ENT/Otolaryngology and Head & Neck Surgery Flashcards
(99 cards)
1
Q
What is the significance of a left supraclavicular enlarged lymph node?
A
Virchow’s Node
- Indicates an abdominal malignancy
2
Q
What is the significance of an enlarged right lymph node?
A
May indicate malignancy of:
- Mediastinum
- Lungs
- Esophagus
3
Q
What is the significance of an enlarged occipital and/or posterior auricular lymph node?
A
Rubella
4
Q
How does one tell the right and left ear apart from an otoscopy picture?
A
- Cone of light
>> Right: 5 o’clock
>> Left: 7 o’clock - Handle of malleus
>> Right: pointing anteriorly
>> Left: pointing posteriorly
NB: Front of card – Left. Back of card – Right.
5
Q
Describe drainage sites and origins of the nasal cavity.
A
- Sphenoethmoidal sinus – Sphenoid sinuses
- Superior meatus – Posterior ethmoid sinuses
- Middle meatus – Frontal, Maxillary and Anterior ethmoid sinuses
- Inferior meatus – Nasolacrimal ducts
6
Q
Define the superior and inferior boundaries of the different parts of the pharynx.
A
- Nasopharynx: skull base to soft palate
- Oropharynx: soft palate to hyoid bone
- Hypo/Laryngopharynx: hyoid bone to inferior cricoid cartilage
7
Q
True nystagmus and vertigo caused by a peripheral lesion will never last longer than a couple of weeks because of compensation.
A
Central lesions do NOT compensate, hence nystagmus and vertigo will persist.
8
Q
What are the four strap muscles of the neck?
A
- Thyrohyoid
- Sternothyroid
- Sternohyoid
- Omohyoid
9
Q
Lung malignancy is the most common cause of extralaryngeal vocal cord paralysis.
A
10
Q
What are the possible causes/differential diagnoses for hoarseness of voice?
A
- *Infectious**
- Acute laryngitis
- Chronic laryngitis
- Laryngotracheobronchitis (Croup)
- *Trauma**
- External laryngeal trauma
- Endoscopy
- Endotracheal intubation – intubation granuloma
- *Inflammatory**
- Vocal nodules/polyps
- Smoking/Chronic EtOH intake
- GERD
Neoplasms
- Benign
>> Papilloma – HPV infection
>> Minor salivary gland tumours
>> Retention cysts
- Malignant
>> SSC (e.g. of the thyroid)
Neurological
- Central
>> Cerebral Vascular Accident (CVA)
>> Multiple Sclerosis (MS)
>> Head injury
>> Skull base tumours
>> Arnold-Chiari Malformation
- Peripheral
>> Unilateral: lung malignancy
>> Bilateral: surgery/forceps delivery
- Neuromuscular
>> Myasthenia gravis (MG)
- Iatrogenic
>> Thyroid surgery
>> Parathyroid surgery
>> Carotid endarterectomy
>> PDA ligation
Systemic
- Endocrine
>> Hypothyroidism
>> Virilization
- Connective tissue disease
>> Rheumatoid arthritis (RA)
>> Systemic lupus arthritis (SLE)
- *Functional**
- Psychogenic/hysterical hoarseness
- *Congenital**
- Laryngeal web
- Laryngeal atresia
- Laryngomalacia
11
Q
If hoarseness persists for >2 weeks in a smoker, laryngoscopy must be done to rule out malignancy.
A
12
Q
What is the definition of acute VS. chronic laryngitis?
A
Acute: of inflammatory changes in the laryngeal mucosa
Chronic: >2 weeks of inflammatory changes in the laryngeal mucosa
13
Q
What are the possible causes of acute laryngitis?
A
- Viral: adenovirus, influenza
- Bacteria: Group A Streptococcus
- Mechanical strain >> submucosal hemorrhage >> vocal cord edema >> hoarseness
- Environemntal: toxic fume inhalation
14
Q
What are the possible causes of chronic laryngitis?
A
- Recurrent acute laryngitis
- Chronic irritants
- Chronic alcohol use
- Chronic voice strain
- Chronic rinosinusitis with postnasal drip
- Esophageal disorders
>> GERD
>> Zenker’s diverticulum
>> Hiatus hernia - Systemic disorders
>> Hypothyroidism
>> Addison’s disease
>> Allergy
NB: MUST rule out malignancy!
15
Q
What are the differences between vocal nodules and vocal polyps?
A
- *Polyps**
- Unilateral and asymmetric
- Acute onset
- May resolve spontaneously
- Usually acute!
