitus
Labyrinthitis -VERTIGO WITH hearing loss + tinnitus
(NB cochlear + SCC = labyrinth)
What are common causes of vestibular neuronitis/labyrinthitis?
-Often following URTI /herpes simplex reactivation
How do you manage vestibular neuronitis/labyrinthitis?
Reassure, could take prochlorperazine/antihistamine for vertigo
vestibular rehab if lasting 1+ week
How does acute otitis media present?
- Otalgia - might be pulling at ear
- Malaise
- Crying, poor feeding, restlessness
- Fever
- Vomiting
- Coryza/rhinorrhoea
Perforation of TM often relieves pain - a child who is screaming and distressed may settle remarkably quickly then ear starts to discharge green pus
What is the management of acute OM?
Analgesia
Acute OM resolves in 60% in 24hr with no abx
When should abx be considered in acute OM?
Immediate abx:
- Systemically unwell
- Immunocompromised
- No improvement in symptoms in >4 days
Immediate or 2 day ‘delayed’ abx:
<3 months old
Perforation / discharge
<2yrs with bilateral OM (most commonly caused by Haemophilus influenza)
What AB in otitis media?
Amoxicillin 40mg/kg/day in 3 divided doses for 5 days
Erythromycin if penicillin allergic
When would you admit a child for Otitis media? (based on temp and age)
Admission if child < 3 months with temp > 38
or
3-6 months with temp > 39 or suspected comps
What is chronic otitis media? (3 types)
1) Benign / inactive COM
- Dry tympanic membrane perforation without active infection
2) Chronic serous OM
- Continuous serous drainage
- Typically straw coloured
3) Chronic suppurative otitis media
- Persistent purulent drainage through a perforated tympanic membrane
What is the management of COM?
- Take swab
- Topical or systemic abx based on swab results
- Aural cleaning
- Water precautions
- Careful follow up
- Surgery
When is surgery considered in COM?
Aural cleaning and abx fail Persistent perforation / discharge Conductive hearing loss Chronic mastoiditis Cholesteatoma formation
What are the two surgical procedures offered in COM?
Myringoplasty = repair of tympanic membrane alone using a graft
Mastoidectomy = surgical repair of tympanic membrane and ossicles
what are the complications of otitis media? (4)
Effusion (common)
- swollen/bulging TM
- chronic inflammatory process without acute inflammation
Perforation (fairly common)
-May progress to chronic Suppurative Otitis Media
Mastoiditis
- severe pain
- forward protrusion of ear w/ tender boggy mass behind ear → can cause meningitis → UEGRNT treatment
Cholesteatoma
-keratinizing squamous epithelium colonizes middle ear due to tympanic membrane retraction
What is the leading cause of hearing loss in children?
OM with effusion (OME) = glue ear
What is the management of OME?
Usually transient, mild and resolves spontaneously
50% with bilateral will resolve within 3 months
Observation for 3 months then reassess hearing
Auto-inflation of eustation tube via a balloon through the nose can help during this period
Surgery (Tympanostomy tube / grommets)
How may a cholesteatoma present?
Foul discharge +/- deafness Headache Pain Facial paralysis Vertigo
These symptoms indicate impending CNS complications
What are risk factors for cholesteatoma?
Chronic otitis media
Trauma
What is the management for cholesteatoma?
Mastoid surgery to remove the sac of squamous debris
What do the otolith organs do?
Detect tilt and acceleration/deceleration
There are 2 otolith organs (utricle + saccule)
What do the semi-circular canals do?
Detect rotation
Control eye movements in the plane of the canal
What does dysfunction of semi-circular canals lead to?
Nystagmus
