Disorders II Flashcards
is endolymphatic hydrops the same as meniere’s?
not really, endolymphatic hydrops is part of meniere’s but isnt the entire picture
the 4 big symptoms of meniere’s
1) fluctuating HL
2) tinnitus
3) aural fullness
4) vertigo
most common age range for meniere’s
30-50 yrs
meniere’s: bilateral or unilateral most commonly
unilateral, but can develop into bilateral
what does a meniere’s attack look like
*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)
drop attacks with meniere’s
- 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
what will you see in between meniere’s attacks?
- maybe nothing
- maybe imbalance
- audio may or may not be abnormal depending on the stage of the disease
prognosis of meniere’s
- 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
Meniere’s treatment
- 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
what tests can be used to confirm diagnosis of menieres
- audio
- VNG
- –could be normal or abnormal depending on the stage, early stages wouldnt show a significant caloric weakness, but later stages would
- EcochG
what would be the point of serial audios with meniere’s
monitor stability of the disease
what is a perilymphatic fistula
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
symptoms of perilymphatic fistula
- 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
how to tell perilymphatic fistula from menieres?
case history
*fistula would be from surgery, injury, scuba, women in labor, weight lifting strains
case history with perilymphatic fistula would reveal
- 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)
two easy tests to check for fistula
- fistula test
- tullio test
- –intro of loud sound while observing for nystagmus, must use reflex decay
symptoms of autoimmune inner ear disease
- 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
how to determine autoimmune disorder vs others
- 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
treatment of AIED
*immunosuppressants
five other names for vestibular neuritis
- vestibular neuronitis
- neurolabyrinthitis
- viral labyrinthitis
- epidemic vertigo
- acute vestibulopathy of unknown etiology
symptoms of vestibular neuritis
- 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
where pts normally go for treatment with vestibular neuritis
- 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
vertigo with vestibular neuritis
- 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
why is longterm consumption of meclizine not a good idea with vestibular neuritis
*will not allow central compensation to occur
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
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
other name for acoustic neuroma
- vestibular schwannoma
- –although the name is vestibular schwannoma, vertigo is rarely a symptom
- –most commonly, pts present with the complaint of disequillibrium
what is an acoustic neuroma
- 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
progression of acoustic neuroma growth
- 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
what is to gold standard for diagnosis of acoustic neuroma?
and other tests to help?
- gold standard= MRI with and without contrast
* other tests are ABR, VNG, and CT