- Tx: surgical excision if persistent or in presence of risk factors for laryngeal cancer
Nodules
- Bilateral
- Chronic onset
- Chronic course
- Can be acute or chronic on onset
>> Early nodules: submucosal hemorrhage
>> Mature nodules: hyalinization with long-term voice abuse
- Tx: surgical excision if refractory (rarely indicated)
16
Q
Vocal polyps are structural manifestations of vocal cord irritation.
A
17
Q
Vocal polyps are more common in the anterior 1/3rd of the vocal cords.
A
18
Q
Vocal nodules are more common at the junction between the anterior 1/3rd and posterior 2/3rd of the vocal cords – this is the point of MAXIMAL VIBRATION.
A
19
Q
What are the possible causes of vocal cord palsy?
A
- *- Lung malignancy
- Thyroid surgery
- Idiopathic: DM, Vasculitis etc.**
- (Peri)Mediastinal/Midline pathologies
>> Tuberculosis
>> CA esophagus
>> CA hypopharynx
>> CA thyroid
>> Aortic aneurysms - Other iatrogenic causes
>> Parathyroid surgery
>> Carotid endarterectomy
>> Cervical esophagus mobilization in CA esophagus
>> PDA ligation in children - *Possible causes for BILATERLAL_ _vocal cord palsy**
- Total thyroidectomy
- Recurrent (bilateral) strokes
- Irradiation (usually as treatment for NPC)
20
Q
What infection is associated with benign laryngeal papillomas?
A
HPV types 6 and 11
21
Q
What infection is associated with CA larynx?
A
HPV-16, HPV-18
22
Q
What is the age of onset of benign laryngeal papillomas?
A
Biphasic
- Juvenile onset – birth to puberty
>> Also known as “recurrent respiratory papillomatosis”
>> Vertical transmission of HPV infection from mother to child
>> Usually regresses in teenagehood - Adult onset
>> Acquired HPV infection
>> Does NOT regress
23
Q
How does RRP or laryngeal papillomas present?
A
- Hoarseness
- Airway obstruction
- NB: Can seed into the tracheobronchial tree
24
Q
How do we manage RRP/laryngeal papillomas?
A
Physical Examination: direct laryngoscopy
Investigations: biopsy for the first 2 times to look out for dysplastic changes – these lesions may undergo malignant transformation (3-5%)
- *Treatment**
- Repeated debulking by microdebridement or CO2 laser
- Intralesional antiviral (cidofovir)
- Interferon treatment slows the progress only
- HPV vaccine may prevent or encourage regression in juvenile types
NB: these papillomas are highly resistant to complete removal
25
What is the most common laryngeal tumour in childhood?
Benign laryngeal papillomas/Recurrent respiratory papillomatosis
26
What is the most common histological type of laryngeal carcinoma?
Squamous cell carcinoma (Almost 99%)
## Footnote
Other types include:
- Myosarcoma
- Adenocystic carcinoma (minor salivary glands)
27
What are the three possible sites of laryngeal carcinoma, and how will they present respectively?
* *_Supraglottis_** (30-35%)
- Boundaries: tip of epiglottis to the middle of the ventricle
- Globus sensation, blood-stained sputum (easily misdx as TB), and palpable lymph nodes
- Usually presents late
* *_Glottis_** (60-65%)
- Boundaries: middle of the ventricle to the inferior surface of true cords
- Hoarseness of voice
- Usually presents early \>\> good prognosis
* *_Infraglottis/Subglottis_** (1%)
- Boundaries: inferior surface of true cords to the inferior cricoid border
- Stridor
- Can be quite acute in presentation
28
**Laryngeal carcinoma takes up 45% of all H&N cancers.**
29
What are the known risk factors for laryngeal carcinoma?
- Male gender (M:F 10:1)
- Smoking
- Alcohol consumption -- especially for supraglottic cancers
- ***HPV-16 infection is strongly associated with the risk of laryngeal squamous cell cancers (Li et al., 2013)***
30
How do we manage CA larynx?
**Depends on TMN staging**
## Footnote
**_Investigations_**: Laryngoscopy with biopsy; CT/MRI
**_Treatment_**:
- Radiotherapy
- Surgery: total laryngectomy +/- (modified) radical neck dissection
- Chemoirradiation: usually for T3 tumours when patient wants to conserve the larynx
- Vocal rehabilitation
\>\> Electrolarynx
\>\> Pneumatic device
\>\> Tracheo-esophageal fistula
\>\> Esophageal speech
NB: survival is similar between surgery and chemoirradiation for T3 tumours -- however, note that the long-term side effects of external irradiation can also be very debilitating when the patient survives the disease
31
How is the prognosis of CA larynx?
