Inner Ear Disease Flashcards
What needs to be excluded for LMN CNV11 palsy?
-Herpes Zoster (Ramsay-Hunt Syndrome- vesicles in conchal bowl, vesicular rash around ear, facial nerve palsy, auricular pain, lower recovery, can affect more than one cranial nerve, oral Aciclovir and corticosteroids)
-Middle ear pathology (cholesteatoma= otoscopy)
-Parotid tumour (masses)
-Trauma
-CPA tumours
Treatment and assessment of Bell’s palsy
-Idiopathic!! acute unilateral LMN CNV11 palsy
=Peak incidence 20-40, pregnant women
=Forehead involved, dry eyes, altered taste, post-auricular pain, hyperacusis
-Extent assessment= House-Brackmann grade
-Prednisolone 50mg od 10/7 if <3/7 onset +/- antivirals (within 72 hours). Combination
-Eye protection (lacrilube, patch/ tape)
-Follow-up
if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT
a referral to plastic surgery may be appropriate for patients with more long-standing weakness e.g. several months
Prognosis
most people with Bell’s palsy make a full recovery within 3-4 months
if untreated around 15% of patients have permanent moderate to severe weakness
Causes of sensori-neural hearing loss
-Presbyacuasis/ age related hearing loss
=slow gradual hearing loss usually bilateral
=normal otoscope, audiometry high frequency
– Iatrogenic (Surgery/Drugs)
– Congenital
- Infective
– Autoimmune
-Acoustic neuroma
– Idiopathic
Treatment of sensori-neural hearing loss
-Hearing tactics
-Conventional hearing aids
-Implantable hearing aids
-Cochlear implant
Causes of conductive hearing loss
-EAM (external auditory meatus)
=Wax (rare unless occlusive) impaction
=Atresia of ear canal (rare)
-Middle ear disease
=OME
=Ossicular discontinuity (COM)
=Ossicular fixation (otosclerosis/ COM)
-Otitis external
-Foreign body
-Tympanic membrane perforation
-Cholesteatoma
General categories of vertigo
-Central (brain issue)
-Peripheral (vestibular)
Overview of BPPV (benign paroxysmal positional vertigo)
The average age of onset is 55 years and it is less common in younger patients
-Transient (seconds) vertigo with movement (sudden onset), may be associated with nausea
-Following other inner ear disease/ head trauma
-Self-limiting
-Hall pike test= rotatory nystagmus and vertigo
-Epley manoeuvre treatment and vestibular rehabilitation (Brandt-Daroff)
Overview of Vestibular Neuronitis/ Labyrinthitis
-Vertigo pattern (long-term)
=Prostrating 3/7 (recurrent vertigo attacks lasting hours or days)
=Housebound 3/52
=Not right 3/12
-Nausea and vomiting
-Horizontal nystagmus
-NO HEARING LOSS OR TINNITUS
-Vestibular sedatives (prochlorperazine/ cinnarizine- buccal or intramuscular) for 3/7, physiotherapy (vestibular rehabilitation exercises)
-Differential diagnosis
viral labyrinthitis
posterior circulation stroke: the HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke
Overview of viral labyrinthitis
-Inflammatory disorder of membranous labyrinth; affects vestibular and cochlear end organs
-Labyrinthitis should be distinguished from vestibular neuritis as there are important differences: vestibular neuritis is used to define cases in which only the vestibular nerve is involved, hence there is no hearing impairment; Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.
-40-70 y/o
-Acute onset: vertigo not triggered but exacerbated by movement), N&V, HL (uni/bilateral, varying severity), tinnitus, preceding or concurrent URTI
-Spontaneous unidirectional horizontal nystagmus towards unaffected side, SNHL, abnormal head impulse test (impaired vestibulo-ocular reflex), gait disturbance (fall towards affected side)
-Self-limiting, prochloperazine or antihistamines
Overview of Meniere’s Disease
-Episodic vertigo mins-hrs
-Fluctuating sensorineural hearing loss
-Fluctuating tinnitus (ALL HAPPENS TOGETHER)
-Aural pressure
-Low frequency SNHL (stabilises over years)
-Nystagmus and positive Romberg test
-Unilateral, bilateral develop after number of years
-Treat with low salt/ caffeine, betahistine, intratympanic injection
-Acute attacks: buccal or intramuscular prochlorperazine, betahistine prevention, vestibular rehabilitation exercises, DVLA
-Resolve 5-10 years, hearing loss, psychological distress
Overview of Vestibular Migraine
-Episodic vertigo mins-hrs
-No fluctuation in hearing/ tinnitus
-Other symptoms: headache, visual disturbance, numbness
-Personal/ FH of migraine
-Can be mistaken for Meniere’s disease
-Treat as per migraine
Describe tinnitus
-Sensation of sound in one or both ears
-Cause uncertain
-Most common with hearing loss (30% population)
-Drugs: aspirin/NSAIDs, aminoglycosides, loop diuretics, quinine
-Impacted ear wax
-If pulsatile vascular cause needs excluding
-If asymmetrical MRI scan for CPA tumour
-Treatment= reassurance, hearing aid/ therapy
Overview of Vestibular Schwannoma
-Unilateral sensori-neural HL, tinnitus, recurrent vertigo, absent corneal reflux
-Slow growing and benign
-MRI IAM cerebellopontine angle, audiogram
-1% of those with unilateral symptoms
-If growing and large= gamma-knife, surgery, radiotherapy, observation
-Bilateral vestibular schwannomas are seen in neurofibromatosis type 2.
What to examine if the ear is normal
-TMJ
-Throat
-Neck
-Nose
-Teeth
Describe Acoustic trauma
-Temporary threshold shift
=tinnitus, unilateral HL
=Resolves over hours-days
-Cumulative effect
=Permanent damage to hair cells
=4 kHz predominates
Control of noise at work regulations 2005
