Ears- Inner

Question 1

what are peripheral vestibular disorders?

Answer 1

• viral labyrinthitis
• bacterial labyrinthitis
• vestibular neuritis
• benign paroxysmal positional vertigo
• acoustic neuroma
• meniere disease

Question 2

what is viral labyrinthitis?

Answer 2

• URI often proceeds
• sudden unilateral HL & severe vertigo, n/v
• pt often bedridden w/sxs
• vertigo may subside after several days-wks, but unsteadiness & positional vertigo may persist for several mos

Question 3

PE findings of viral labyrinthitis?

Answer 3

• spontaneous nystagmus towards normal side
• diminished or absent caloric responses in affected ear
• hearing loss mild to moderate

Question 4

what is a unique form of viral labyrinthitis? SSxs?

Answer 4

• herpes zoster oticus (ramsay-hunt syndrome)
• reactivation of varicella-zoster virus infxn yrs after primary infxn
• SSxs: initial deep burning auricular pain followed by eruption of vesicular rash in external auditory canal and concha, vertigo, HL, facial weakness

Question 5

what is bacterial labyrinthitis?

Answer 5

• direct bac invasion or pass of bac toxins into inner ear
• meningitis affects both ears, spread via CSF
• infections of middle ear or mastoid commonly spread via dehiscent horizontal semicircular canal

Question 6

SSxs of bacterial labyrinthitis?

Answer 6

-profound HL, severe vertigo, ataxia, n/v

Question 7

what is vestibular neuritis?

Answer 7

• benign & temporary disorder of vestibular nerve
• URI often proceeds
• more common in spring & early summer
• commonly viral

Question 8

SSxs of vestibular neuritis?

Answer 8

-sudden acute vertigo w/o HL

Question 9

PE findings of vestibular neuritis?

Answer 9

• horizontal nystagmus
• some gait instability
• NO HEARING LOSS

Question 10

what is benign paroxysmal positional vertigo?

Answer 10

-sudden vertigo from provacative positions, triggering nystagmus

Question 11

what are canalithiasis?

Answer 11

• canal rocks
• particles in canal portion of SCCs, free floating & mobile
• cause vertigo by exerting a force

Question 12

what are cupulolithiasis?

Answer 12

• densities adhered to cupula of crista ampullaris

- not free floating

Question 13

risk factors for benign paroxysmal positional vertigo?

Answer 13

• inactivity
• alcohol
• caffeine
• major surgery
• CNS dz

Question 14

causes of BPPV?

Answer 14

• idiopathic
• vestibular neuritis
• head/ear trauma
• OM
• meniere disease

Question 15

SSxs of BPPV?

Answer 15

• sudden onset, while trying to sit up, lying down, rolling over in bed
• start suddenly, gone in 20-30 secs

Question 16

PE findings for BPPV?

Answer 16

• generally unremarkable

- Dix-hallpike maneuver

Question 17

what is an acoustic neuroma?

Answer 17

-benign slow growing tumor derived from schwann cells of CN 8

Question 18

SSxs of acoustic neuroma?

Answer 18

• unilateral, progressive SN hearing loss
• vertigo, tinnitus, disequilibrium
• H/A in 50-60% of pts

Question 19

what is unilateral SNHL always considered until proven otherwise?

Answer 19

ACOUSTIC NEUROMA

Question 20

what is meniere disease? cause?

Answer 20

• increased vol & pressure in endolymph in inner ear

- idiopathic

Question 21

SSxs of meniere disease?

Answer 21

• triad: waxing & waning SNHL, tinnitus & vertigo
• prodrome: fullness or blocked sensation in 1 ear
• tinnitus followed by decrease in hearing
• n/v, diarrhea, pallor, sweating w/acute attack
• vertigo w/or shortly following hearing sxs
• lasts mins-hrs or several days
• H/A, unsteady gait may persist for several days

Question 22

what is the course of meniere disease?

Answer 22

• after acute attack hearing may return to normal
• recurrence is common but unpredictable
• hearing may decrease over time

Question 23

weird sign with meniere disease?

Answer 23

-sometimes pts may experience such severe vertigo they may collapse= Tumarkin crises

Question 24

diagnostic criteria for meniere?

Answer 24

1. isolated attacks of whirling, vertigo w/n/v for at least 20 mins up to several hrs
2. tinnitus
3. SNHL

Question 25

what are the central vestibular disorders?

Answer 25

• toxic vestibulopathy

- others

Question 26

what is toxic vestibulopathy?

Answer 26

caused by toxic agents

• aminoglycoside abx
• aspirin
• alcohol