T4 lesions with adjuvant radiotherapy: \>40%
Early lesions: \>90% with radiation
32
How do we stage carcinoma of the larynx?
**_T-staging_**
T1: limited to one subsite and normal cord mobility
T2: more than one subsite and impaired cord mobility, BUT NO FIXATION
T3: limited to larynx with cord fixation
T4: extension into tissues beyond larynx
\>\> NB: subsites of larynx include supraglottis, glottis and subglottis
**_N-staging_**
N0: no regional nodal metastases
N1: single ipsilateral node \<= 3cm
N2a: single ipsilateral node 3-6cm
N2b: multiple ipsilateral nodes \<6cm
N2c: bilateral nodal metastases or contralateral nodal metastases \<6cm
N3: any nodal metastases \>6cm
**_M-staging_**
M0: no evidence of metastases
M1: distant metastases present
33
Name the common ototoxic drugs (5 groups).
1. Aminoglycosides: neomycin, streptomycin, gentamicin
2. Loop diuretics: furosemide, bumetanide
3. Antineoplastics: cisplatin
4. Salicylates
5. Quinine
34
What are the possible causes of dizziness?
**_True Vertigo_**
- Peripheral (Vestibular) Causes
\>\> **Benign Paroxysmal Positional Vertigo (BPPV)**
\>\> **Meniere's disease**
\>\> **Labyrinthitis**
\>\> Vestibular neuronitis
\>\> Recurrent vestibulopathy
\>\> Cholesteatoma
\>\> Perilymph fistula
\>\> Autoimmune inner ear disease
\>\> Drug ototoxicity
\>\> Temporal bone fractures
\>\> Superior semicircular canal dehiscence
- Central Causes
\>\> **Migrainous Vertigo**
\>\> **Multiple Sclerosis**
\>\> **Cerebrovascular Disorders**
:: Vertebrobasilar Insufficiency
:: Transient Ischemic Attacks
:: Wallenburg's Syndrome
:: Cerebellar infarction
\>\> Tumours
:: Cerebellopontine angle
:: Posterior fossa
\>\> Inflammation
:: Meningitis
:: Cerebellar abscess
\>\> Trauma
:: Cerebellar contusions
\>\> Toxins
**_Non-Vertiginous_**
- Organic causes
\>\> **Cardiac causes
:: Arrhythmia
:: Aortic stenosis**
\>\> Orthostatic hypotension
\>\> Vasovagal attacks
\>\> Anemia
- Functional
\>\> Depression
\>\> Anxiety
\>\> Phobia
35
What are the possible causes of hearing loss?
* *_Conductive Hearing Loss_**
- External ear
- Middle ear
- Inner ear
* *_Sensorineural Hearing Loss_**
- Congenital
- Acquired
36
What are the common presenting symptoms and signs of vertebrobasilar insufficiency?
**The 5Ds**
## Footnote
- **D**rop attacks
- **D**izziness
- **D**iplopia
- **D**ysarthria
- **D**ysphagia
37
What does panendoscopy include?
1. Microlaryngoscopy
2. Esophagoscopy (OGD)
3. Pharyngoscopy
4. Rigid bronchoscopy
+/- Tonsillectomy (microprimary in the tonsils)
38
What are the possible causes of otalgia?
**_External Ear_**
- Infection
\>\> Otitis externa
\>\> Herples simplex/zoster
\>\> Auricular cellulitis
\>\> External canal abscess
- Trauma
\>\> Burns
\>\> Hematoma
\>\> Laceration
\>\> Frostbite
- Others
\>\> Neoplasms of the external ear canal
\>\> Foreign body
\>\> Cerumen impaction
**_Middle Ear/Inner Ear_**
- Infection
\>\> Acute otitis media
\>\> Otitis media with effusion
\>\> Mastoiditis
\>\> Myringitis
\>\> Skull base infections
- Trauma
\>\> Traumatic perforation
\>\> Barotrauma
- Others
\>\> Neoplasms
\>\> Wegener's
\>\> Cholesteatoma
**_Referred Pain_**
- Infection
\>\> Tonsilitis
\>\> Tracheitis
\>\> Ramsay-Hunt Syndrome
- Trauma
\>\> Thyroiditis
\>\> Cervical arthritis
- Others
\>\> TMJ Syndrome
\>\> Trismus
\>\> Dental problems
\>\> Glossopharyngeal neuralgia
\>\> Carcinoma/Neoplasms of the oral cavity/pharynx/larynx
39
Which tuning fork is used for audiological tuning fork tests?
