EENT #6 (Ears) Flashcards
Tympanic membrane rupture MC occurs due to ________ and MC occurs at what location?
Penetrating or noise trauma
Pars tensa
Symptoms of TM perforation
- Acute ear pain, hearing loss
- Sudden pain relief with bloody otorrhea
- Tinnitus and vertigo
Although most TM perforations heal spontaneously, what should always be remembered if prescribing antibiotics for the ear?
Do not give aminoglycosides or water. They are ototoxic
What is a cholesteatoma
-Abnormal keratinized collection of desquamated squamous epithelium in the middle ear that can lead to bony erosion of the mastoid
What is a cholesteatoma MC from?
Chronic middle ear disease or Eustachian tube dysfunction
Symptoms of a cholesteatoma
- Painless otorrhea (brown or yellow discharge with a strong odor)
- May develop peripheral vertigo, tinnitus, dizziness, or cranial nerve palsies
What is seen on otoscopy of a patient with a cholesteatoma?
-Granulation tissue (cellular debris) and may have TM perforation
True or False: A patient with a cholesteatoma will have conductive hearing loss?
True
Management of a cholesteatoma
-Surgical excision of debris and cholesteatoma with reconstruction of the ossicles
What is otosclerosis?
Abnormal bony overgrowth of the footplate of the stapes leading to conductive hearing loss
Otosclerosis is what type of genetic inheritance pattern?
Autosomal dominant (may have family history of conductive hearing loss)
Symptoms of otosclerosis
- Slowly progressive conductive hearing loss (especially low frequencies)
- Tinnitus
- Vertigo is UNCOMMON
Although conductive hearing loss is one way to diagnose otosclerosis, what is the most USEFUL?
Tone audiometry
Management for otosclerosis
- Stapedectomy with prosthesis or hearing amplification (hearing aid)
- Cochlear implantation if severe
What is the difference in nystagmus with peripheral vertigo vs central vertigo?
Peripheral: Horizontal nystagmus (beats away from affected side, fatiguable)
Central: Vertical nystagmus (nonfatiguable and continuous)
What are some causes of peripheral vertigo?
BPPV (MC) Meniere Vestibular Neuritis Labyrinthitis Cholesteatoma
Nausea and vomiting is caused by sensory conflict mediated by which neurotransmitters (5)
GABA Acetylcholine Histamine Dopamine Serotonin
What is the first line medication for vertigo?
Meclizine
Scopolamine
Dimenhydrinate
Diphenhydramine
Contraindications for antihistamines/anticholinergics such as Meclizine and Scopolamine?
Acute narrow angle glaucoma, BPH with urinary retention
What is the mechanism of action of ondansetron and granisetron?
Blocks serotonin receptors both centrally and peripherally in the medulla (suppressing the vomiting center)
Benign Paroxysmal Positional Vertigo is a type of peripheral vertigo that most commonly is due to _______
displaced otolith particles (calcium crystals) within the semicircular canals of the inner ear (Canalithiasis)
MCC of peripheral vertigo
BPPV
Symptoms of BPPV
- Recurrent episodes of sudden, episodic peripheral vertigo (lasting 60 seconds or less) and provoked with specific head movements
- Nausea, vomiting
- NO HEARING LOSS, TINNITUS, or ATAXIA
How do you diagnose BPPV?
Dix Hallpike (Nylen Barany) Test: produces fatiguable nystagmus
How do you manage a patient with BPPV?
-Canalith repositioning treatment of choice (Epley Maneuver) or Semont Maneuver
What is vestibular neuritis?
Inflammation of the vestibular portion of Cranial Nerve VIII (8)
On the contrary, what is labyrinthitis?
Inflammation of the vestibular and cochlear portion of CNVIII (8)
Although the etiologies of vestibular neuritis and labyrinthitis are idiopathic, what may it be associated with?
Viral or postviral inflammation
Symptoms of both vestibular neuritis and labyrinthitis
Continuous peripheral vertigo
Dizziness, nausea, vomiting, gait disturbances
Horizontal and rotary nystagmus (away from affected side in fast phase)
What does labyrinthitis only have?
Unilateral hearing loss, tinnitus
Management of vestibular neuritis and labyrinthitis
- Glucocorticoids are first line
- Antihistamines (Meclisine) or anticholinergics for symptoms
- Both are self-limited and resolve within weeks
What is Meniere’s Disease?
Idiopathic distention of the endolymphatic compartment of the inner ear due to excess fluid
Meniere Disease is characterized by four findings. What are they?
- Episodic peripheral vertigo (lasting minutes-hours)
- Fluctuating sensorineural hearing loss
- Tinnitus
- Ear Fullness
-Other symptoms: Horizontal nystagmus, nausea, vomiting
Management of Meniere Disease
- Initial: Dietary modification: avoidance of salt, caffeine, nicotine, chocolate, and alcohol
- Medical: antihistamines (Meclizine) and diuretics (Hydrochlorothiazide) to reduce pressure are options
If the case of Meniere’s Disease is refractory, what treatments can be pursued
Surgical decompression (T tube) Labyrinthectomy Intraaural Gentamicin
What is an acoustic CNVII neuroma?
Vestibular schwannoma–benign tumor involving Schwann cells which produce myelin sheath
Where does an acoustic neuroma arise?
Cerebellopontine angle and can compress structures (CNVIII, VII, and V)
Symptoms of an acoustic neuroma
- Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise
- Tinnitus
- Facial numbness
- Facial paresis
- Ataxia
- Headache
What is the imaging study of choice for an acoustic neuroma
MRI
However, what is the laboratory study of choice for an acoustic neuroma?
-Audiometry
Treatment for an acoustic neuroma
-Surgery or focused radiation therapy
