Inner Ear Flashcards
What are some common causes of hearing loss?
Presbycusis, noise exposure, congenital, trauma, ototoxic medications, infection, others
What are some ototoxic medications?
Antibiotics, NSAIDS, salicylates, chemotherapy, loop diuretics
What are the three types of hearing loss?
Conductive (infection, fluid, wax, perforation, ossicular problems), sensorineural (aging, noise exposure, retro cochlear tumors), mixed
What tests can you use for unilateral hearing loss?
Rinne & weber
What type of hearing loss is it if the vibration is heard louder on the affected side?
Conductive
What type of hearing loss is it if you hear the vibration louder on the normal side?
Sensorial
What is sensorineural hearing loss?
damage to inner ear (cochlea) or nerve pathways
What is presbycusis?
Natural old age hearing loss
What is sudden sensorineural hearing loss?
occurs within a 72 hour window, which affects >3 frequencies, usually unilateral, DIZZINESS IS IMPORTANT
Abnormal functioning
How do you treat a patient with sudden sensorineural hearing loss?
Send to audiologist, then ENT, possible treatment with intratympanic corticosteroids within 2 weeks
Must consider MRI to rule out tumor for unilateral, but this is after audiology
What is a vestibular schwannoma?
benign tumor of 8th cranial nerve
What is the clinical presentation of vestibular schwannoma?
unilateral hearing loss, tinnitus, vertigo, loss of balance (may be continuous), headache, facial paresis, sensorineural hearing loss
How do you diagnose vestibular schwannoma?
MRI w/ contrast – ANYONE should be evaluated for unilateral mass lesion
How do you treat vestibular schwannoma?
Surgery or monitoring, radiation (could not grow very much), refer to ENT!
When do you make an ENT referral?
- can’t remove a foreign body
- sudden hearing loss with normal exam and no symptoms of infection (includes tinnitus), see ENT within a week
What is tinnitus?
sensation of sound when there is no sound, “ringing”, which often indicates hearing loss, either from blockage, effusion, etc.
What is pulsatile tinnitus?
When you hear blood movement within the ear..this requires a LOT of testing to rule out aneurysms, cancer…
What is vertigo?
A false sensation of movement “spinning”, may accompany difficulty with balance
Giddy = asian culture
NOT a diagnosis
What of the vestibular system is involved in balance?
Inner ear – semicircular canals & vestibule
8th cranial nerve
vestibular nuclei in brain stem
What is the difference between peripheral vertigo and central vertigo?
Peripheral is sudden onset, unidirectional nystagmus, worsened by certain positions, and no neurological symptoms.
Central can be gradual or subtle, vertical nystagmus is RED FLAG, not improved with different positions, and associated w neurological symptoms
What is benign paroxysmal positional vertigo?
recurrent spells of vertigo related to otoconia positioning within a semicircular canal, changing of head
How do you treat BPPRV?
Physical therapy – Dix-Hallpike for DIAGNOSIS, Eply manuever for TREATMENT
Most get better on their own! Recurrent needs MRI to rule out tumors!
Cannot prescribe meclizine
What are the causes of peripheral vertigo?
BBPV, Meniere disease, vestibular neuronitis, ethanol intoxication, barotrauma, semicircular canal dehiscence, vestibular weakness
What are the causes of mixed peripheral and central vertigo?
Migraine, CVA, meningioma, vestibular scwhannoma, lyme disease, syphilis, hypothyroidism
What cannot you prescribe for BPPV
Meclizine as it can delay recovery although have more immediate relief
What is Meniere’s disease?
extra fluid in the endolymphatic sac
What symptoms would indicate Meniere’s disease?
leading to episodic vertigo (20 min to several hours) and LOW frequency sensorineural hearing loss, tinnitus (blowing), vertigo, unilateral ear pressure
How do you treat Meniere’s disease?
Low salt diet, diuretics (acetazolamide, vasopressin)
ENT specific: intratympanic steroid injections, sac decompression, vestibular ablation (refer to ENT) and remember MRI to rule out tumor :)
What is labryinthitis?
Inflammation of the whole inner ear pretty much
What symptoms indicate labryinthitis?
Hearing loss and tinnitus, onset of continuous, SEVERE vertigo
How do you treat labyrinthitis?
Febrile = antibiotics
Valium or Meclizine can help during acute attacks
Steroid injection
What is vestibular neuronitis?
inflammation of vestibular portion of the NERVE
What symptoms indicate vestibular neuronitis?
vertigo WITHOUT auditory impairment, maybe nystagmus, may last several days to a week
How do you treat vestibular neuronitis?
supportive care, Valium or Meclizine, therapy
What are central causes of vertigo?
Some sort of brain issue - seizure, MS, tumors, cerebellar ataxia syndrome, brainstem vascular disease, chiari malformation
What are signs and symptoms of central hearing impairment?
Gradual onset
Nystagmus vertical, auditory function is normal, gait and balance dysfunction, signs of brainstem dysfunction
What does a good physical exam of vertigo include?
Nystagmus, ENT systems, cranial nerve exam, cerebellar function (assess gait etc), romberg testing, dix hallpike, vitals, orthostatics
What are red flags during an exam of vertigo?
Ataxia, head or neck pain, loss of consciousness, focal neurological deficit, severe symptoms for >1 hour, vertical nystagmus
What are some additional tests for vertigo if needed?
Glucose, pregnancy, MRI with contrast, arrhythmias? IF chronic vertigo and bilateral hearing loss –> syphilis serology
What ROS for the ear should you do?
Changes in hearing, vision or medications?
Recent URI? Sound exposure? Head injury? Exacerbating/remitting factors? History of vascular anomaly? Prior ear/head surgeries? Pain? Tinnitus? Dizziness? Family history of ear issues?
