Hearing loss/ Dizziness

Question 1

in conductive hearing loss, where does weber’s test localise to

Answer 1

will be louder in the deaf ear

Question 2

in sensorineural hearing loss, where does webers test localise to

Answer 2

will be louder in normal ear

Question 3

if AC>BC what type of hearing loss is there

Answer 3

normal hearing

Question 4

if BC > AC what type of hearing loss is there

Answer 4

conductive hearing loss

Question 5

causes of conductive hearing loss

Answer 5

outer or middle ear abnormalities

ear infections
middle ear fluid
perforated ear drums

Question 6

what does an audiogram show for conductive hearing loss

Answer 6

significant gap between air and bone conduction with bone being low

Question 7

causes of sensorineural hearing loss

Answer 7

damage to hair cells in cochlea
damage to vestibulocochlear nerve

sound exposure 
raging 
ototoxic drugs 
birth defects 
rubella 
benign tumours on auditory nerve (schwannoma) 
genetic predisposition

Question 8

what does the audiogram show for sensorineural hearing loss

Answer 8

no gap between bone and air conduction

Question 9

what is mixed hearing loss

Answer 9

both conductive and sensorineural

Question 10

what are the vertigo causing ENT conditions

Answer 10

Labrynthitis 
vestibular neuritis 
Benign paroxysmal positional vertigo 
Meniere's disease
Acoustic neuroma/vestibular schwannoma

Question 11

how does BPPV present

Answer 11

most common cause of vertigo
short lasting vertigo on specific movement
-looking up
-turning over in bed

episodes last seconds - mins

Question 12

cause of BPPV

Answer 12

otolith crystals from the utricle get displaced into the semicircular canals (most commonly posterior)

this stimulates hair follicles during certain movements making your brain think you’re moving

Question 13

how do you diagnose BPPV

Answer 13

dix-hallpike manoeuvre

Question 14

treatment of BPPV

Answer 14

Epely manoeuvre

Question 15

what is labrynthitis

Answer 15

inflammation of the inner ear (labyrinth) usually caused by infection

Question 16

symptoms of labrynthitis

Answer 16

vertigo (prolonged - days) 
nausea/vomiting 
hearing loss 
nystagmus 
tinnitus 
flu-like symptoms 

(mainly hearing loss and tinnitus)

Question 17

how do you diagnose labrynthitis

Answer 17

history

audiogram - sensiruneural hearing loss
weber’s test - sensorineural hearing loss
Rinne’s test - sensorineural hearing loss

Question 18

treatment of labrynthitis

Answer 18

viral
-vestibular suppressants
benzodiazepines + anti-emetics + corticosteroids

bacterial
-vestibular suppressants, anti emetics

Question 19

what is vestibular neuronitis

Answer 19

infection of the vestibular nerve in the inner ear causing it to be inflamed and a loss of balance

usually viral

Question 20

main difference between vestibular neuritis and labrynthitis

Answer 20

vestibular neuronitis has NO tinnitus or hearing loss

Question 21

presentation of vestibular neuronitis

Answer 21

prolonged vertigo (days)
no tinnitus or hearing loss
prodromal symptoms

Question 22

treatment of vestibular neuronitits

Answer 22

vestibular suppressants - benzodiazepines
anti-emetics
corticosteroids

Question 23

how does meniere’s disease present

Answer 23

sensorineural hearing loss
profound vertigo (at least 2 episodes >20 mins)
comes in clusters - few times a week/month/year
worsening on affected side
sense of aural fullness on affected side

Question 24

cause of meniere’s disease

Answer 24

end-lymphatic high drops - overproduction or impaired absorption of endolymph - leads to mixing of endolymph and perilymph

Question 25

management of meniere's disease

Answer 25

``` supportive treatment during episodes tinnitus therapy hearing aids intratympanic steroids/gentamicin surgery - end-lymphatic system surgery ```

Question 26

preventions for meiere's disease

Answer 26

``` anti-vertigo medications -betahistine diuretics low salt diet reduce alcohol/caffeine consumption stress reduction ```

Question 27

what is acoustic neuroma/vestibular schwannoma

Answer 27

benign tumour that grows from the superior vestibular component of the vestibulochoclear nerve grow 1-2mm per year only cause serious problems if 2.5-2mm

Question 28

most common side of vestibular schwannoma

Answer 28

cerebellopontine notch

Question 29

presentation of vestibular schwannoma/acoustic neuroma

Answer 29

``` vertigo hearing loss tinnitus facial numbness loss of balance absent corneal reflex ```

Question 30

histological finding of vestibular schwannoma

Answer 30

verocay bodies nuclear palisading spindle needles

Question 31

how do you diagnose vestibular schwannoma

Answer 31

MRI scan | audiogram - shows sensorineural loss

Question 32

treatment of vestibular schwannoma

Answer 32

observation - as they're v slow growing | radiation and surgery if they get v big

Question 33

what causes nystagmus

Answer 33

impairment of vestibulo-occlear reflex

Question 34

what is otosclerosis

Answer 34

fixation of the stapes footplate to the oval window of the cochlea

Question 35

how does otosclerosis present

Answer 35

gradual onset conductive hearing loss more common in females - progresses more rapidly in pregnancy

Question 36

treatment for otosclerosis

Answer 36

stapedectomy

Question 37

what is seen in audiometry for otosclerosis

Answer 37

Carhart's notch at 2kHz