512Hz
40
What is the clinical significance of weber test lateralization?
- Ipsilateral conductive hearing loss
- Contralateral Sensorineural hearing loss
41
How do we quote Rinne and Weber test results?
* *_Rinne test_**
- AC \> BC = normal = ***positive*** Rinne
* *_Weber test_**
- Central = normal = Weber ***negative***
- Unilateral lateralization = abnormal = Weber right/Weber left
42
**The Weber test will only lateralize if the difference in hearing loss between the two ears is \>6dB.**
43
**Note that a vibrating tuning fork on the mastoid stimulates the cochlea bilaterally.**
If the right ear is a dead ear, if the tuning fork is placed at the right ear, the left cochlea will be stimulated by the Rinne test on the right.
Therefore, it would appear that the right ear has better BC than AC, when in truth, the right ear is deaf to both BC and AC.
The interpretation of sound is actually by bone conduction to the left ear.
This will thus be a false negative test.
44
What is the range of frequencies audible to the human ear?
20 - 20,000Hz
45
What is the range of frequencies the human ear is most sensitive to?
1000 - 4000Hz
46
What is the range of frequencies of the daily human speech?
500 - 2000Hz
47
What is the range of frequencies tested in a pure tone audiogram (PTU)?
250 - 8000Hz
48
What is a "threshold" in a pure tone audiogram (PTA)?
The lowest intensity level at which a patient can hear the tone (i.e. the frequency) 50% of the time at each ear
## Footnote
In a PTA, thresholds are obtained for each ear for frequencies 250-8000Hz
49
**Hearing loss most often occurs at higher frequencies.**
- Noise-induced (occupational) hearing loss: 4000Hz
- Otosclerosis-related hearing loss: 2000Hz (Carhart's notch)
50
How do we gauge the severity of hearing loss by PTA?
0-20db: Normal
20-40db: Mild
40-55db: Moderate
55-70db: Moderate - Severe
70-90db: Severe
\>90db: Profound
51
How do one define conductive hearing loss on PTA?
- Bone conduction in normal range
- Air conduction out of normal range
- **Air-bone gap: gap between AC and BC _\>10db_**
52
How do we define sensorineural hearing loss on PTA?
- Bone conduction out of normal range
- Air conduction out of normal range
- No air bone gap: difference between BC and AC \<10db
53
How do we define mixed hearing loss on PTA?
- Bone conduction out of normal range
- Air conduction out of normal range
- Air bone gap present: difference between AC and BC \>10db
54
How is the speech discrimination test conducted?
- Determines the percentage of words the patient correctly repeats from a list of 50 monosyllabic words
- Tested at a level 35-50dB more than SRT (speech reception threshold), so **degree of hearing loss is taken to account**
\>\> Patients with normal hearing/CHL will have \>90%
\>\> Therefore the score depends on the extent of **SNHL**
55
What is the speech recognition threshold?
The lowest hearing level (db) at which a patient is able to repeat 50% of spondee words (two syllable words which have equal emphasis on each syllable) -- e.g. "baseball", "airplane", "mushroom"
56
What is the pure tone average?
The average of hearing sensitivity (db) at 500, 1000, and 2000Hz
\>\> Approximates SRT to within 5db and SFT within 6-8db
57
How do PTA (pure tone average) and SRT (speech recognition threshold) compare?
SRT and PTA (or the best pure tone threshold) in the 500-2000Hz (normal human speech range) should agree **_within 5db_**.
## Footnote
- Pseudohypoacusis: SRT is significantly better than PTA
- Central involvement/retrocochlear lesion: PTA is significantly better than SRT
- SRT is usually better than the PTA in malingerers
58
What is the speech discrimination test?
The percentage of words the patient correctly repeats from a list of 50 monosyllabic words at an intensity level 35-50 higher than his/her SRT
59
What is the clinical use of the speech discrimination test?
1. To determine how much intelligibility is left without hearing aids
2. To predict and evaluate the intelligibility improvement by hearing aids
3. To compare the effects of different hearing aids
60
What is the rollover effect in the speech discrimination test?
