Inner Ear & Hearing Loss

Question 1

Vertigo is

Answer 1

a Sx of vestibular dysfunction

Question 2

Peripheral Vs. Central vestibular dysfunction

Answer 2

Peripheral: onset rapid, associated w/tinnitus or hearing loss

Central: gradual onset, no association with auditory Sx’s

Question 3

most common causes of peripheral vestibular dysfunction

Answer 3

BPPV
Vestibular neuritis
Meniere disease

Question 4

most common cause of central vestibular dysfunction

Answer 4

vestibular migraine

vascular etiologies

Question 5

Endolymphatic Hydrops (Meniere Syndrome)

Answer 5

secondary to distention of endolymphatic space w/in balance organs of inner ear

2 knwon causes are syphilis & head trauma

Question 6

Classic Diagnosis of Meniere Syndrome

Answer 6

1. Episodic vertigo 20 min - several hours
2. SNHL- fluctuating & usually lower frequencies
3. Tinnitus - low tone & blowing
4. Sensation unilateral aural fullness

Question 7

eval of Meniere Syndrome

Answer 7

1. Audiometry: SHL

2. Caloric Testing: Loss / impairment on involved side

Question 8

Tx of Meniere Syndrome

Answer 8

symtomatic;
Acute: oral meclizine (25mg) or valium (5mg)

Primary: low salt diet & diuretics (acetazolamide)

Question 9

those with Meniere Syndrome should avoid to reduce Sx’s

Answer 9

High salt/MSG diet
Caffeine & nicotine
Alcohol

Question 10

Sx’s of Vestibular Neuronitis (Neuritis)

Answer 10

1. Acute onset- persistent days-weeks
2. Nausea/vomiting
3. Hearing preserved
4. Unilateral SHL
   +/- Tinnitus

Question 11

Vestibular neuritis w/ unilateral hearing loss is called

Answer 11

Labrynthitis

Question 12

physical findings of vestibular neuritis

Answer 12

spontaneous horizontal nystagmus, suppressed w/visual fixation
positive head thrust test

Question 13

Sx Tx of vestibular neuritis

Answer 13

antihistamines/benzos (meclizine or diazepam) DC’d asap to prevent long-term dysequilibrium from inadequate compensation

Question 14

after acute Sx of vestibular neuritis have subsided what should be provided

Answer 14

Vestibular Therapy (rehab)

Question 15

Benign Paroxysmal Positioning Vertigo (BPPV) is r/t

Answer 15

otoconia (Ca2+ carb cystals) other sediment become free floating & enter 1 of semicircular canals

Question 16

sudden onset vertigo lasting less than 1 minute, triggered by change in head position should key you to

Answer 16

BPPV;

Sx’s occur in clusters for several days

no hearing loss

Question 17

what maneuver is used to Diagnose BPPV & what is Positive finding

Answer 17

Dix-Hallpike Maneuver (DHM);

nystagmus during maneuver is positive finding

Question 18

Tx of BPPV

Answer 18

Epley particle repositioning maneuver

Question 19

Most common cause of vertigo s/p head injury

Answer 19

labyrinthine concussion;

Sx’s deminish in several days may linger for months

Question 20

severe vertigo lasting days-a week w/deafness in involved ear should consider

Answer 20

basilar skull Fx

Question 21

Tx of traumatic vertigo

Answer 21

diazepam or meclizine in acute phase

a vestibular therapy

Question 22

leakage of perilymphatic fluid into middle ear is a

Answer 22

perilymphatic fistula

Question 23

perilymphatic fistula is associated with vertigo that is?

Answer 23

worse with straining & SHL

Question 24

Tx of perilymphatic fistula

Answer 24

bed rest, head elevation, & avoidance of straining;

Failure»middle ear exploration & window sealing w/tissue graft

Question 25

Episodic vertigo w/HA, visual & motion sensitivity, phono & photo phobia, worsen w/lack of sleep & anxiety or stress describes?

Answer 25

Migrainous Vertigo

Question 26

Tx of Migrainous Vertigo

Answer 26

dietary & lifestyle modifications (get more sleep), antimigraine prophylactic medication

Question 27

what is semicircular Canal Dehiscence

Answer 27

Deficiency in the bony covering of the superior semicircular canal

Question 28

how is vertigo triggered in a Pt w/ semicircular Canal Dehiscence

Answer 28

by loud noise exposure , or straining

Question 29

other than vertigo what else is present with semicircular Canal Dehiscence

Answer 29

conductive hearing loss

Question 30

what is associated w/ central causes of vertigo?

Answer 30

CNS deficits; ``` Diplopia dysarthria HA altered mental status cerebeller/motor/sensory abnomalities ```

Question 31

Nystagmus in central causes of vertigo is usually described as

Answer 31

nonfatigable vertical w/o latency unsupressed w/visual fixation (often worse)

Question 32

auditory function in central causes of vertigo is?

