Cholesteatoma and mastoiditis Flashcards

Question

Whare are the investigations for otosclerosis?

Answer 1

Audiometry is the primary investigation of choice. Tuning fork test

Answer 2

Hearing aid Stapedectomy - Can cause total unilateral sensorineural hearing loss (rare) - Facial nerve injury may occur - Disturbance of taste sensation

Answer 3

Labyrinthitis is an inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs. Labyrinthitis can be viral, bacterial or associated with systemic diseases. Viral labyrinthitis is the most common form of labyrinthitis. Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.

Answer 4

Labyrinthitis should be distinguished from vestibular neuritis as there are important differences: vestibular neuritis is used to define cases in which only the vestibular nerve is involved, hence there is no hearing impairment;

Answer 5

The average age of presentation is 40-70 years Patients typically present with an acute onset of: - Vertigo: not triggered by movement but exacerbated by movement - Nausea and vomiting - Hearing loss: may be unilateral or bilateral, with varying severity - Tinnitus - Preceding or concurrent symptoms of upper respiratory tract infection Signs of labyrinthitis: - Spontaneous unidirectional horizontal nystagmus towards the unaffected side - Sensorineural hearing loss: shown by Rinne's test and Weber test - Abnormal head impulse test: signifies an impaired vestibulo-ocular reflex - Gait disturbance: the patient may fall towards the affected side The diagnosis is largely based on history and examination.

Answer 6

Episodes are usually self-limiting Prochlorperazine or antihistamines may help reduce the sensation of dizziness

Answer 7

Vestibular neuronitis is a cause of vertigo that often develops following a viral infection.

Answer 8

Recurrent vertigo attacks lasting hours or days Nausea and vomiting may be present Horizontal nystagmus is usually present No hearing loss or tinnitus

Answer 9

Viral labyrinthitis Posterior circulation stroke: the HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

Answer 10

Vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms Buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases A short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases

Answer 11

Meniere's disease is a disorder of the inner ear of unknown cause. It is characterised by excessive pressure and progressive dilation of the endolymphatic system. It is more common in middle-aged adults but may be seen at any age. Meniere's disease has a similar prevalence in both men and women.

Answer 12

Recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom A sensation of aural fullness or pressure is now recognised as being common Other features include nystagmus and a positive Romberg test Episodes last minutes to hours Typically symptoms are unilateral but bilateral symptoms may develop after a number of years

Answer 13

Symptoms resolve in the majority of patients after 5-10 years The majority of patients will be left with a degree of hearing loss Psychological distress is common

Answer 14

ENT assessment is required to confirm the diagnosis Patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved Acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required Prevention: betahistine and vestibular rehabilitation exercises may be of benefit

Answer 15

Vestibular schwannomas (sometimes referred to as acoustic neuromas) account for approximately 5% of intracranial tumours and 90% of cerebellopontine angle tumours.

Answer 16

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex. Features can be predicted by the affected cranial nerves: Cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus Cranial nerve V: absent corneal reflex Cranial nerve VII: facial palsy Bilateral vestibular schwannomas are seen in neurofibromatosis type 2.

Answer 17

Patients with a suspected vestibular schwannoma should be referred urgently to ENT. It should be noted though that the tumours are often slow-growing, benign and often observed initially. MRI of the cerebellopontine angle is the investigation of choice. Audiometry is also important as only 5% of patients will have a normal audiogram. Management is with either surgery, radiotherapy or observation.