Vertigo, Hearing Loss, Tinnitus and Larynx Flashcards
Definition of vertigo
Illusion of movement
Causes of vertigo
IMBALANCE
Infection
Meniere’s disease
BPPV
Arterial
Lymph
Aminoglycosides
Nerve
Central lesion
Epilepsy
Ototoxic drugs which can cause vertigo
Gentamicin
Loop diuretics
Metronidazole
Co-trimoxazole
Ix for vertigo
Hearing
CNs
Romberg’s test
Dix-Hallpike manouvre
Audiometry
Romberg’s test interpretation
+ve = vestibular or proprioception dysfunction
Pathology of Meniere’s disease
Dilatation of endolymph spaces of membranous labyrinth
Sx of meniere’s
Vertigo
Tinnitus
Aural fullness / SNHL
Attacks in clusters
Mx of Meniere’s
Antihistamine - betahistone, cyclizine
Gentamicin ablation in severe disease
Other name for vestibular neuritis
Labyrinthitis
Presentation of labyrinthitis
Sudden onset vertigo
N/V
No hearing loss
Causes of labyrinthitis
Post viral infection
Mx of labyrithitis
Reassure
Sedate / Rx symptoms
Recovery from labyrithitis
Vertigo resolves in days
Complete recovery 3-4 wks
Conductive hearing loss def
impaired between auricle and round window
Causes of external canal obstruction
wax, pus, foreign body
Causes of tympanic membrane perforation
trauma
infection
Causes of ossicle defects
Otosclerosis
Infection
Trauma
Causes of conductive hearing loss
External canal obstruction
TM perforation
Ossicle defects
Sensorineural hearing loss def?
defects of cochlea, cochlear nerve or brain
Causes of sensorineural hearing loss?
drugs
post-infective
others
Drugs causing sensorineural hearing loss
aminoglycosides
vancomycin
Post-infective causes of sensorineural hearing loss
meningitis
measles
mumps
herpes
Other causes of sensorineural hearing loss?
Menieres
Trauma
MS
low B12
Purpose of audiometry
quantify hearing loss and determine its nature
Types of audiometry
- Pure tone audiometry (PTA)
- Tympanometry
- Evoked response audiometry
Features of pure tone audiometry
- Headphones deliver tones at different frequencies and strengths
- Pt. indicates when sound appears and disappears
- Mastoid vibrator → bone conduction threshold
- Threshold at different frequencies are plotted to give an audiogram.
Features of tympanometry
Measures stiffness of ear drum
Evoked response audiometry features
- Auditory stimulus with measurement of brain response by surface electrode
- Used for neonatal screening
Tinnitus definition
Sensation of sound without external sound stimulation
Causes of tinnitus
Meniere’s
Acoustic neuroma
Otosclerosis
Noise induced
Drugs
Drugs causing tinnitus
Aspirin
Aminoglycosides
Loop diuretics
EtOH
Unilateral tinnitus
Acoutsic neuroma
Ix of tinnitus
Audiometry
MRI (acoustic neuroma)
Mx of tinnitus
Treat underlying cause
Psychiatric support: tinnitus retraining therapy
Hypnotics at night
Laryngitis causes
Usually viral and self limiting
Consequences of laryngitis
Secondary bacterial infection
Sx of laryngitis
Pain
Hoarse voice
Fever
Red vocal cords
Mx of laryngitis
Usually self limiting
Penicillin V if required
Laryngeal papilloma definition
Pedunculated vocal cord swellings
Laryngeal papilloma cause
HPV
Laryngeal papilloma sx
Hoarse voice
Laryngeal papilloma Mx
Laser removal
Sx of recurrent laryngeal nerve palsy
Hoarse voice
Breathy voice
Cough
Exertional dyspnoea
Causes of recurrent laryngeal nerve palsy
Cancers
Iatrogenic
Aortic aneurysm
Cancers causing recurrent laryngeal nerve palsy
Larynx
Thyroid
Oesophagus
Presentation of Laryngeal squamous cell carcinoma
Male smoker
Progressive hoarseness → stridor
Weight loss
Mx of laryngeal SCC
Radiotherapy
Total laryngectomy
Total laryngectomy
Permanent tracheostomy
Speech valve
Sx of acoustic neuroma
Unilateral hearing loss
Vertigo later
Cranial nerve involvement
Late raised ICP
Cranial nerves affected by acoustic neuroma
5, 6, 9, 10
