Inner Ear And HL Flashcards
What is the fluid that surrounds the membranous labrynth of the ear
Perilymph
What is the fluid within the membranous Labryth
Endo lymph
Define peripheral vertigo
2/2 dysfunction in the labryntth or vestibular nerve
Sudden onset
Vertigo in response to head turning
Fatiguable Nystagumus (horizontal)
Define central vertigo
Dysfunction in the balance centers of the Brain
(Cerebellum or in the brainstem)
+slurred speech
+ diplopia
VERTICAL NONFATIGUBALE nystagmus
What is the normal response to caloric testing for vertigo
Normal response- COWS
- Cold Opposite Warm Same
- Fast beat of nystagmus goes away from cold
- Fast beat of nystagmus goes toward warm
A pt presents with vertigo lasting 2pm in- a few hours, with low freq tinnitus, and UNILATERAL aural pressure
Think
Menieres syndrome
What are the two known causes of Menieres syndrome
Syphilis and Head trauma
What is the major exam finding in Menieres syndrome
ABNML color is on affected side
What is the treatment for Menieres syndrome/ Endolymphatic Hydrops
Low salt diet
Diuretics
Diazepam/ Meclizine
+/- Vestibular ablation with gentamycin
Or Surgery
What are the s.s of labrythintis
HL
Sudden onset of vertigo, that is continous and severe
+ tinnitus
2/2 a bacterial or viral cause
On exam they will have spont. Horizontal nystagmus that improves with visual fixation
And a positive head impulse test
Head impulse test is sensitive for what type of vertigo
Peripheral
What is the Tx approach to labrynthisit
If a known bacterial infection the ABX
Otherwise Diazepam. meclizine
Only for 2-3 days@
If a pts vertigo is interfering with life and is persistent what is the appraoch
Vestibular rehab
A pt that presents with vertigo from “rolling over in bed” or with head movements and typically lasts on 60 seconds
Think
BPPV
What is the most common cause of vertigo
BPPV
What is the physical exam finding for BPPV
Pos. Did-Hallpke test
What is the tx for BPPV
Eppley maneuver
DO NOT USED VESTIBULAR SUPPRESANTS
Pts with frequent recurrence of BPPV should get what study ordered?
MRI
A pt presents with sudden onset of veritgo that is worse in the first 24 hours then gets better over a week
+N/V
NO HL!!
Think
Vestibular neuronitis
Inflammation of CN VIII, 2/2 a viral infection often a URI and has no HL, + vertigo
Think
Vestibular neuronitis
What is the tx for vestibular neuronitis
Physical exam will show absent calorics, with + head tilts test
Treat suppporting
+diazepam/ Meclizine
May need referal for vestibular rehab
What is the most common cause of vertigo post trauma
Labrythine concussion
What is the tx approach to traumatic vertigo
Supportive care
Vestibular suppressants for the acute pahse only
+/- vestibular rehab
A pt gets sudden onset vertigo with hearing loss while doing exertion activity of diving
Think
Peri lymph fistula
REFER!! For tissue grafts
What are the two cause of cervical vertigo
Hyperextension (trauma)
Degen Disk Dz
What is the main complaint of a pt with a vestibular schwannoma
Hearing loss
Typically unilateral
With very poor speech discrimination
+continous vertigo
A pt presents with unilateral sensoryneuronal hearing loss, with deterioration of speech discrimination
Think ?
Possible vestibular schwannoma
Order MRI!
Anyone with unilateral or asymmetric Senony Neruo HL should get what?
MRI!
This is a condition commonly in the elderly that has vertigo with posture changes and neck extension
Think
Vasc. Compromise
What is the treatment for vertigo caused by vascular compromise?
Think eledrly pt
Asprin and vasodilators
Define conductive hearing loss
External or middle ear dysfunction
Impairment of sound vibrations to the inner ear
Define sensorineural hearing loss
Sensory- Deterioration of the cochlea
Neural- Deterioration of nerve tracts
What are the 4 main causes of conductive hearing loss
Obstruction Mass loading (EffusioN) Stiffness (otosclerosis ) Discontinuity (disruption)
What is the most common cause of SNHL
Presbyacusis
What is the treatment for acute (72 hours) SNHL
Oral steroids and REFER!
Everyone with tinnitus should get what order..
Audiogram
What should you R.o in a pt with unilateral HL and tinnitus
Acuostic neuroma
What are the Rx options for tinnitus
Nortypityline
What is the tx for a pt with hiperacusis and cochlear dysfunction
Hearind aids with compression circuits
What is the audiometry for 0dB
quiet tone that a young adult can hear 50%of the time
What is an abNML dB for an Audiogram
Greater than 25
What is a NML score for a speech discrimination test
90-100
Low score= Poor hearing air candidate
What is the dB for profound HL
Greater than 80
What is the dB for hearing loss that is severe
60-80
Moderate HL
40-60
Mild HL
Less than 40
NML hearing
0-20
What is the sig. threshold shift on an Audiogram set by OSHA
Occupational Safety and Health Administration (OSHA) defines this as a change in hearing threshold, relative to the baseline audiogram for that employee, of an average of 10 decibels (dB) or more at 2000, 3000, and 4000 Hz in one or both ears,
OR
if the sum of shifts at 2000, 3000, and 4000 Hz is greater than 30dB.
Where is the peak on a normal tympanogram
Near 0
With peak complicance from .2-1.8
What does a shallow (type A) tympanogram tell you
Often associated with ossicular fixation, otosclerosis or TM scarring
What does a Type AD (deep) tympanogram tell you
The peak of the pressure curve is above 2
Diagnoses: ossicular disarticulation or ossicular chain discontinuity
What tympanogram would indicate fluid in the middle ear
Flat
Type B
What deos a Type C tympanogram tell you
retracted TM or ETD
Peak pressure is negative, approx. -150 daPa or less (moved to left)
