Hyperacusis/Vertigo/ear trauma Flashcards
Hyperacusis
general
Excessive sensitivity to sounds
May occur in
Normal hearing patients
Associated with ear disease
Following noise trauma
Migraines
Underlying psychological disease
“Recruitment”
Abnormal sensitivity to loud sounds despite reduced sensitivity to soft ones
hyperacusis
Tx
Normal hearing patients
Earplugs in noisy environments
Habituation
Patients with hearing devices
Compression circuitry to avoid overamplification
Vertigo
general
Cardinal symptom of vestibular disease
Differentiate peripheral from central etiologies of vestibular dysfunction
Ear vs nerve/brain
Typically experienced as a distinct “spinning” sensation or a sense of tumbling or of falling forward or backward
Sensation of motion when there is no motion
Exaggerated sense of motion in response to movement
Distinguish from imbalance, light-headedness, and syncope
Nonvestibular in origin
Duration of vertigo episodes and association with hearing loss are the key to diagnosis
Vertigo
Peripheral
Onset is sudden
Often associated with tinnitus and hearing loss
Horizontal nystagmus may be present
Vertigo may be more intense
Vertigo
Central
Onset is gradual
No associated auditory symptoms
Vertigo less intense
Vertigo
Diagnostics
Audiogram
Electronystagmography (ENG) or videonystagmography (VNG)
MRI head
Meniere Sydrome
general
(Endolymphatic Hydrops)
Classic syndrome: Episodic vertigo with discrete spells lasting 10 minutes to several hours
Etiology
Excess endolymph results in increased pressure within the semicircular canals
Precise cause of hydrops cannot be established in most cases
Two known causes are syphilis and head trauma
Meniere Disease
Symptoms
Symptoms wax and wane as the endolymphatic pressure rises and falls
Typically accompanied by
Unilateral aural fullness (feeling of pressure in the ear)
Tinnitus (low-tone or blowing sound)
Fluctuating low-frequency sensorineural hearing loss
Vertigo
Meniere Disease
PE
Physical Exam
Often normal
Sometimes pneumo-otoscopy will cause nystagmus
Meniere Disease
Dx
Diagnostic Studies
Audiometry at the time of an attack shows a characteristic asymmetric low-frequency hearing loss
Hearing commonly improves between attacks
Permanent hearing loss may eventually occur.
Meniere Disease
Tx
Patients suspected of having Meniere disease should be referred to an otolaryngologist for further evaluation
Initial treatment
Diuretics
Acetazolamide
Sodium restriction
For symptomatic relief of acute vertigo attacks
Meclizine (25 mg)
Diazepam (2–5 mg)
Meniere Disease
Refractory disease Tx
Injections of glucocorticoids or gentamicin into the middle ear may be considered
Non-ablative surgical options
Decompression
Shunting of the endolymphatic sac
Full ablative procedures
Vestibular nerve section
Labyrinthectomy
Labrynthitis
general
Acute onset of continuous, usually severe vertigo lasting several days to a week, accompanied by hearing loss and tinnitus
Etiology
The cause is often unknown
Can be linked at times to infection
Mainly in young to middle-aged adults
Sometimes gives a history of an antecedent upper respiratory infection
Labrinthitis
S/Sx
Nausea, vomiting
The need to remain immobile
During a recovery period that lasts for several weeks, the vertigo gradually improves.
Hearing may return to normal or remain permanently impaired in the involved ear.
If no hearing issues occur, it is simply known as vestibular neuritis
Labrinthitis
PE
Exam
Nystagmus (quick component) and a sense of body motion are to the opposite side, whereas falling and past pointing are to the side of the affected labyrinth.
Examination discloses vestibular paresis on one side, i.e., an absent or diminished response to motion of the horizontal semicircular canal. If the patient will tolerate small head movements, perform rapid–head-impulse test- see next slide
TM perf
Dx
Based on otoscopic examination
May note:
Conductive hearing loss
Decreased perception of whisper on affected side
Weber test
Rinne test
This is a right ear
