Inner Ear And HL Flashcards by Demetré Harris

What is the fluid that surrounds the membranous labrynth of the ear

Perilymph

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What is the fluid within the membranous Labryth

Endo lymph

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Define peripheral vertigo

2/2 dysfunction in the labryntth or vestibular nerve

Sudden onset

Vertigo in response to head turning

Fatiguable Nystagumus (horizontal)

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Define central vertigo

Dysfunction in the balance centers of the Brain
(Cerebellum or in the brainstem)

+slurred speech
+ diplopia

VERTICAL NONFATIGUBALE nystagmus

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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

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A pt presents with vertigo lasting 2pm in- a few hours, with low freq tinnitus, and UNILATERAL aural pressure

Think

Menieres syndrome

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What are the two known causes of Menieres syndrome

Syphilis and Head trauma

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What is the major exam finding in Menieres syndrome

ABNML color is on affected side

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What is the treatment for Menieres syndrome/ Endolymphatic Hydrops

Low salt diet

Diuretics

Diazepam/ Meclizine

+/- Vestibular ablation with gentamycin

Or Surgery

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What are the s.s of labrythintis

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

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Head impulse test is sensitive for what type of vertigo

Peripheral

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What is the Tx approach to labrynthisit

If a known bacterial infection the ABX

Otherwise Diazepam. meclizine

Only for 2-3 days@

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If a pts vertigo is interfering with life and is persistent what is the appraoch

Vestibular rehab

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A pt that presents with vertigo from “rolling over in bed” or with head movements and typically lasts on 60 seconds

Think

BPPV

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What is the most common cause of vertigo

BPPV

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What is the physical exam finding for BPPV

Pos. Did-Hallpke test

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What is the tx for BPPV

Eppley maneuver

DO NOT USED VESTIBULAR SUPPRESANTS

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Pts with frequent recurrence of BPPV should get what study ordered?

MRI

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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

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Inflammation of CN VIII, 2/2 a viral infection often a URI and has no HL, + vertigo

Think

Vestibular neuronitis

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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

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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)