Inner Ear (Exam 2)

Conductive Hearing loss

-Obstruction/blockage of sound

-Mechanical dysfunction of external or middle ear

Sensorineural

-Nerve loss

-Cochlear or Retrocochlear hearing loss

Mixed Hearing Loss

-Combination of conductive & sensorineural losses lesions

Tinnitus

-Sound originates in or around the ears with no source

-Heard only by patient 95% and 5% examiner

History Check for Tinnitus

-Noise exposure

-Aspirin

-Quinine

-Caffeine

-Drugs

-HTN

-Whiplash

-High frequency loss

Causes of Tinnitus

-Infection

-Presbycusis

-Rare tumors

Vertigo

-Hallucination of movement; you or room is moving

-SYMPTOM not a disease

-All dizziness is not this

-Does not include: LOC, Diplopia, lasting greater than weeks

Common causes of Conductive hearing loss

-Cerumen impaction

-Serous Otitis Media

-Foreign objects

-Retracted TM

-Perforated TM

Frequent Causes of Hearing Loss

-Presbycusis

-Mumps or viral illness

-Sudden trauma

-Meniere's disease

-CNS disorders

-Otosclerosis

-Power tools

-Vehicles

-Loud music

-Hunting

Presbycusis

-High frequency hearing loss with difficulty understanding

-Seen in old age

Eustachian Tube Dysfunction

-Ventilation & drainage

-Follows URI & allergies

-Air trapped in middle air becomes absorbed

-Untreated can lead to infection

Signs & Symptoms of ETD

-Aural fullness

-Fluctuating Hearing

-Discomfort with pressure change

-Popping/crackling

-Retracted TM

-Lasts days to weeks

Treatment of ETD

-Nasal Decongestants: Pseudoephedrine; Oxymetazoline (Afrin)

-Intranasal Steroids

-Auto-inflation

Ear Trauma

-Impact injury

-Avoid exposure to water

-Spontaneous resolution

-Monitor for conductive hearing loss

Workups of Vertigo

-Audiogram

-MRI head

-Otoneurological exam

-VNG

Balance Factors

-Vision

-Proprioception

-Labyrinth

Meniere's Disease

-Recurrent Vertigo separated by periods of normalcy

-Ear fullness, decreased hearing, Tinnitis

-Etiology: Unknown

-Symptoms: Vertigo, low frequency hearing loss, tinnitus, aural pressure

Diagnosis of Meniere's Disease

-Caloric Testing (VNG)

-MRI head

-Audiogram

-Otoneurologic exam

-Findings on VNG: loss or impairment of involved side; COWS (Cold, Opposite, Warm, Same)

Treatment of Meniere's Disease

-Low salt diet

-Diuretics (HCTZ 25mg, Lasix 20mg)

-Refractory cases: Steroid injection; decompression; vestibular ablation

Labyrithitis

-Bacterial is very rare

-Viral is referred to as Vestibular Neuronitis

-Follows URI

-Vertigo without hearing loss

-Symptoms: Paroxysmal single attack, days to weeks, no auditory dysfunction

Diagnosis of Vestibular Neuronitis

-PE shows nystagmus

-Diagnose with VNG

-No hearing change on audiogram

Treatment of Vestibular Neuronitis

-Diazepam (Valium)

-Meclizine (Antivert)

Benign Paroxysmal Postioning Vertigo

-Etiology: free floating Otoconia in semicircular canals

-Symptoms: provoked by position; latent perion 10-15 seconds; Resolves after 10-60 seconds; fatigable

-Diagnosis: Dix-Hallpike test; clinical

-TX: Epley maneuver; Brandt-Daroff maneuvers

Dix-Hallpike Test

-Positive: Rotational Nystagmus, Fatigable, latency noted

-May need MRI to r/o lesion

Acoustic Neuroma

-Tumor of the 8th Nerve

-Asymmetric sensorineural loss

-Unilateral tinnitis

-Unilateral poor discrimination

-Occasional source of vertigo

-Source of disequilibrium

-Source of sudden sensorineual hearing loss

Treatment of Acoustic Neuroma

-Observation

-Surgical removal

-Stereostatic radiosurgery

Sudden Hearing Loss

-Viral in origin if other etiologies ruled out

-Basic audiogram

-MRI head to rule out retrocochlear lesion

-CT temporal bone

-Labs

-Prognosis: Absent hearing; absent hearing with associated vertigo

Treatment of Sudden Hearing Loss

-Combined Oral/transtympanic steroid injection

-TX after one week less effective

Ototoxicity

-Can affect auditory & vestibular systems

-MC is aminoglycosides

-High risk pts: preexisting hearing loss & kidney disease

-Avoid using otic drops with amino's is presence of a perforated ear drum

-Pre & post tx audiograms mandatory when using parenteral