Diseases of the Inner Ear

persistent, intermittent, high/low pitched buzzing/ringing that interferes with sleep and concentration

tinnitus

main causes of tinnitus:

hearing loss/age, noise exposure, head/neck trauma

most common cost of tinnitus:

hearing loss and age, noise exposure

how to evaluate for tinnitus

gather history, refer to audiology, diagnostic imaging

hx of events leading to tinnitus:

trauma, dizziness, noise exposure, family hx

diagnostic imaging for tinnitus is only used for ________

unilateral tinnitus

what image would you order for unilateral tinnitus?

MRI of brain & IAC with contrast to rule out acoustic neuroma

medical conditions leading to tinnitus:

hypo/hyperthyroidism, lyme disease, fibromyalgia, thoracic outlet syndrome

ear conditions leading to tinnitus:

meniere's dx, acoustic neuroma, impacted cerumen, labyrinthitis, eustachian tube dysfxn, FB

management of tinnitus:

masking devices (white noise), hearing device, avoid CATS, antidepressants, supplements

Which medications/supplements are best for tinnitus?

nortriptyline, omega-3, vitamin B complex

which disorder of the middle ear is very rare and is associated with staccato "clicking" tinnitus that results from middle ear muscle spasms?

objective tinnitus

what to do for objective tinnitus:

refer to EENT

difference between objective tinnitus and regular tinnitus:

you can hear the staccato clicking with objective and it lasts a few seconds to minutes

Patient presentation of vertigo:

dizziness, spinning, could be sudden onset or gradual

associated symptoms of vertigo:

tinnitus, N/V, hearing decrease

what makes symptoms of vertigo worse?

movement

Diagnostics of vertigo:

examine ears and CN, presence of nystagmus, gait, romberg test, MRI

Nylen-Barany Manuver:

used to reproduce vertigo, more likely positive in peripheral vertigo

what is the most common cause of vertigo and involves clusters lasting several days with a quick onset due to a change in the head position as well as a quick subside?

benign paroxysmal positional vertigo

diagnosis of benign paroxysmal positional vertigo:

vestibular nystagnogram, dix hallpike

___Head piece is lowered completely

___Pt positioned on table so shoulders & head are clear of the end of table

___Patient's head turned *30-45 degrees* towards the side being tested, head is supported by examiner

___Examiner helps the pt lie back quickly so their head is below the horizontal

___Pt is held in this position for *8-10 sec* while looking for nystagmus then raised up

___Examiner reassesses the pt's eyes for an additional 8-10 seconds

___Bilaterally performed

___*Positive finding*: Nystagmus &/or vertigo after a brief delay that lasts no longer than 1 min

___*Indication*: Benign positional vertigo (BPPV)

Nylen-Barany Maneuver (Dix-Hallpike)

treatment of benign paroxysmal positional vertigo:

canalith repositioning, PT

which kind of vertigo is not associated with a hearing loss?

benign paroxysmal positional vertigo

characteristics of peripheral vertigo:

sudden onset, nausea & vomiting, tinnitus, decreased hearing

characteristics of central vertigo:

slower onset, nausea & vomiting, motor, sensory or cerebellar deficits

how to assess cerebellar deficets?

gait funciton

if a patient presents with vertigo and they are above the age of 80, it is likely due to:

central issues

types of peripheral vertigo associated with EENT:

positional vertigo (BPPV), meniere's syndrome, labyrinthitis, vestibular neuritis

what are other types of peripheral vertigo not associated with EENT?

migrainous vertigo, obstructing anatomic abnormalities

which peripheral vertigo is caused by endolymph not being reabsorbed in the labyrinth? (distends endolymphatic compartment of inner ear)

meniere's syndrome

what are the trio of unexplained symptoms associated with meniere's syndrome?

unilateral hearing loss, ipsilateral tinnitus, dizziness or vertigo

meniere's syndrome is also known as:

endolymphatic hydrops

patient presentation of meniere's syndrome:

episodic vertigo, low freq SNHL, unilateral tinnitus (same ear as SNHL), ear pressure

Physical exam of meniere's syndrome is typically:

normal

diagnostic evaluation of meniere's syndrome:

comprehensive audiology eval, possibly dx imaging

what diagnostic imaging should you order to eval meniere's syndrome

MRI of internal auditory canal

management of endolymphatic hydrops:

low-sodium diet, diuretics (maxzide), refer to vestibular rehab

which peripheral vertigo disorder is characterized by a sudden onset of vertigo with NO new hearing loss or tinnitus? (may also have N/V, fever, headache, nystagmus)

vestibular neuritis

what is different between vestibular neuritis and labyrinthitis?

vestibular neuritis is inflammation of CN VIII only, labyrinthitis is inflammation of the entire labyrinth

which peripheral vertigo disorder presents with continuous and severe vertigo with hearing loss and tinnitus?

labyrinthitis

what other symptoms can be associated with labyrinthitis?

N/V, fever, headache

the etiology of labyrinthitis and vestibular neuritis are both:

unknown

suspected etiology of labyrinthitis:

inflammation of inner ear, may occur following otitis media or viral URI

vestibular neuritis only effects ________

vestibular nerve

labyrinthitis effects _____________

semicircular canals and labyrinth

labyrinthitis is ________ than vestibular neuritis

less common

prognosis of labyrinthitis:

weeks of recovery, rapid head movement may cause vertigo

what happens to hearing with labyrinthitis?

either becomes normal or remains permanently impaired

treatment of labyrinthitis:

zofran, promethazine, meclizine

non-pharmaceutical treatments for vertigo:

lessen movement, decrease salt intake

decreased salt intake is especially important in which form of vertigo?

Meniere's syndrome

medications for vertigo:

meclizine, ondansetron, scopolamine, diazepam (last resort)

which nerves are typically impaired with an acoustic neuroma?

vestibular nerve and facial nerve

acoustic neuromas on the vestibulocochlear nerve puts pressure on the:

facial nerve

acoustic neuromas is also referred to as:

vestibular schwannoma

benign lesion of internal auditory canal that is one of the most common intracranial tumors, MC in females:

acoustic neuroma

patient presentation of acoustic neuroma:

gradual onset of unilateral hearing loss & ipsilateral tinnitus, often associated with vertigo, facial nerve issues, ataxia, dizziness

ataxia

difficulty walking

which images would you order for acoustic neuromas?

MRI of brain and IAC with contrast, CT if not possible