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IPAP Senior ENT > Inner Ear & Hearing Loss > Flashcards

Inner Ear & Hearing Loss Flashcards

1
Q

Vertigo is

A

a Sx of vestibular dysfunction

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2
Q

Peripheral Vs. Central vestibular dysfunction

A

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

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

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3
Q

most common causes of peripheral vestibular dysfunction

A

BPPV
Vestibular neuritis
Meniere disease

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4
Q

most common cause of central vestibular dysfunction

A

vestibular migraine

vascular etiologies

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5
Q

Endolymphatic Hydrops (Meniere Syndrome)

A

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

2 knwon causes are syphilis & head trauma

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6
Q

Classic Diagnosis of Meniere Syndrome

A
  1. Episodic vertigo 20 min - several hours
  2. SNHL- fluctuating & usually lower frequencies
  3. Tinnitus - low tone & blowing
  4. Sensation unilateral aural fullness
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7
Q

eval of Meniere Syndrome

A
  1. Audiometry: SHL

2. Caloric Testing: Loss / impairment on involved side

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8
Q

Tx of Meniere Syndrome

A

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

Primary: low salt diet & diuretics (acetazolamide)

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9
Q

those with Meniere Syndrome should avoid to reduce Sx’s

A

High salt/MSG diet
Caffeine & nicotine
Alcohol

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10
Q

Sx’s of Vestibular Neuronitis (Neuritis)

A
  1. Acute onset- persistent days-weeks
  2. Nausea/vomiting
  3. Hearing preserved
  4. Unilateral SHL
    +/- Tinnitus
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11
Q

Vestibular neuritis w/ unilateral hearing loss is called

A

Labrynthitis

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12
Q

physical findings of vestibular neuritis

A

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

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13
Q

Sx Tx of vestibular neuritis

A

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

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14
Q

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

A

Vestibular Therapy (rehab)

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15
Q

Benign Paroxysmal Positioning Vertigo (BPPV) is r/t

A

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

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16
Q

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

A

BPPV;

Sx’s occur in clusters for several days

no hearing loss

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17
Q

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

A

Dix-Hallpike Maneuver (DHM);

nystagmus during maneuver is positive finding

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18
Q

Tx of BPPV

A

Epley particle repositioning maneuver

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19
Q

Most common cause of vertigo s/p head injury

A

labyrinthine concussion;

Sx’s deminish in several days may linger for months

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20
Q

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

A

basilar skull Fx

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21
Q

Tx of traumatic vertigo

A

diazepam or meclizine in acute phase

a vestibular therapy

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22
Q

leakage of perilymphatic fluid into middle ear is a

A

perilymphatic fistula

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23
Q

perilymphatic fistula is associated with vertigo that is?

A

worse with straining & SHL

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24
Q

Tx of perilymphatic fistula

A

bed rest, head elevation, & avoidance of straining;

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

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25
Q

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

A

Migrainous Vertigo

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26
Q

Tx of Migrainous Vertigo

A

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

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27
Q

what is semicircular Canal Dehiscence

A

Deficiency in the bony covering of the superior semicircular canal

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28
Q

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

A

by loud noise exposure , or straining

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29
Q

other than vertigo what else is present with semicircular Canal Dehiscence

A

conductive hearing loss

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30
Q

what is associated w/ central causes of vertigo?

A

CNS deficits;

Diplopia
dysarthria
HA
altered mental status
cerebeller/motor/sensory abnomalities
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31
Q

Nystagmus in central causes of vertigo is usually described as

A

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

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32
Q

auditory function in central causes of vertigo is?

A

spared

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33
Q

Causes of central vertigo

A 
Brainstem vascular disease
A/V malformation
Brainstem/cerebellum tumor
MS
Vertebrobasilar migraine
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34
Q

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

A

Acoustic Neuroma aka. Vestibular Schwannoma

35
Q

presentation of Acoustic Neuroma

A

progressive / sudden unilateral SNHL

Vague & continuous disequilibrium, tinnitus occasionally

36
Q

Diagnosis of Acoustic Neuroma is made by

A

MRI w/gadolinium

37
Q

Tx of Asymptomatic Acoustic Neuroma

A

observation + annual MRI for slow growing

38
Q

Tx of symptomatic Acoustic Neuroma

A

excision, radiation + annual MRI

39
Q

Sx’s of MS

A 
Episodic vertigo / chronic imbalance
SHL (MC unilat & rapid)
Sx's affecting adjacent cranial nerves:
Hyper/Hypoacusis
Facial numbness
Diplopia
40
Q

