Inner Ear

Acute Labyrinthitis (vestibular neuritis)

Inflammation of the labyrinth as a result of a viral or post-viral disorder affecting the vestibular portion of CN VIII

prednisone, anti-emetics, meclazine (antivert)

Patient presents to the ER for vertigo and hearing loss in their right ear. Patient reports that they have recently gotten over a cold. Patient notes nausea/vomiting. On a physical exam, you note a unstable gait. What treatments can we use in the 1st 48 hours to treat this condition?

vestibular rehab

Long term treatment of vestibular neuronitis labyrinthitis

rule out other causes of vertigo

Concerning acute peripheral vestibulopathy, why do we need to refer to ENT?

none

What is the confirmatory test you can use to determine the diagnosis of neruo-labyrinthitis?

Benign paroxysmal positional vertigo (bppv)

A 77 y/o male presents to the ER for sudden onset nausea vomiting. While collecting a history you discover that the patient has a history of a TM rupture. Patient also reports tinnitus and short episodes of vertigo that occur when he moves his head. What are we thinking team?

tinnitus

The perception of noise or ringing in the ears that affects 1/5 people and is a symptom of an underlying injury such as age-related hearing loss or ear injury

ringing, buzzing, roaring, clicking or hissing

Tinnitus can be described by

ENT, audiology

Concerning tinnitus who do we refer to

lessen awareness and impact, aimed at underlying abnormality

When treating tinnitus what is the goal of treatment?

Acoustic neuroma (vestibular schwannoma)

A benign schwannoma of CN VIII that affects about 3,000 per year in the US, usually people 30-60 y/o.

asymmetric hearing loss, tinnitus, vertigo

What are the initial symptoms of an acoustic neuroma?

facial numbness/weakness (compression of CN V/VII)

Symptoms of progressive vestibular schwannoma

asymmetric SNHL (Sensorioneural hearing loss)

What will an audiogram in an acoustic neuroma show?

Nodular advancing lesions in the internal auditory canals

What will a MRI in a vestibular schwannoma show?

surgical removal, radiation

In acoustic neuroma how are you treating large tumors, young patients, or significant hearing impairment?

observation (yearly imaging/audiometry)

In acoustic neuroma how are you treating older patients, small tumors, or limited hearing loss?

Meniere’s Disease

What is an inner ear problem characterized by an abnormal accumulation of endolymph fluid within the inner ear (endolymphatic hydrops) from an unknown cause?

Sodium and water retention

What is a possible cause of Meniere’s disease?

avoid triggers, low sodium diet (2-3 g/day), vestibular rehab, diuretics (hydrocholorothiazide), vasodilator (betahistamine)

Patient presents to the ER for extreme bouts of dizziness. Patient reports these episodes last 20 minutes to 12 hours and she loses hearing in the right ear. They note tinnitus and ear fullness - all on the right side. A physical exam shows low sensorineural hearing loss in her right ear. What are the long term treatments for this condition?

fluctuating asymmetric hearing loss (SNHL), tinnitus, vertigo

Triad of Meniere’s disease

vestisbular schwannoma, MS, TIA, migraine (vertigo/vestibular), BPPV

Differentials of Meniere’s Disease

SNHL on the affected side

Audiometry for Meniere’s disease will show

abnormal on the affected side

Vestibular testing for Meniere’s disease will be

rule out tumors, aneurysms, MS, etc

Why do you do an MRI in a Meniere’s disease workup?

2 or more spontaneous episodes of vertigo (20min-12 hours), audiometrically documented low-mid frequency SNHL in affected ear, fluctuating aural symptoms (tinnitus, reduced/distorted hearing/fullness) in affected ear, symptoms not better accounted for by another vestibular diagnosis

Criteria to diagnose Meniere’s disease

No (educate your patients and address expectations)

Is there a cure for Meniere’s?

reduce frequency and severity of vertigo attacks, reduce/eliminate tinnitus and hearing loss associated with attacks, alleviated chronic tinnitus and disequilibrium, minimize disability, prevent progressive hearing loss

Goals in managing Meniere’s disease

Vestibular suppressants (clonazepam, diazepam), anti-emetics (promethazine, ondasetron)

Acute treatment for Meniere disease