U of U PA School ENT Hearing Loss, Dizziness, and Facial Nerve Paralysis

What is the difference between vertigo and dizziness?

Dizziness refers to a number of symptoms from weakness to head spinning

Vertigo is a vestibular disorder resulting in illusion of motion

What is conductive hearing loss?

Hearing loss that is due to diminished sound reaching middle and inner ear.

What pathophysiology can lead to conductive hearing loss? (5)

Cerumen accumulation

External ear canal infection

TM perforation

Middle ear fluid

Ossicular chain abnormalities

Tympanogram Type A indicates

Normal ear

Tympanogram Type B indicates

Fluid filled ear

Tympanogram Type C indicates

Drum retracted (negative middle ear pressure)

What tools/tests can be used to investigate conductive hearing loss?

Otoscope/opthalmascope

Tuning fork

Audiometry testing

What case of conductive hearing loss would warrant immediate ENT referral?

Unilateral or acute/rapid onset

What case of tinnitus would warrant ENT referral?

Pulsing tinnitus

What is sensorineural hearing loss?

Hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves

What pathophysiology can cause sensorineural hearing loss? (7)

Injury to hair cells on cochlea

Presbycusis

Persistent noise exposure

Genetics

Stroke

Ototoxic substance

Vestibular schwannoma on 8th nerve

What medications are most commonly associated with sensorineural hearing loss?

Aminoglycosides

Loop diuretics

Platinum chemotherapy agents

What does a presbycusis audiogram look like?

What does a noise induced hearing loss audiogram look like?

When should sensorineural hearing loss be referred to ENT?

Always

What treatments can be used for sensorineural hearing loss?

Cochlear implants

Hearing protection

Hearing aides

What is benign paroxysmal vertigo?

-brief episodes (20-60 sec) of intense whirling vertigo with changes in head position

What is the most common cause of vertigo?

Benign paroxysmal vertigo

What pathophysiology is associated with benign paroxysmal vertigo?

Sediment becoming free floating n semicircular canals and moves in fluid, stimulating the vestibular nerve causing brief vertigo

What history can lead to benign paroxysmal vertigo? (3)

Head trauma

Vestibular neuronitis

Spontaneous

What are the signs and symptoms of benign paroxysmal vertigo?

Patient can usually describe motion that causes the vertigo

What tests can be diagnostic for benign paroxysmal vertigo?

Dix-Hallpike is main one

Supine roll test

What is the treatment for benign paroxysmal vertigo? (4)

Epily maneuver

Canalith repositioning maneuver

Brandt-Daroff exervises

Surgery if severe

What is vestibular neuronitis?

Inflammation of the vestibular portion of the 8th cranial nerve

What history can lead to vestibular neuronitis?

Recent flu like symptoms/URI

What are the symptoms of vestibular neuronitis?

Sudden onset of room spinning for 24-48 hours with vertigo/nausea

How is vestibular neuronitis diagnosed?

Gait assessment

Eye movements

ENG testing

What is the treatment for vestibular neuronitis?

Treatment of nausea

Vestibular nerve suppressants and rehabilitation

What is labyrinthitis?

Inflammation of the labyrinth (inner ear)

What is Meniere's disease?

Fluctuating sensorineural hearing loss in adults with dizzy spells, fullness in ear and tinnitus

Usually unilateral

What is the triad of Meniere's disease?

Vertigo

Hearing loss and aural fullness

Tinnitus

How long do Meniere's disease spells last? What can activate the spells?

Brief 2-4 hours

Salt, high water intake, and caffeine

How is Meniere's disease diagnosed?

Clinically:

->1 episode lasting > 20 minutes

-Documented hearing loss, tinnitus and aural fullness at least once

Vestibular evoked myogenic potentials (VEMP) testing confirms

What is the treatment for Meniere's disease?

Salt restriction and diuretics

Vestibular ablation

Surgery if severe

What is Bell's Palsy?

Inflammation or viral infection of the facial nerve that causes one sided weakness or the entire face

What is the pathophysiology of Bell's Palsy?

Inflammation causes facial nerve to pinch off

What history can lead to Bell's Palsy?

Recent infection

Idiopathic

What are the signs of Bell's Palsy?

Unilateral facial paralysis

What testing is used to diagnose Bell's Palsy?

Diagnosis of exclusion after looking for other causes

What is used to treat Bell's Palsy?

Oral steroids within 3 days of onset

Antivirals possibly effective

What is Ramsay Hunt syndrome?

Herpes infection that commonly involves CN VIII

What history can lead to Ramsay Hunt syndrome?

Vesicular lesions preceeding paralysis

What are the signs and symptoms of Ramsay Hunt syndrome?

Facial nerve paralysis with severe pain
Vesicular eruption in external auditory canal and auricle

Treatment for Ramsay Hunt syndrome

Antiviral agents

Oral steroids

What are the 5 branches of the facial nerve?

Temporal

Zygomatic

Buccal

Mandibular

Cervical