Vertebrobasilar Insufficiency

A

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

41
Q

Tx of Vertebrobasilar Insufficiency

A

Empiric Tx w/vasodilators & aspirin

Vestibular Rehab

42
Q

Normal Hearing range

A

0-20 dB, Soft whisper

43
Q

Mild Hearing loss

A

20-40 dB, Soft spoken voice

44
Q

Moderate Hearing loss

A

40-60dB, Normal Spoken voice

45
Q

Severe Hearing Loss

A

60-80 dB, Loud spoken voice

46
Q

Profound Hearing Loss

A

> 80 dB, Shout

47
Q

weber test on someone with conductive hearing loss

A

sound lateralize & be percieved as louder on affected side

48
Q

weber test on someone with sensorineuroal hearing loss

A

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

49
Q

Conductive hearing loss is a dysfunction of

A

the external or middle ear

50
Q

four causes of conductive hearing loss (CHL)

A
  1. Obstruction (MC)
  2. Mass loading (middle ear effusion)
  3. Stiffness effect (otosclerosis)
  4. Discontinuity (Ossicular disruption)
51
Q

Transient CHL usually caused by

A

cerumen impaction or ETD r/t URI

52
Q

Persistent CHL usually caused by

A

chronic ear infection, trauma, or otosclerosis

53
Q

Tx of CHL

A

Medical: Tx infection / impaction

Surgical: Tympanoplasty / prosthesis

54
Q

Sensory hearing loss is due to

A

deterioration of the cochlea

55
Q

Neural Hearing loss involves

A

Lesions on CNVIII or highter

56
Q

SNHL is usually

A

bilateral & symetric

57
Q

Unilateral or asymptomatic SNHL suggests

A

lession proximal to the cochlea (accoustic neuroma)

58
Q

Most common SNHL

A

Presbycusis- age related hearing loss (MCC)

59
Q

2nd most common cause of SNHL

A

Noise Trauma

60
Q

Sounds > 85dB

A

injure the cochlea

61
Q

Noise trauma usually begins at

A

high frequencies (especially 4000Hz)

62
Q

Sources of noise trauma

A

industrial machinery, weapons, loud music

63
Q

Ototoxic substances may affect

A

both auditory & vestibular systems

64
Q

MC ototoxic medications

A

aminoglycosides
loop diuretics
antineoplastic agents

65
Q

How to reduce risk of ototoxic medications

A

serial audiometry
monitor peak & trough
Substitution of meds

66
Q

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

A

Prompt Tx w/ corticosteroid PO / intratymoanic improves odds of recovery

Prompt audiogram

not effective > 6 weeks after onset

67
Q

connexin-26 mutation is

A

MCC of genetic deafness

68
Q

Tx of hereditary hearing loss

A

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

69
Q

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

A

Autoimmune Hearing loss

70
Q

Tx of autoimmune HL

A

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

2nd line cytotoxic medications (methotrexate)

71
Q

Sensory HL Tx

A

not usually correctable by Medical/surgical therapy

hearing amplification
assistive devices

72
Q

Tx of profound sensory hearing loss or partial hearing loss

A

cochlear implants

73
Q

Perception of abnormal ear/head noise that is persistent indicates

A

tinnitus and SNHL

74
Q

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

A

Tinnitus in normal hearing person

75
Q

Diagnostics for routine non-pulsatile tinnitus

A

obtain audiogram to r/o HL

76
Q

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

A

MRI

77
Q

Tx of Tinnitus

A
  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
78
Q

excessive sensitivity to sound w/normal hearing

A

Hyperacusis

79
Q

Causes of Hyperacusis

A

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

80
Q

Tx of Hyperacusis

A

earplugs

habituation

81
Q

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

A

inner ear viral infection,

vascular accident

82
Q

Gradual HL that indicates Vestibular Schwannomas

A

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

83
Q

Gradual HL that indicates Meniere disease

A

episodic vertigo, tinnitus, and aural fullness

IPAP Senior ENT (7 decks)

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