Disorders II

Question 1

is endolymphatic hydrops the same as meniere’s?

Answer 1

not really, endolymphatic hydrops is part of meniere’s but isnt the entire picture

Question 2

the 4 big symptoms of meniere’s

Answer 2

1) fluctuating HL
2) tinnitus
3) aural fullness
4) vertigo

Question 3

most common age range for meniere’s

Answer 3

30-50 yrs

Question 4

meniere’s: bilateral or unilateral most commonly

Answer 4

unilateral, but can develop into bilateral

Question 5

what does a meniere’s attack look like

Answer 5

*aural fullness begins along with a low pitched roaring tinnitus
*hearing loss will follow
*vertigo begins
—attacks of vertigo may last several minutes to hours
*nausea, vomiting and diaphoresis (excessive sweating)
*after vertigo is resolved, pt may experience imbalance that is ongoing for days
(can see word rec change before pure tones)

Question 6

drop attacks with meniere’s

Answer 6

• otolithic crisis of tumarkin
• pt drops suddenly to the floor without any warning, the pts can immediately stand up afterward and are often very embarrassed and unsteady
• can occur with meniere’s but are rare

Question 7

what will you see in between meniere’s attacks?

Answer 7

• maybe nothing
• maybe imbalance
• audio may or may not be abnormal depending on the stage of the disease

Question 8

prognosis of meniere’s

Answer 8

• pts will have repeat attacks with fluctuation in hearing often progressively worsening with each attack (remission and exacerbations)
• vertigo often causes pts to quit working as the nausea, vomiting prevents them from being productive
• eventually after years the disease will typically burn out and the pt may be left with an unusable ear and hopefully without vertigo attacks, imbalance often persists (because they now have a weakness)
• some pts may never progress past a mild to moderate loss

Question 9

Meniere’s treatment

Answer 9

• dietary
• –sodium restriction
• –elimination of caffeine
• –potassium supplements with diuretics
• surgical
• –endolymphatic shunt
• –transtymapnic injections of aminoglycosides for ablation
• –vestibular nerve sectioning
• medication
• –transtympanic injections of steroids
• –diuretics
• –use of vestibular suppressants during attacks

Question 10

what tests can be used to confirm diagnosis of menieres

Answer 10

• audio
• VNG
• –could be normal or abnormal depending on the stage, early stages wouldnt show a significant caloric weakness, but later stages would
• EcochG

Question 11

what would be the point of serial audios with meniere’s

Answer 11

monitor stability of the disease

Question 12

what is a perilymphatic fistula

Answer 12

an abnormal opening of the bony capsule or round or oval window membranes of the inner ear
—usually the result of trauma of some sort

Question 13

symptoms of perilymphatic fistula

Answer 13

• episodic vertigo
• fluctuating and progressive hearing loss
• tinnitus
• aural fullness
• may have only auditory or only vestibular symptoms, they do not have to have both

Question 14

how to tell perilymphatic fistula from menieres?

Answer 14

case history

*fistula would be from surgery, injury, scuba, women in labor, weight lifting strains

Question 15

case history with perilymphatic fistula would reveal

Answer 15

• some sort of event that was the start of symptoms
• –car accident, lifting, childbirth
• chronic balance issues with intermittent vertigo
• if experiencing auditory symptoms it is typically fluctuating and progressive
• exacerbation of dizziness with physical exercise or straining (lifting, pulling, pushing, bowel movements)

Question 16

two easy tests to check for fistula

Answer 16

• fistula test
• tullio test
• –intro of loud sound while observing for nystagmus, must use reflex decay

Question 17

symptoms of autoimmune inner ear disease

Answer 17

• typically bilateral asymmetric progressive/fluctuating SNHL
• may progress rapidly or over months to years
• may or may not experience vertigo but menieres can be a result of AIED

Question 18

how to determine autoimmune disorder vs others

Answer 18

• case history
• –if pt reports other autoimmune disorders and no other otologic cause can be pinpointed the it is likely AIED
• VNG testing will often find reduced caloric responses
• blood tests can specifically target autoimmune disorders
• –the problem is that sometimes the tests are not sensitive meaning they can show negative for a true positive

Question 19

treatment of AIED

Answer 19

*immunosuppressants

Question 20

five other names for vestibular neuritis

Answer 20

• vestibular neuronitis
• neurolabyrinthitis
• viral labyrinthitis
• epidemic vertigo
• acute vestibulopathy of unknown etiology

Question 21

symptoms of vestibular neuritis

Answer 21

• severe prolonged episode of vertigo may last several hours to days
• no hearing loss
• no neurologic symptoms
• may develop BPPV due to degeneration of the utricle which can result in the otoconia becoming dispersed

Question 22

where pts normally go for treatment with vestibular neuritis

Answer 22

• often seen in the ER because pts become violently ill from the incapacitating vertigo
• –will easily become dehydrated from significant vomiting and diaphoresis
• –nystagmus will easily be seen and friends/family members will report the pts eyes look crazy, are dancing, or are jumping
• —-beats away from the site of lesion and to the healthy ear

Question 23

vertigo with vestibular neuritis

Answer 23

• is persistent for days and will gradually improve over days but the pt will be lest with vestibular effects for weeks
• most pts will eventually become completely resolved from symptoms but how quickly they resolve is up to them (doing rehab exercises)
• key is to avoid continuation of vestibular suppressants liek meclizine and too be consistent with rehab exercises

Question 24

why is longterm consumption of meclizine not a good idea with vestibular neuritis

Answer 24

*will not allow central compensation to occur

Question 25

if there is damage to the peripheral vestibular system and one side is function while the other is impaired or non-functional, what would we expect to see in VNG testing

Answer 25

1) spontaneous nytagmus beating away from the side of the lesion
2) caloric weakness on the side of the lesion
3) positive hear shake test
4) possible positional testing will show nystagmus with fixation denied

Question 26

other name for acoustic neuroma

Answer 26

• vestibular schwannoma
• –although the name is vestibular schwannoma, vertigo is rarely a symptom
• –most commonly, pts present with the complaint of disequillibrium

Question 27

what is an acoustic neuroma

Answer 27

• a benign tumor which can become invasive if not treated

- –typically the disequillibrium is not the symptom that will cause the pt to seek medical attention

Question 28

progression of acoustic neuroma growth

Answer 28

• small tumors begin in the internal auditory canal and as it grows it becomes invasive
• –from IAC to cisternal (cerebellopontine angle)
• –to brainstem compressive
• –to hydrocephalic
• ——-auds usually become involved during the beginning stages as the cochlear and vestibular nerve become compressed (disequilibrium and progressive HL with tinnitus)
• ——- as growth continues, pt may report facial numbness, trigeminal neuralgia, headaches, vision issues, and hydrocephalus

Question 29

what is to gold standard for diagnosis of acoustic neuroma?

and other tests to help?

Answer 29

• gold standard= MRI with and without contrast

* other tests are ABR, VNG, and CT