4.4 Hearing Loss and Vertigo

Question 1

Sensorineural vs conductive hearing loss

Answer 1

Conductive: sound cannot reach the inner ear (e.g. wax)

Sensorineural: Problem of inner ear, cochlear nerve, or central processing of sounds in the brain itself

Question 2

Explain weber’s test, and how to interpret results

Answer 2

• Place a vibrating tuning fork along the midline, and ask which ear is louder
• In sensorineural hearing loss, the better ear will hear it louder (since the vibration reaches the inner ear)
• In conductive hearing loss, the sound is localised to the poorer hearing ear, the sound is amplified since the vibration is stuck in the skull

Question 3

In Rinne’s test, a patient hears the bone conduction sound louder than the air conduction sound. What does this indicate?

Answer 3

Conductive hearing loss; the sound reaches the ear better through the vibrations of the skull, since there is a blockage of the ear canal, and the inner ear is functioning normally.

Question 4

What does impedance audiometry measure?

Answer 4

The ability of the middle ear to transmit sound to the inner ear

Question 5

What three systems contribute to balance?

Answer 5

• Proprioception
• Vestibular system
• Oculomotor system

Question 6

What is nystagmus?

Answer 6

Periodic, rhythmic oscillation of the eyes

Question 7

What questions might you ask in a vertigo history?

Answer 7

• Single or multiple episodes?
• Duration?
• Frequency?
• Triggers?

Question 8

In a clinical setting, what examinations might be indicated by vertigo?

Answer 8

• Posture & gait testing
• Oculomotor tests
• Cerebellar tests

Question 9

Describe the head impulse test

Answer 9

• Patient focuses on examiner’s nose
• Head is turned sharply
• In abnormal test, there is a corrective saccade (eyes need to refocus on nose); normally, they remain focussed

Question 10

Describe the Dix Hallpike test

Answer 10

Patient leans back with head tilted down 30° and head to the side. Check for nystagmus.