Distortion in words/decrease in the ablity in discrimination as sound intensity increases/at higher volumes
Typical of a retrocochlear/CNVIII lesion (e.g. acoustic neuroma)
61
**One should investigate further if scores for the speech discrimination test is _more than 20%_ between the ears -- asymmetry may indicate a retrocochlear lesion**
62
**If the patient is suspected to have profound hearing loss, the testing with PTA should start at the 250Hz -- individuals with profound hearing loss often having testable hearing only in the low frequency range.**
63
Describe the PTA.
A mild rising sensorineural hearing loss in the right ear
Typical of Meniere's disease
64
Describe the PTA.
Moderate-severe conductive hearing loss with the Carhart's notch present at the 2000Hz interval
Typical of otosclerosis
65
Describe the PTA.
High-frequency sensorineural hearing loss with the greatest HL at the 4000-6000Hz region with some recovery at 8000Hz
Typical of noise-induced hearing loss
66
Describe the PTA
Bilateral symmetrical high frequency sensorineural hearing loss with no rebound
Typical of presbycusis
67
Describe the types of tympanograms and their respective clinical significance.
**_Type A_**: normal
- Peak at +/- 100daPa
- Compliance: 0.3-1.4mmho
![]()
**_Type As_**: shallow
- Peak at +/-100daPa
- Compliance: \<0.3mmho
- Poor middle ear compliance due to otitis media/otosclerosis/tympanosclerosis
![]()
**_Type Ad_**: deep
- Peak at +/-100daPa
- Complaince: \>1.4mmho
- Excessive middle ear compliance due to ossicular chain disruption or TM perforations/grommetts
![]()
**_Type B low_**
- Middle ear pathology: e.g. otitis media with effusion
![]()
**_Type B high_**
- Grommet
- TM perforation
![]()
**_Type C_**: negative peak
- Peak at -100mmho or more negative
- Suggests negative pressure in the middle ear cavity
- Likely causes include Eustachian tube dysfunction
- Patients with chronic Type C tympanograms are at risk for cholesteatoma
![]()
68
**Ear canal volumes of \>2cc in children and \>2.5cc in adults indicate TM perforation or presence of a patent ventilation tube/grommet**
69
What is the acoustic reflex threshold?
The intensity (db) at which the stapedius muscle contracts due to loud sound
70-100db greater than the hearing threshold, as determined by PTA
If hearing threshold is \>85db, the reflex is likely to be absent
70
What is the acoustic reflex decay test?
The ability of the stapedius muscle to *_sustain_* contraction for ***_10s***_ at _***10db_***
71
What happens to the acoustic stapedial reflex with cochlear and retrocochlear hearing losses respectively?
**_Cochlear hearing loss_**: acoustic reflex thresholds at 25-60dB
* *_Retrocochlear hearing loss_**
- Absent acoustic reflex OR
- Marked reflex decay (\>50%) within 5s
72
What are otoacoustic emissions?
**_AN OBJECTIVE TEST_**
A series of clicks is presented to the ear and the cochlea generates an echo which can be measured
73
What are the clinical applications for OAE?
1. Newborn screening
2. Malingering patients
74
What can cause absent OAE?
1. Hearing loss
2. Fluid in the middle ear cavity
75
What is the auditory brainstem response (ABR)?
The measurement of neuroelectric potentials in response to a stimulus in five different anatomic sites according to the order of the auditory neural pathway
\>\> To map the lesion according to the site of the defect
\>\> Does not require the volition/cooperation of the patient
76
What is abnormal in an ABR (auditory brainstem response)?
Delay in brainstem response
## Footnote
1. Cochlear abnormalities
2. Retrocochlear abnormalities
77
What are the clinical applications for ABR?
1. Children
2. Malingering patients
78
Name the different type of hearing aids.
1. BTE (behind the ear)
2. ITE (in the ear)
3. ITC (in the canal)
4. CIC (contained in canal)
5. Bone conduction/BAHA (bone-anchored hearing aid)
6. CROS (Contralateral routing of signals)
\>\> Cochlear implants
79
How does the BAHA work?
Components:
1. Titanium implant
2. External abutment (by drilling or magnet)
3. Sound processor
\>\> The sound processor transmits vibration through the external abutment to the titanium implant, which then causes vibrations directly to the cochlea
80
What are the indications for BAHA?
1. Conductive hearing loss
2. Unilateral hearing loss
3. Mixed hearing loss who cannot wear conventional hearing aids
81
How does a cochlear implant work?
An electrode is inserted directly into the cochlea to allow direct stimulation of the auditory nerve (CNVIII)
82
What are the indications for cochlear implants?
Profound bilateral sensorineural hearing loss NOT rehabilitated with conventional hearing aids
83
What is the difference between pre-lingual and post-lingual deafness?