Answer 32

spared

Question 33

Causes of central vertigo

Answer 33

``` Brainstem vascular disease A/V malformation Brainstem/cerebellum tumor MS Vertebrobasilar migraine ```

Question 34

Most common intracranial tumor that arise in internal auditory canal & grows to involve cerebellopontine angle (CPA)?

Answer 34

Acoustic Neuroma aka. Vestibular Schwannoma

Question 35

presentation of Acoustic Neuroma

Answer 35

progressive / sudden unilateral SNHL Vague & continuous disequilibrium, tinnitus occasionally

Question 36

Diagnosis of Acoustic Neuroma is made by

Answer 36

MRI w/gadolinium

Question 37

Tx of Asymptomatic Acoustic Neuroma

Answer 37

observation + annual MRI for slow growing

Question 38

Tx of symptomatic Acoustic Neuroma

Answer 38

excision, radiation + annual MRI

Question 39

Sx's of MS

Answer 39

``` Episodic vertigo / chronic imbalance SHL (MC unilat & rapid) Sx's affecting adjacent cranial nerves: Hyper/Hypoacusis Facial numbness Diplopia ```

Question 40

Vertebrobasilar Insufficiency

Answer 40

elderly w/arteriosclerosis reduced flow in vertebrobasilar system triggered by posture changes/extension of neck

Question 41

Tx of Vertebrobasilar Insufficiency

Answer 41

Empiric Tx w/vasodilators & aspirin Vestibular Rehab

Question 42

Normal Hearing range

Answer 42

0-20 dB, Soft whisper

Question 43

Mild Hearing loss

Answer 43

20-40 dB, Soft spoken voice

Question 44

Moderate Hearing loss

Answer 44

40-60dB, Normal Spoken voice

Question 45

Severe Hearing Loss

Answer 45

60-80 dB, Loud spoken voice

Question 46

Profound Hearing Loss

Answer 46

> 80 dB, Shout

Question 47

weber test on someone with conductive hearing loss

Answer 47

sound lateralize & be percieved as louder on affected side

Question 48

weber test on someone with sensorineuroal hearing loss

Answer 48

sound will be percieved as louder in better / normal hearing ear

Question 49

Conductive hearing loss is a dysfunction of

Answer 49

the external or middle ear

Question 50

four causes of conductive hearing loss (CHL)

Answer 50

1. Obstruction (MC) 2. Mass loading (middle ear effusion) 3. Stiffness effect (otosclerosis) 4. Discontinuity (Ossicular disruption)

Question 51

Transient CHL usually caused by

Answer 51

cerumen impaction or ETD r/t URI

Question 52

Persistent CHL usually caused by

Answer 52

chronic ear infection, trauma, or otosclerosis

Question 53

Tx of CHL

Answer 53

Medical: Tx infection / impaction Surgical: Tympanoplasty / prosthesis

Question 54

Sensory hearing loss is due to

Answer 54

deterioration of the cochlea

Question 55

Neural Hearing loss involves

Answer 55

Lesions on CNVIII or highter

Question 56

SNHL is usually

Answer 56

bilateral & symetric

Question 57

Unilateral or asymptomatic SNHL suggests

Answer 57

lession proximal to the cochlea (accoustic neuroma)

Question 58

Most common SNHL

Answer 58

Presbycusis- age related hearing loss (MCC)

Question 59

2nd most common cause of SNHL

Answer 59

Noise Trauma

Question 60

Sounds > 85dB

Answer 60

injure the cochlea

Question 61

Noise trauma usually begins at

Answer 61

high frequencies (especially 4000Hz)

Question 62

Sources of noise trauma

Answer 62

industrial machinery, weapons, loud music

Question 63

Ototoxic substances may affect

Answer 63

both auditory & vestibular systems

Question 64

MC ototoxic medications

Answer 64

aminoglycosides loop diuretics antineoplastic agents

Question 65

How to reduce risk of ototoxic medications

Answer 65

serial audiometry monitor peak & trough Substitution of meds

Question 66

Tx of sudden HL, unilateral, typically > 20y/o

Answer 66

Prompt Tx w/ corticosteroid PO / intratymoanic improves odds of recovery Prompt audiogram not effective > 6 weeks after onset

Question 67

connexin-26 mutation is

Answer 67

MCC of genetic deafness

Question 68

Tx of hereditary hearing loss

Answer 68

restoration of lost hair cells via gene therapy / stem cell-mediated techniques (under development)

Question 69

SHL bilateral progressive w/ periods of deterioration aternating w/ partial / complete remission (evolves to permanent HL)

Answer 69

Autoimmune Hearing loss

Question 70

Tx of autoimmune HL

Answer 70

1st line corticosteroids (60-80mg Prednisone q am for 2-3 weeks) 2nd line cytotoxic medications (methotrexate)

Question 71

Sensory HL Tx

Answer 71

not usually correctable by Medical/surgical therapy hearing amplification assistive devices

Question 72

Tx of profound sensory hearing loss or partial hearing loss

Answer 72

cochlear implants

Question 73

Perception of abnormal ear/head noise that is persistent indicates

Answer 73

tinnitus and SNHL

Question 74

intermittent periods of milf high-pitched noise lasting seconds to minutes indicates

Answer 74

Tinnitus in normal hearing person

Question 75

Diagnostics for routine non-pulsatile tinnitus

Answer 75

obtain audiogram to r/o HL

Question 76

Diagnostic for unilateral tinnitus w/HL w/o cause (noise trauma)

Answer 76

MRI

Question 77

Tx of Tinnitus

Answer 77

1. Avoid exposure noise/ototoxic agents 2. Habitation Techniques 3. Masking w/music or amplification 4. Antidepressant Nortriptyline 50mg PO qHS 5. Transcranial mag stim / implant brain stim

Question 78

excessive sensitivity to sound w/normal hearing

Answer 78

Hyperacusis

Question 79

Causes of Hyperacusis

Answer 79

Ear disease, following noise truama, migraines, or psychological reasons

Question 80

Tx of Hyperacusis

Answer 80

earplugs | habituation

Question 81

sudden onset of unilateral HL w/ or w/o tinnitus may represent

Answer 81

inner ear viral infection, | vascular accident

Question 82

Gradual HL that indicates Vestibular Schwannomas

Answer 82

asymmetric HL, Tinnuitus, & imbalance, then craniial neuropathy (CN V or VII)

Question 83

Gradual HL that indicates Meniere disease

Answer 83

episodic vertigo, tinnitus, and aural fullness