Inner Ear Disorders

What is labyrinthitis?

Inflammation of the labyrinth, often viral or post-viral.

What cranial nerve is affected in labyrinthitis?

Vestibulocochlear nerve (CN VIII).

What common history precedes labyrinthitis?

Recent viral upper respiratory infection.

Key symptoms of labyrinthitis?

Vertigo, unilateral hearing loss, nausea, vomiting, gait instability

Is labyrinthitis self-limited or chronic?

Self-limited, lasting days to weeks.

First-line medications in labyrinthitis?

Prednisone, antiemetics, vestibular suppressants (Meclizine).

What is long-term treatment for labyrinthitis?

Vestibular rehabilitation.

What does BPPV stand for?

Benign Paroxysmal Positional Vertigo.

Who is most commonly affected by BPPV?

Elderly patients

What triggers BPPV?

Head movements.

Duration of BPPV episodes?

Seconds to minutes.

Common symptoms of BPPV?

Vertigo, nausea, vomiting, tinnitus

What is tinnitus?

Perception of sound (ringing/buzzing) without external source.

How common is tinnitus?

Affects about 1 in 5 people.

Is tinnitus a disease or a symptom?

A symptom of underlying condition.

Examples of underlying causes of tinnitus?

Age-related hearing loss, ear injury.

Treatment goal for tinnitus?

Reduce awareness and impact on quality of life.

What is another name for acoustic neuroma?

Vestibular schwannoma.

Which cranial nerve is affected by acoustic neuroma?

Cranial nerve VIII (vestibulocochlear).

Most common age group for acoustic neuroma?

30-60 years old.

Most common presenting symptom of acoustic neuroma?

Asymmetric sensorineural hearing loss.

Best diagnostic test for acoustic neuroma?

MRI of internal auditory canals.

Classic triad of Ménière disease?

Vertigo, tinnitus, fluctuating sensorineural hearing loss.

Pathophysiology of Ménière disease?

Idiopathic endolymphatic hydrops.

Dietary modification for Ménière disease?

Low sodium diet (2-3 g/day).

Long-term medication for Ménière disease?

Diuretics (HCTZ), betahistine.

Key lifestyle changes for Ménière disease?

Avoid salt, caffeine, alcohol, nicotine, stress, MSG.

Why is ENT referral important in labyrinthitis?

To rule out other causes of vertigo

What vestibular suppressant is used in labyrinthitis?

Meclizine (Antivert).

What percentage of BPPV patients have prior trauma or infection?

About 50%.

What test is used to diagnose BPPV?

Dix-Hallpike maneuver.

Dix-Hallpike maneuver.

Epley repositioning maneuver.

List 5 descriptors of tinnitus.

Ringing, buzzing, roaring, clicking, hissing.

Why should tinnitus patients be referred to audiology?

To rule out hearing loss or pathology.

What type of hearing loss is commonly associated with tinnitus?

Sensorineural hearing loss.

What is the main challenge in tinnitus treatment?

It is a symptom, not a disease—hard to cure.

What cranial nerves can be compressed by acoustic neuroma progression?

CN V and CN VII.

What symptom may occur with CN V involvement in acoustic neuroma?

Facial numbness/weakness

What management is chosen for small tumors in older patients?

Observation with yearly MRI and audiometry.

What is the risk of observation-only management in acoustic neuroma?

Progressive hearing loss.

What is the annual incidence of acoustic neuroma in the US?

About 3,000 cases/year.

How long do Ménière episodes typically last?

Minutes to hours.

Within how many years can hearing loss become permanent in Ménière disease?

8-10 years.

What antiemetics are used in Ménière disease acute treatment?

Promethazine, ondansetron.

What vestibular suppressants are used in acute Ménière attacks?

Clonazepam, diazepam.

What vestibular test finding is expected in Ménière disease?

Abnormal testing on affected side.

List three key differentials for Ménière disease.

Vestibular schwannoma, TIA, vestibular migraine.

Diagnostic criteria: How many vertigo episodes are required?

At least 2, lasting 20 min-12 hours.

What audiometric finding is required for diagnosis of Ménière?

Low- to mid-frequency SNHL in affected ear

Name one long-term rehabilitative therapy for Ménière disease.