**_Pre-lingual deafness_**: deafness ocurring *_before_* speech and language are acquired
**_Post-lingual deafness_**: deafness occurring *_after_* speech and language are acquired
84
**Pre-lingually deaf infants are the best candidates for aural rehabilitation because they have maximum benefit from ongoing _developmental plasticity_.**
85
What is the definition of vertigo?
Illusion of _rotational_, _linear_ or _tilting_ movement of self or environment
86
Which semicircular canal is most commonly affected in BPPV (benign paroxysmal positional vertigo)?
The **posterior canal** is affected in \>90% cases.
87
What is BPPV (Benign Paroxysmal Positional Vertigo)?
Acute attacks of transient vertigo lasting seconds to minutes initiated by certain head positions, accompanied by *_torsional_* (i.e. rotatory) nystagmus, with the fast phase pointing towards the floor (geotropic)
88
What is the most common cause of episodic vertigo?
BPPV
| (Benign Paroxysmal Positional Vertigo)
89
What is the cause of BPPV?
1. Canalithiasis: migration of otoliths within the endolymph
2. Cupulolithiasis: attachment of otoliths to the cupula of the semicircular canal
90
How are the Brandt-Daroff exercises performed?
1. Sit upright on bed
2. Lie down on the side within 1-2s, with the head looking up at a 45 degree angle
3. Remain in this position for 30s or until the dizziness subsides
4. Return to upright position for 30s
5. Repeat steps 2 and 3 on the other side.
\>\> Repeat cycle 5 times for one set. Repeat 3 sets per day for 14 days.
![]()
91
How is the Epley Maneuvre performed?
1. Dix-Hallpike position: hold for 1-2 minutes
2. ![]()Rotate patient's head for 90 degrees to the opposite direction so that the opposite ear faces the ground, while maintaing the neck at 30 degrees extension -- remain in the position for 1-2 minutes
3. Keeping the head nad neck fixed, the patient rolls onto the shoulder, rotating the head another 90 degrees so he/she is now looking downwards at a 45 degree angle. -- remain in the position for 1-2 minutes
4. Patient is slowly brought up to an upright sitting posture, while maintaining a 45 degree rotation of the head
5. Remain in the sitting position for up to 30 seconds
92
What does it mean to have a positive Dix-Hallpike test?
- **Nystagmus MUST be present for a positive test** -- geotropic rotatory nystagmus
- Associated with onset of vertigo: crescendero/decrescendo vertgio for 20s
---------------------------------------------------------------------------------------------------------------------------
- Fatigues with repeated maneuvre and fixation
- Reversal of nystagmus upon sitting up
- Latency of ~20s
93
How accurate is the Dix-Hallpike test for BPPV?
Sensitvity: 82%
Specificity: 71%
94
How do we manage BPPV?
BPPV resolves spontaneously
## Footnote
1. Epley maneuvre
2. Brandt-Daroff exercises
3. Anti-emetics for nausea/vomiting
4. Surgery for refractory cases
**Drugs to suppress the vestibular system actually *_delay eventual recovery_* and are therefore NOT used.**
95
What are the differences between peripheral and central vertigo?
**_Imbalance_**
Peripheral: Moderate-severe
Central: Mild-moderate
**_Nausea and vomiting_**
Peripheral: Severe
Central: Variable
**_Auditory symptoms_**
Peripheral: Common
Central: Rare
**_Neurologic symptoms_**
Peripheral: Rare
Central: Common
**_Compensation_**
Peripheral: Rapid
Central: Slow
**_Nystagmus_**
Peripheral: Unidirectional, horizontal or rotatory; never vertical!
Central: Bidirectional, horizontal or vertical
96
What is Meniere's Disease?
Also known as endolymphatic hydrops
Episodic attacks of vertigo, hearing loss, tinnitus and aural fullness lasting _minutes to hours_
97
What is the diagnostic criteria for Meniere's disease?
All of the following three criteria must be present
1. Two spontaneous episodes of rotational vertigo lasting at least 20 minutes
2. Audiometric confirmation of sensorineural hearing loss
3. Tinnitus and/or aural fullness
98
How does Meniere's disease present?
- Vertigo
- **_Fluctuating**_, _**low-frequency_** sensorineural hearing loss
- Tinnitus
- Aural fullness
\>\> Vertigo is transient
\>\> Later stages: persistent tinnitus and progressive hearing loss
============================================================
- Tumarkin crisis: sudden falls without warning and without LOC
99
