Vertigo, Hearing Loss, Tinnitus and Larynx

Question 1

Definition of vertigo

Answer 1

Illusion of movement

Question 2

Causes of vertigo

Answer 2

IMBALANCE

Infection

Meniere’s disease

BPPV

Arterial

Lymph

Aminoglycosides

Nerve

Central lesion

Epilepsy

Question 3

Ototoxic drugs which can cause vertigo

Answer 3

Gentamicin
Loop diuretics
Metronidazole
Co-trimoxazole

Question 4

Ix for vertigo

Answer 4

Hearing
CNs
Romberg’s test
Dix-Hallpike manouvre
Audiometry

Question 5

Romberg’s test interpretation

Answer 5

+ve = vestibular or proprioception dysfunction

Question 6

Pathology of Meniere’s disease

Answer 6

Dilatation of endolymph spaces of membranous labyrinth

Question 7

Sx of meniere’s

Answer 7

Vertigo

Tinnitus

Aural fullness / SNHL

Attacks in clusters

Question 8

Mx of Meniere’s

Answer 8

Antihistamine - betahistone, cyclizine

Gentamicin ablation in severe disease

Question 9

Other name for vestibular neuritis

Answer 9

Labyrinthitis

Question 10

Presentation of labyrinthitis

Answer 10

Sudden onset vertigo

N/V

No hearing loss

Question 11

Causes of labyrinthitis

Answer 11

Post viral infection

Question 12

Mx of labyrithitis

Answer 12

Reassure

Sedate / Rx symptoms

Question 13

Recovery from labyrithitis

Answer 13

Vertigo resolves in days

Complete recovery 3-4 wks

Question 14

Conductive hearing loss def

Answer 14

impaired between auricle and round window

Question 15

Causes of external canal obstruction

Answer 15

wax, pus, foreign body

Question 16

Causes of tympanic membrane perforation

Answer 16

trauma
infection

Question 17

Causes of ossicle defects

Answer 17

Otosclerosis
Infection
Trauma

Question 18

Causes of conductive hearing loss

Answer 18

External canal obstruction
TM perforation
Ossicle defects

Question 19

Sensorineural hearing loss def?

Answer 19

defects of cochlea, cochlear nerve or brain

Question 20

Causes of sensorineural hearing loss?

Answer 20

drugs
post-infective
others

Question 21

Drugs causing sensorineural hearing loss

Answer 21

aminoglycosides
vancomycin

Question 22

Post-infective causes of sensorineural hearing loss

Answer 22

meningitis
measles
mumps
herpes

Question 23

Other causes of sensorineural hearing loss?

Answer 23

Menieres
Trauma
MS
low B12

Question 24

Purpose of audiometry

Answer 24

quantify hearing loss and determine its nature

Question 25

Types of audiometry

Answer 25

- Pure tone audiometry (PTA) - Tympanometry - Evoked response audiometry

Question 26

Features of pure tone audiometry

Answer 26

- 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.

Question 27

Features of tympanometry

Answer 27

Measures stiffness of ear drum

Question 28

Evoked response audiometry features

Answer 28

- Auditory stimulus with measurement of brain response by surface electrode - Used for neonatal screening

Question 29

Tinnitus definition

Answer 29

Sensation of sound without external sound stimulation

Question 30

Causes of tinnitus

Answer 30

Meniere’s Acoustic neuroma Otosclerosis Noise induced Drugs

Question 31

Drugs causing tinnitus

Answer 31

Aspirin Aminoglycosides Loop diuretics EtOH

Question 32

Unilateral tinnitus

Answer 32

Acoutsic neuroma

Question 33

Ix of tinnitus

Answer 33

Audiometry MRI (acoustic neuroma)

Question 34

Mx of tinnitus

Answer 34

Treat underlying cause Psychiatric support: tinnitus retraining therapy Hypnotics at night

Question 35

Laryngitis causes

Answer 35

Usually viral and self limiting

Question 36

Consequences of laryngitis

Answer 36

Secondary bacterial infection

Question 37

Sx of laryngitis

Answer 37

Pain Hoarse voice Fever Red vocal cords

Question 38

Mx of laryngitis

Answer 38

Usually self limiting Penicillin V if required

Question 39

Laryngeal papilloma definition

Answer 39

Pedunculated vocal cord swellings

Question 40

Laryngeal papilloma cause

Answer 40

HPV

Question 41

Laryngeal papilloma sx

Answer 41

Hoarse voice

Question 42

Laryngeal papilloma Mx

Answer 42

Laser removal

Question 43

Sx of recurrent laryngeal nerve palsy

Answer 43

Hoarse voice Breathy voice Cough Exertional dyspnoea

Question 44

Causes of recurrent laryngeal nerve palsy

Answer 44

Cancers Iatrogenic Aortic aneurysm

Question 45

Cancers causing recurrent laryngeal nerve palsy

Answer 45

Larynx Thyroid Oesophagus

Question 46

Presentation of Laryngeal squamous cell carcinoma

Answer 46

Male smoker Progressive hoarseness → stridor Weight loss

Question 47

Mx of laryngeal SCC

Answer 47

Radiotherapy Total laryngectomy

Question 48

Total laryngectomy

Answer 48

Permanent tracheostomy Speech valve

Question 49

Sx of acoustic neuroma

Answer 49

Unilateral hearing loss Vertigo later Cranial nerve involvement Late raised ICP

Question 50

Cranial nerves affected by acoustic neuroma

Answer 50

5, 6, 9, 10