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ENT > Diseases of the Inner Ear > Flashcards

Diseases of the Inner Ear Flashcards

1
Q

A generic term used to describe any number of sensations: ie giddiness, lightheadedness, mental confusion, off balance, etc

A

Dizziness

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2
Q

A sensation of movement, either of oneself or their environment

A

Vertigo

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3
Q

Subjective sound: ringing, roaring, buzzing, blowing, etc

A

Tinnitus

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4
Q

Abnormal sensitivity to sound

A

Hyperacusis

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5
Q

Gold standard for screening for hearing loss is what?

A

whispered voice test

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6
Q

What is the third most common disease in elderly?

A

Hearing impairment

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7
Q

Most cochlear disease results in bilateral what?

A

bilateral symmetrical SNHL

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8
Q

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

A

presbycusis

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9
Q

What is the hallmark of presbycusis?

A

Characterized by a progressive, bilateral, symmetric loss of high frequency hearing (SNHL) over many years

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10
Q

What is the most common cause of sensory hearing loss?

A

presbycusis

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11
Q

In presbycusis, what is the predominantly frequency loss with advancing age?

A

high frequency

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12
Q

What is the second most common cause of sensory hearing loss?

A

Noise Trauma

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13
Q

Sounds greater than what dB for prolonged exposure causes noise trauma?

A

Sounds > 85 dB

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14
Q

In ototoxicity, what system(s) of the ear can be affected?

A

Both auditory and vestibular systems

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15
Q

What are some reversible medications responsible for ototoxicity?

A

Salicylates

ASA

NSAIDs

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16
Q

What are some irreversible medications responsible for ototoxicity?

A

Aminoglycosides

Loop Diuretics

Antineoplastic agents (Cisplatin very common)

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17
Q

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

A

Sudden Sensory Hearing Loss

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18
Q

Approximately how many patients with idiopathic SSNHL will experience recovery – the recovery is often not complete?

A

two thirds

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19
Q

What are the three most common causes of conductive hearing loss in children?

A

Chronic purulent otorrhea
Mastoiditis
Meningitis

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20
Q

Hearing loss is common in kids with what genetic disorder?

A

Down Syndrome

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21
Q

Dizziness is more common in what groups of people?

A

More common in women and the elderly

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22
Q

These diagnostic groups account for >75% of the dizziness etiology

A

Peripheral vestibular disorders
Psychiatric disorders
Multiple sensory deficits

23
Q

This symptom is a cardinal symptom of vestibular disease

A

Vertigo

24
Q

Vertigo is classified into what two categories?

A

Peripheral and Central

25
Q

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

A

Peripheral

26
Q

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

A

Central

27
Q

When trying to determine if vertigo is peripheral or central, what is important to keep in mind?

A

Evidence of brainstem involvement rules out peripheral lesion
(except advanced acoustic neuroma)

Absence of brainstem symptoms DOES NOT rule out a central lesion

28
Q

Evidence of brainstem involvement rules out peripheral lesion in vertigo except what?

A

advanced acoustic neuroma

29
Q

Vertical, bi-directional or unilateral nystagmus should alert the
provider to what vertigo lesion ideology?

A

central lesion ideology

30
Q

The pattern of recurrent long-standing episodes of vertigo followed by
remissions suggests what disease and needs to be worked up?

A

Multiple Sclerosis

31
Q

List some causes that could cause a peripheral vertigo

A

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

32
Q

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

A

Benign paroxysmal positional vertigo (BPPV)

33
Q

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

A

Benign paroxysmal positional vertigo (BPPV)

34
Q

Idiopathic endolymphatic hydrops

Episodic vertigo last minutes to hours (can be disabling)

Recur in several months or years

No history of URI

A

Meniere’s Disease

35
Q

What is the triad in Meniere’s disease?

A

Hearing loss (SNHL)

Tinnitus

Vertigo (and ear fullness)

36
Q

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,

A

Acute Labyrinthitis

37
Q

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

A

Vestibular Neuronitis

38
Q

More permanent form of positional vertigo

Constant positional vertigo and severe nausea

“disabling positional vertigo”

A

Vascular Compression of the Vestibular Nerve

39
Q

Can injure the peripheral

A

ototoxicity

40
Q

Which two medications are the most injurious to the vestibular portion of CN VIII?

A

Streptomycin and gentamycin

40
Q

What is the most notable antineoplastic agent that causes ototoxicity?

A

Cisplatin

40
Q

What is another term for acoustic neuroma?

A

Vestibular Schwannoma

40
Q

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

A

Vestibular Schwannoma

41
Q

What is the most common sign/symptom of vestibular schwannoma?

A

Unilateral SNHL, frequently accompanied by tinnitus

41
Q

What are some signs/symptoms of a vestibular schwannoma?

A

Unilateral SNHL, frequently accompanied by tinnitus
Facial numbness/weakness
Decreased corneal reflex
Decline of speech discrimination

42
Q

What is the gold standard in diagnosing a vestibular schwannoma?

A

MRI with contrast

43
Q

What is the most common cause of vertigo post head injury?

A

Labrinthine concussion

44
Q

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)

A

Perilymphatic Fistula

45
Q

Positional receptors

Cervical proprioception dysfunction (Neck movements)

A

Cervical Vertigo

46
Q

What are some causes of central vertigo?

A

Drugs (most common cause)
Multiple sclerosis
Vertebrobasilar insufficiency

47
Q

What is the most common cause of central vertigo?

A

Drugs

48
Q

What are some drugs that can cause central vertigo?

A

Reticular activating system suppressants:

Sedatives
Antibiotics
Anticonvulsants
Analgesics
EtOH

49
Q

Demyelination in vestibular pathway

Prob. Autoimmune disease

Pattern of recurrent long standing episodes followed by remissions
suggests this disease

A

Multiple Sclerosis

50
Q

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

A

Vertebrobasilar Insufficiency

ENT (13 decks)

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