Ear: vestibular schwannoma, acute vestibular syndrome, Meniere's disease

Question 1

Define/cause of acoustic neuroma/vestibular schwannoma?

Answer 1

Benign subarachnoid tumour that exerts local pressure effects on the VIII cranial nerve.

Slow growing tumour

Arises from schwann cells in the vestibulocochlear nerve sheath

Question 2

Presentation of acoustic neuroma/vestibular schwannoma?

Answer 2

Unilateral
Sensorineural hearing loss
progressive ipsilateral tinnitus
vertigo
headache
neurological symptoms (5,7,8th cranial nerves can be compressed if large tumour)

Question 3

Diagnosis of acoustic neuroma/vestibular schwannoma?

Answer 3

Pure tone audiometry
MRI head

Question 4

Management of acoustic neuroma/vestibular schwannoma?

Answer 4

Surgery -DEFINITIVE if tumour size >40mm

MRI scan for monitoring if tumour size <40mm

Radiotherapy?

Question 5

How is acute vestibular syndrome classified?

Answer 5

Acute vestibular syndrome can be classified into:
- vestibular neuritis
- labyrinthitis
- stroke (posterior circulation)

Question 6

Define vestibular neuritis? What is it linked to?

Answer 6

inflammation of the vestibular nerve.

linked to a viral infection.

Question 7

Define labyrinthitis? What is it linked to?

Answer 7

inflammation of the bony labyrinth of the inner ear.

this includes:
- semicircular canals
- vestibule
- cochlea

linked to viral URTI

Question 8

Presentation of acute vestibular syndrome?

Answer 8

Sudden onset
n+v
vertigo
preceding URTI
nystagmus (opposite side)

Question 9

Diagnosis/IVx of acute vestibular syndrome?

Answer 9

HINTS exam
- head impulse test
- nystagmus type
- skew

this distinguishes vestibular neuritis or labyrinthitis from stroke.

used in pts with acute, ongoing vertigo and spontaneous nystagmus.

Question 10

Management of acute vestibular syndrome?

Answer 10

Rapid symptom relief:
- buccal prochlorperazine or IM prochloperazine or cyclizine.

Less severe symptoms relief:
- oral prochlorperazine or antihistamine (e.g. cinnarizine)

Abx (for bacterial labyrinthitis or if underlying infection is otitis media, meningitis)

Refer to ENT or stroke specialist.

Question 11

Define/causes of Meniere’s disease?

Answer 11

Inner ear disorder

Caused by increased fluid pressure/dilation in/of the ENDOLYMPHATIC SPACES of the membranous labyrinth.

Question 12

Presentation of Meniere’s disease?

Answer 12

Aural fullness
Low frequency sensorineural hearing loss
n+v
vertigo episode lasts between 12-24hrs
paroxysmal vertigo
nystagmus
tinnitus

Question 13

Diagnosis/IVx of Meniere’s disease?

Answer 13

ENT exam
Romberg test
Audiometry

Question 14

Management of Meniere’s disease?

Answer 14

Prophylaxis:
- betahistine (reduces frey of attacks)

Acute:
- prochlorperazine (manage symptoms during attacks)

Diuretics
- reduce endolymphatic fluid

Low-salt diets
- reduce endolymphatic fluid
- prevent attacks