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Neurology and Special Senses > Inner Ear > Flashcards

Inner Ear Flashcards

(53 cards)

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1
Q

Where is the inner ear?

A

Petrous part of temporal bone

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2
Q

What does the inner ear consist of?

A

Vestibule and semicircular canals

Cochlea

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3
Q

What is the function of the oval window?

A

Transmit vibrations from stapes into cochlea. This moves perilymph which causes hair cells on the tectorial membrane to vibrate at different frequencies and send impulses down CNVIII. The pressure change is compensated by the round window

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4
Q

What is the membranous labyrinth?

A

Labyrinth of endolymph that is surrounded by a bony labyrinth. It is suspended in perilymph

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5
Q

What is the difference between endolymph and perilymph?

A

Endolymph resembles intracellular fluid

Perilymph resembles CSF

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6
Q

How can the vestibular system be divided?

A

Semicircular canals
Utricle
Saccule

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7
Q

How do the semicircular canals exist with respect to one another? What do they detect?

A

3 canals all 90 degrees from one another

They detect rotatory movement

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8
Q

What to the utricle and saccule detect?

A

Linear motion

Utricle - point up - detect horizontal motion
Saccule - stick out to Side - verticle motion

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9
Q

How is balance maintained?

A

Input from vestibular system integrated centrally with proprioceptive and visual inputs

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10
Q

What is vertigo?

A

“Hallucination of movement” -symptom of dizziness associated with vestibular system

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11
Q

What central causes could lead to vertigo?

A 
Stroke
Migraine
Neoplasms
Demyelination
Drugs
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12
Q

What are possible peripheral causes of vertigo?

A

BPPV
Meniere’s disease
Vestibular neuritis

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13
Q

What is BPPV?

A

Benign Paroxysmal Positional Vertigo

Vertigo associated with particular head movements that last a short time

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14
Q

What causes BPPV?

A

Otoliths (crystals) in the semicircular canals (commonly posterior) leading to abnormal stimulation of hair cells

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15
Q

How is BPPV described?

A

Spinning sensation upon moving head
Associated with nausea
Rapid onset, last 30s then stop

No vomiting, pain, tinnitus or hearing loss

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16
Q

How is BPPV diagnosed?

A

Dix-Hallpike test

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17
Q

How is BPPV treated?

A

Epley manoevre

Brandt Daroff exercises

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18
Q

What is Dix Hallpike test?

A

Patient lowered quickly to supine and neck extended to 30 degrees

If vertigo symptoms + nystagmus –> BPPV

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19
Q

What is epley manoevre?

A

Manoeuvring into various positions to treat BPPV by relocating particles in the semicircular canals

https://en.wikipedia.org/wiki/Epley_maneuver

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20
Q

What is the pathophysiology of Meniere’s disease?

A

Increased endolymph causes distention of membranous labyrinth which compress vestibular system

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21
Q

What are the clinical features of Meniere’s?

A

Tinnitus in affected ear

Episodic vertigo with N&V - last minutes to hours

Fluctuating sensorineural hearing loss which can become permanent

Aural fullness

Lasts minutes to hours

Well between attacks

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22
Q

How does Meniere’s disease progress?

Study These Flashcards
A

Initially patients are well between attacks

As it progresses patients feel unsteady between attacks.
Reduced vestibular function and progressive sensorineural hearing loss

Over time, disease burn itself out so don’t get acute vertigo but still have reduced hearing and general unbalanced feeling

23
Q

What are the 3 parts of management for Meniere’s disease?

Study These Flashcards
A

Dietary changes
Medical intervention
Surgical intervention

Safety advice and support

24
Q

What dietary changes are suggested for Meniere’s disease?

Study These Flashcards
A

Reduce SACCC:

Salt
Alcohol
Chocolate
Caffeine
Chinese food
25
What medical interventions are used in Meniere's disease?
Thiazides - bendroflumathiazide Betahistine (antivertigo) Antiemetic - prochlorperazine
26
What surgical interventions are used in Meniere's disease?
``` Grommets Dexamethasone middle ear injection Endolymph sac decompression Vestibular destruction using middle ear gentamicin injection Surgical labyrinthectomy (rare) ```
27
How does vestibular neuritis/labyrinthitis cause vertigo?
Vestibular neuritis - herpes simplex affects the vestibular nerve Labyrinthitis - inflammation of the membranous labyrinth due to prior URT infection Inflammation of the middle ear cause severe incapacitating vertigo with N&V lasting several days
28
What would you see on examination of a patient suffering from vestibular neuritis?
Sudden, constant severe vertigo Worse with head movement Horizontal Nystagmus during attacks Lasts for days Hearing loss and tinnitus
29
How is an acute vestibular neuritis investigated?
MRI to exclude acoustic neuroma
30
What is labyrinthitis?
Inflammatory disorder of the membranous labyrinth that effects the cochlear and vestibular end organs
31
Describe the process of sound transmission to hearing in the cochlea
Stapes articulate with oval window with pass vibrations into Scala vestibuli Movement of perilymph and pressure changes (compensated by round window) Vibrations transmit endolymph to tectorial membrane Movement of tectorial membrane move hair cells Inner hair cells move in response to endolymph to detect sound, Outer stereocilia amplify sound
32
What risk factors are associated with Menieres disease?
Genetics Allergy Autoimmune
33
How is vestibular neuritis managed?
Urgent ENT referral if sudden onset unilateral hearing loss Encourage to be as active as possible Antiemetic - prochlorperazine
34
What is an acoustic neuroma?
Tumour of vestibular cochlear nerve arising from Schwann cells
35
What risk factors are associated with acoustic neuromas?
Neurofibromatosis | High dose head/neck radiation
36
How does acoustic neuroma present?
Unilateral progressive hearing loss Fluctuations in hearing Balance disturbance Tinnitus
37
How are acoustic neuromas managed?
Wait and see if it grows Surgery Targeted radiation
38
What is the Unterberger Test?
Patient walk on spot with eyes shut - rotate head to side of labyrinth lesion
39
What is Romberg's test?
Feel together, eyes closed Taken away sight leaves only vestibular and proprioception. If dysfunction in one of these then likely to become unbalanced - e.g. dorsal columns issue or vestibular issue
40
How is degree of hearing loss characterised?
Mild - 20-40dB - can't hear whispers Moderate - 40-70dB - can't hear conversation Severe 70-90dB - can't hear shouting Profound - >95dB - can't hear sounds that would normally be painful
41
What key questions may you ask if someone has hearing loss?
How well do you cope with background noise How well do you hear someone sat next to you Secondary symptoms Past ear history Ototoxic drugs Exposure to noisy environments
42
What conductive causes may there be for hearing loss??
External canal - obstruction (painless), growths, infection TM - rupture (painful), tympanosclerosis Middle ear - cholesteatoma (progressive), otosclerosis (painless, progressive), infection Other - adenoids (painless, bilateral), TMJ syndrome (pain in ears, jaw, neck and head)
43
What sensorineural causes may lead to hearing loss?
Presbyacusis Noise induced Ototoxic - aminoglyocsies, cisplatin, salicylates, quinine, loop diuretics Autoimmune - present like menieres Idiopathic Perilymph fistula Systemic - meningitis, diabetes, MS, MD
44
What pattern of hearing loss is seen with noise induced?
Bilateral gradual or Acute with tinnitus
45
What pattern of hearing loss is seen with ototoxic drug induced?
Gradual Fullness Tinnitus Balance problems
46
How does autoimmune sensorineural hearing loss present?
Like Menieres disease
47
How does idiopathic hearing loss present?
Sudden onset, unilateral Tinnitus Fullness Vertigo
48
When should hearing loss be referred?
Sudden onset unilateral - ENT 50-80 no underlying pathology - hearing aids Slight hearing difficulty and unwilling to have hearing aid - watchful waiting Tinnitus >5mins - audiology Mix of problems or under 50 - ENT
49
What characterises sudden onset hearing loss?
>30dB in 72 hours
50
What may idiopathic sudden onset hearing loss be associated with?
Vertigo Aural fullness Tinnitus Diagnosis of exclusion but don't delay management with investigations
51
How is idiopathic sudden onset hearing loss managed?
14 days oral prednisolone If it doesn't work then refer for intratympanic steroids 50% get hearing back within 2 weeks
52
What are the red flags for sudden onset hearing loss?
Concurrent head trauma Neurological signs Unilateral middle ear effusion
53
How is sudden onset hearing loss investigated?
Examine - lymph nodes, cranial nerves, otoscope, tuning fork Pure tone audiometry Tympanometry Flexible nasoendoscopy MRI

Neurology and Special Senses (28 decks)

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