Inner Ear

Question 1

What are some common causes of hearing loss?

Answer 1

Presbycusis, noise exposure, congenital, trauma, ototoxic medications, infection, others

Question 2

What are some ototoxic medications?

Answer 2

Antibiotics, NSAIDS, salicylates, chemotherapy, loop diuretics

Question 3

What are the three types of hearing loss?

Answer 3

Conductive (infection, fluid, wax, perforation, ossicular problems), sensorineural (aging, noise exposure, retro cochlear tumors), mixed

Question 4

What tests can you use for unilateral hearing loss?

Answer 4

Rinne & weber

Question 5

What type of hearing loss is it if the vibration is heard louder on the affected side?

Answer 5

Conductive

Question 6

What type of hearing loss is it if you hear the vibration louder on the normal side?

Answer 6

Sensorial

Question 7

What is sensorineural hearing loss?

Answer 7

damage to inner ear (cochlea) or nerve pathways

Question 8

What is presbycusis?

Answer 8

Natural old age hearing loss

Question 9

What is sudden sensorineural hearing loss?

Answer 9

occurs within a 72 hour window, which affects >3 frequencies, usually unilateral, DIZZINESS IS IMPORTANT
Abnormal functioning

Question 10

How do you treat a patient with sudden sensorineural hearing loss?

Answer 10

Send to audiologist, then ENT, possible treatment with intratympanic corticosteroids within 2 weeks

Must consider MRI to rule out tumor for unilateral, but this is after audiology

Question 11

What is a vestibular schwannoma?

Answer 11

benign tumor of 8th cranial nerve

Question 12

What is the clinical presentation of vestibular schwannoma?

Answer 12

unilateral hearing loss, tinnitus, vertigo, loss of balance (may be continuous), headache, facial paresis, sensorineural hearing loss

Question 13

How do you diagnose vestibular schwannoma?

Answer 13

MRI w/ contrast – ANYONE should be evaluated for unilateral mass lesion

Question 14

How do you treat vestibular schwannoma?

Answer 14

Surgery or monitoring, radiation (could not grow very much), refer to ENT!

Question 15

When do you make an ENT referral?

Answer 15

• can’t remove a foreign body
• sudden hearing loss with normal exam and no symptoms of infection (includes tinnitus), see ENT within a week

Question 16

What is tinnitus?

Answer 16

sensation of sound when there is no sound, “ringing”, which often indicates hearing loss, either from blockage, effusion, etc.

Question 17

What is pulsatile tinnitus?

Answer 17

When you hear blood movement within the ear..this requires a LOT of testing to rule out aneurysms, cancer…

Question 18

What is vertigo?

Answer 18

A false sensation of movement “spinning”, may accompany difficulty with balance
Giddy = asian culture

NOT a diagnosis

Question 19

What of the vestibular system is involved in balance?

Answer 19

Inner ear – semicircular canals & vestibule
8th cranial nerve
vestibular nuclei in brain stem

Question 20

What is the difference between peripheral vertigo and central vertigo?

Answer 20

Peripheral is sudden onset, unidirectional nystagmus, worsened by certain positions, and no neurological symptoms.

Central can be gradual or subtle, vertical nystagmus is RED FLAG, not improved with different positions, and associated w neurological symptoms

Question 21

What is benign paroxysmal positional vertigo?

Answer 21

recurrent spells of vertigo related to otoconia positioning within a semicircular canal, changing of head

Question 22

How do you treat BPPRV?

Answer 22

Physical therapy – Dix-Hallpike for DIAGNOSIS, Eply manuever for TREATMENT

Most get better on their own! Recurrent needs MRI to rule out tumors!

Cannot prescribe meclizine

Question 23

What are the causes of peripheral vertigo?

Answer 23

BBPV, Meniere disease, vestibular neuronitis, ethanol intoxication, barotrauma, semicircular canal dehiscence, vestibular weakness

Question 24

What are the causes of mixed peripheral and central vertigo?

Answer 24

Migraine, CVA, meningioma, vestibular scwhannoma, lyme disease, syphilis, hypothyroidism

Question 25

What cannot you prescribe for BPPV

Answer 25

Meclizine as it can delay recovery although have more immediate relief

Question 26

What is Meniere's disease?

Answer 26

extra fluid in the endolymphatic sac

Question 27

What symptoms would indicate Meniere's disease?

Answer 27

leading to episodic vertigo (20 min to several hours) and LOW frequency sensorineural hearing loss, tinnitus (blowing), vertigo, unilateral ear pressure

Question 28

How do you treat Meniere's disease?

Answer 28

Low salt diet, diuretics (acetazolamide, vasopressin) ENT specific: intratympanic steroid injections, sac decompression, vestibular ablation (refer to ENT) and remember MRI to rule out tumor :)

Question 29

What is labryinthitis?

Answer 29

Inflammation of the whole inner ear pretty much

Question 30

What symptoms indicate labryinthitis?

Answer 30

Hearing loss and tinnitus, onset of continuous, SEVERE vertigo

Question 31

How do you treat labyrinthitis?

Answer 31

Febrile = antibiotics Valium or Meclizine can help during acute attacks Steroid injection

Question 32

What is vestibular neuronitis?

Answer 32

inflammation of vestibular portion of the NERVE

Question 33

What symptoms indicate vestibular neuronitis?

Answer 33

vertigo WITHOUT auditory impairment, maybe nystagmus, may last several days to a week

Question 34

How do you treat vestibular neuronitis?

Answer 34

supportive care, Valium or Meclizine, therapy

Question 35

What are central causes of vertigo?

Answer 35

Some sort of brain issue - seizure, MS, tumors, cerebellar ataxia syndrome, brainstem vascular disease, chiari malformation

Question 36

What are signs and symptoms of central hearing impairment?

Answer 36

Gradual onset Nystagmus vertical, auditory function is normal, gait and balance dysfunction, signs of brainstem dysfunction

Question 37

What does a good physical exam of vertigo include?

Answer 37

Nystagmus, ENT systems, cranial nerve exam, cerebellar function (assess gait etc), romberg testing, dix hallpike, vitals, orthostatics

Question 38

What are red flags during an exam of vertigo?

Answer 38

Ataxia, head or neck pain, loss of consciousness, focal neurological deficit, severe symptoms for >1 hour, vertical nystagmus

Question 39

What are some additional tests for vertigo if needed?

Answer 39

Glucose, pregnancy, MRI with contrast, arrhythmias? IF chronic vertigo and bilateral hearing loss --> syphilis serology

Question 40

What ROS for the ear should you do?

Answer 40

Changes in hearing, vision or medications? Recent URI? Sound exposure? Head injury? Exacerbating/remitting factors? History of vascular anomaly? Prior ear/head surgeries? Pain? Tinnitus? Dizziness? Family history of ear issues?