Diseases of the Inner Ear Flashcards
A generic term used to describe any number of sensations: ie giddiness, lightheadedness, mental confusion, off balance, etc
Dizziness
A sensation of movement, either of oneself or their environment
Vertigo
Subjective sound: ringing, roaring, buzzing, blowing, etc
Tinnitus
Abnormal sensitivity to sound
Hyperacusis
Gold standard for screening for hearing loss is what?
whispered voice test
What is the third most common disease in elderly?
Hearing impairment
Most cochlear disease results in bilateral what?
bilateral symmetrical SNHL
Age-related hearing loss which affects more than half of all adults by age 75 years
Characterized by a progressive, bilateral, symmetric loss of high frequency hearing (SNHL) over many years
presbycusis
What is the hallmark of presbycusis?
Characterized by a progressive, bilateral, symmetric loss of high frequency hearing (SNHL) over many years
What is the most common cause of sensory hearing loss?
presbycusis
In presbycusis, what is the predominantly frequency loss with advancing age?
high frequency
What is the second most common cause of sensory hearing loss?
Noise Trauma
Sounds greater than what dB for prolonged exposure causes noise trauma?
Sounds > 85 dB
In ototoxicity, what system(s) of the ear can be affected?
Both auditory and vestibular systems
What are some reversible medications responsible for ototoxicity?
Salicylates
ASA
NSAIDs
What are some irreversible medications responsible for ototoxicity?
Aminoglycosides
Loop Diuretics
Antineoplastic agents (Cisplatin very common)
Hearing loss that has a rapid onset, occurring over a 72 hour period
May involve one or both ears
Sudden SNHL is a subset of sudden hearing loss that is sensorineural in nature
Sudden Sensory Hearing Loss
Approximately how many patients with idiopathic SSNHL will experience recovery – the recovery is often not complete?
two thirds
What are the three most common causes of conductive hearing loss in children?
Chronic purulent otorrhea
Mastoiditis
Meningitis
Hearing loss is common in kids with what genetic disorder?
Down Syndrome
Dizziness is more common in what groups of people?
More common in women and the elderly
These diagnostic groups account for >75% of the dizziness etiology
Peripheral vestibular disorders
Psychiatric disorders
Multiple sensory deficits
This symptom is a cardinal symptom of vestibular disease
Vertigo
Vertigo is classified into what two categories?
Peripheral and Central
What type of vertigo is described below?
Sudden onset
Associated with tinnitus and loss of hearing
Horizontal nystagmus may be present
Cochlear or retrocochlear
Vertigo typically occurs in ISOLATION of brainstem deficits except CN VIII
Peripheral
What type of vertigo is described below?
Gradual onset
No auditory symptoms
Typically presents with vertigo in ASSOCIATION with other brainstem
deficits (may include CN VIII)
Brainstem and cerebellar dysfunction
Common in elderly with known cerebrovascular disease
Central
When trying to determine if vertigo is peripheral or central, what is important to keep in mind?
Evidence of brainstem involvement rules out peripheral lesion
(except advanced acoustic neuroma)
Absence of brainstem symptoms DOES NOT rule out a central lesion
Evidence of brainstem involvement rules out peripheral lesion in vertigo except what?
advanced acoustic neuroma
Vertical, bi-directional or unilateral nystagmus should alert the
provider to what vertigo lesion ideology?
central lesion ideology
The pattern of recurrent long-standing episodes of vertigo followed by
remissions suggests what disease and needs to be worked up?
Multiple Sclerosis
List some causes that could cause a peripheral vertigo
Menieres disease
Acute labyrinthitis
Benign paroxysmal positional vertigo (BPPV)
Vestibular neuronitis
Vascular compression of the vestibular nerve
Ototoxicities
Acoustic neuroma
Vestibular schwannoma
Head trauma
Perilymphatic fistula
Cervical vertigo
This condition is most commonly attributed to calcium debris within the posterior semicircular canal – canalithiasis
Recurrent episodes of vertigo lasting one minute or less
Episodes are provoked by specific head movements
Benign paroxysmal positional vertigo (BPPV)
The following nystagmus findings is suggestive of what condition?
Nystagmus begins shortly after (typically seconds) maneuver is
completed (latency) and resolves within 60 seconds
Fast component of the nystagmus has a characteristic mixed torsional and vertical movement
Benign paroxysmal positional vertigo (BPPV)
Idiopathic endolymphatic hydrops
Episodic vertigo last minutes to hours (can be disabling)
Recur in several months or years
No history of URI
Meniere’s Disease
What is the triad in Meniere’s disease?
Hearing loss (SNHL)
Tinnitus
Vertigo (and ear fullness)
Exact etiology is unknown
Recent history of viral URI followed by vertigo, tinnitus, and hearing loss
Involves the cochlea and labyrinth
Acute temporary vertigo, nausea,
Acute Labyrinthitis
Acute labyrinthitis without cochlear involvement
Single attack of vertigo, no hearing loss, and full clearing
Occur in middle-aged and young adults
Can last days
Unknown etiology
Vestibular Neuronitis
More permanent form of positional vertigo
Constant positional vertigo and severe nausea
“disabling positional vertigo”
Vascular Compression of the Vestibular Nerve
Can injure the peripheral
ototoxicity
Which two medications are the most injurious to the vestibular portion of CN VIII?
Streptomycin and gentamycin
What is the most notable antineoplastic agent that causes ototoxicity?
Cisplatin
What is another term for acoustic neuroma?
Vestibular Schwannoma
Most worrisome peripheral lesion (retrocochlear location)
Dx commonly between 30-60 years old
Benign schwannoma of CN VIII
Can produce serious brainstem compression
Initial symptoms are the same: asymmetric hearing loss, tinnitus, vague vertigo
Progressive clinical course
Vestibular Schwannoma
What is the most common sign/symptom of vestibular schwannoma?
Unilateral SNHL, frequently accompanied by tinnitus
What are some signs/symptoms of a vestibular schwannoma?
Unilateral SNHL, frequently accompanied by tinnitus
Facial numbness/weakness
Decreased corneal reflex
Decline of speech discrimination
What is the gold standard in diagnosing a vestibular schwannoma?
MRI with contrast
What is the most common cause of vertigo post head injury?
Labrinthine concussion
Leakage of perilymphatic fluid (Round or oval window)
Vertigo worse with straining and SNHL
Seen in divers, blunt head trauma patients, ear trauma, surgery (stapedectomy)
Perilymphatic Fistula
Positional receptors
Cervical proprioception dysfunction (Neck movements)
Cervical Vertigo
What are some causes of central vertigo?
Drugs (most common cause)
Multiple sclerosis
Vertebrobasilar insufficiency
What is the most common cause of central vertigo?
Drugs
What are some drugs that can cause central vertigo?
Reticular activating system suppressants:
Sedatives
Antibiotics
Anticonvulsants
Analgesics
EtOH
Demyelination in vestibular pathway
Prob. Autoimmune disease
Pattern of recurrent long standing episodes followed by remissions
suggests this disease
Multiple Sclerosis
Usually produces vertigo in conjunction with diplopia, sensory loss, dysarthria, dysphasia, hemiparesis, and other brainstem deficits
May begin as only transient vertigo, later episodes almost always include other brainstem symptoms
Vertebrobasilar Insufficiency
