Ear

Question 1

What is tinnitus?

Answer 1

Noises in the ear, real or imagined caused by prolonged exposure to noise that is high intensity

Question 2

Name 3 places that objective sounds can come from?

Answer 2

1. the temporo-mandibular joint
2. eustachian tube
3. carotid artery

Question 3

What is the difference between objective and subjective tinnitus?

Answer 3

Subjective means that it can only be heard by the patient and objective means that other people can also hear the sound

Question 4

What presentation of tinnitus requires a full neurological work-up and investigation?

Answer 4

Unilateral symptoms accompanied by hearing loss requires a MRI scan

Question 5

What kind of sounds does the patient hear on subjective tinnitus?

Answer 5

• rushing
• hissing
• buzzing

Question 6

What are the external ear causes of tinnitus?

Answer 6

wax

Question 7

What are the middle ear causes of tinnitus?

Answer 7

• otosclerosis

- middle ear effusion

Question 8

What are the inner ear causes of tinnitus?

Answer 8

• presbyacusis
• noise induced hearing loss
• ototoxic drugs such as aminoglycosides, loop diuretics, quinines
• menieres disease
• labyrinthitis
• trauma

Question 9

What is the Mx of tinnitus?

Answer 9

• Most patients can live with it and can manage it
• some use tinnitus masking devices
• some surgery
• psychotherapy could also be useful

Question 10

How do we separate the causes of vertigo?

Answer 10

1. Central

2. Peripheral/otological causes

Question 11

What is the definition of vertigo?

Answer 11

Hallucination of movement

Question 12

What are the inputs that contribute to equilibrium?

Answer 12

1. Eyes
2. Ears
3. Joint proprioception
4. Higher centres-cerebellum, cortex

Question 13

When considering peripheral causes of dysequilibrium, name some major causes?

Answer 13

1. Benign paroxysmal positional vertigo
2. Menieres disease
3. Labyrinthitis
4. Acoustic Neuroma
5. fistula
6. fracture of the petrous temporal bone
7. alcohol/ anticonvulsants/tranquilisers/vestibulotoxins

Question 14

When considering central causes of dysequilibrium name some major causes?

Answer 14

1. cerebellum- cerebellitis
2. CVA
3. boxers
4. age
5. multplie sclerosis

Question 15

What is the classical triad of Menieres disease?

Answer 15

1. Sensorineural hearing
2. tinnitus
3. vertigo
   pneumonic: MEN get STV’s

Question 16

What is true vertigo and how does it present?

Answer 16

It is vestibular/peripheral vertigo

1. It is episodic
2. severe
3. nystagmus starts 2-20 seconds after
4. lasts less than 1 minute
5. patient fatigues with repetition
6. Usually with nausea and vomiting

Question 17

What is not true vertigo?

Answer 17

It is central vertigo

1. It is constant
2. less severe
3. Nystagmus starts immediately
4. Patient does not fatigue after the episode

Question 18

What is labyrinthitis and what are the features?

Answer 18

It is infection of the labyrinth from viral/bacterial components or destruction of the cochlea
It presents with rapid nystagmus, vertigo and hearing loss if it affects the cochlea

Question 19

What is the Rx of labyrinthitis?

Answer 19

Viral: bed rest, steroids for the SNHL, monitor
bacterial: treat choleastatoma or middle ear infection

Question 20

What is vestibular neuritis and what is the Rx?

Answer 20

It is inflammation of the nerve that gives the signal from the ears to the brain
-presents with nystagmus, no hearing loss, debilitating continuous vertigo
Rx: mobilise the patient to allow for central compensation
-it takes days to weeks to gradually improve

Question 21

What is the management for menieres disease?

Answer 21

1. stopping smoking, caffeine and salt intake
2. Give diuretics to drain the endolymph fluid and betahistine which is a vasodilator
3. surgery: labyrinthectomy, vestibular neurectomy