Vestibular rehabilitation.

What MRI finding must be excluded in Ménière disease workup?

Tumors, aneurysms, or MS lesions.

What are the three main types of hearing loss?

Sensorineural, conductive, and mixed hearing loss.

What is presbyacusis?

Age-related progressive symmetric SNHL, starting with high-frequency loss.

What is the 2nd most common cause of SNHL?

Noise trauma from prolonged exposure to >85 dB.

What drugs are ototoxic?

Salicylates, NSAIDs, aminoglycosides, erythromycin, tetracycline, cisplatin.

What is sudden SNHL?

Acute unilateral SNHL <72 hrs, often idiopathic; treat with steroids ± antivirals

A 45-year-old woman presents with acute vertigo, nausea, and unilateral hearing loss following a viral upper respiratory infection. Exam reveals gait instability. What is the most likely diagnosis?

A) Benign paroxysmal positional vertigo

b) Acoustic neuroma

c) Acute labyrinthitis

d) Ménière disease

C

A 70-year-old man reports recurrent brief episodes of vertigo lasting seconds, triggered by turning his head in bed. He denies hearing loss. What is the most likely diagnosis?

A) Acute labyrinthitis

B) Benign paroxysmal positional vertigo

C) Acoustic neuroma

D) Ménière disease

B

A 58-year-old man complains of asymmetric hearing loss and persistent tinnitus. MRI of the internal auditory canal reveals a mass. Which nerve is most likely affected?

A) CN V

B) CN VII

C) CN VIII

D) CN IX

C

A 36-year-old woman presents with tinnitus described as 'buzzing' and 'roaring.' She denies vertigo but has age-related hearing loss. Which is the most appropriate next step?

A) Start diuretics

B) Refer to ENT or Audiology

C) Order immediate MRI

D)Begin vestibular suppressants

B

A 42-year-old patient presents with recurrent disabling vertigo lasting 1-2 hours, accompanied by roaring tinnitus and fluctuating hearing loss. Audiometry shows low-frequency sensorineural hearing loss. What is the most likely diagnosis?

A) Benign paroxysmal positional vertigo

B) Ménière disease

C) Acoustic neuroma

D) Labyrinthitis

B

A 33-year-old woman has sudden onset vertigo, nausea, and vomiting lasting several days after a URI. No hearing loss is reported. What is the best management in the first 48 hours?

A) Prednisone and vestibular suppressants

B) Diuretics and salt restriction

c) Surgical excision

D) Observation only

A

A 75-year-old man with a history of ear trauma presents with vertigo triggered by rolling over in bed. Episodes last less than a minute. What test would most likely reproduce his symptoms?

A) Valsalva maneuver

B) Head impulse test

C) Dix-Hallpike maneuver

D) MRI of brain

C

A 55-year-old woman with asymmetric hearing loss and vertigo is found to have a vestibular schwannoma. Which additional symptom would suggest tumor compression of CN V?

A) Facial numbness

B) Hearing loss

c) Facial paralysis

d) Tinnitus

A

A 30-year-old woman presents with recurrent vertigo, nausea, and vomiting. She is diagnosed with Ménière disease. Which lifestyle recommendation is appropriate for long-term management?

A) Avoid air travel

B) Increase salt intake

C) Low sodium diet

D) Daily prednisone

C

A 47-year-old man presents with progressive unilateral hearing loss, tinnitus, and occasional vertigo. MRI shows a 1.5 cm vestibular schwannoma. Which management is most appropriate in an older patient with small tumors and limited hearing loss?

A) Immediate surgical excision

B) Radiation therapy

C) Observation with yearly imaging

D) Prednisone therapy

C

A 63-year-old patient presents with tinnitus and asymmetric hearing loss. Which diagnostic test is most useful to confirm acoustic neuroma?

A) CT head

B) MRI of internal auditory canal

C) Audiogram only

D) Vestibular testing

B

A 50-year-old woman has episodic vertigo and tinnitus. Audiometry shows low-frequency SNHL. Which diagnostic criteria must also be met for Ménière disease?

A) At least two vertigo episodes lasting 20 min-12 hrs

B) Continuous vertigo >24 hrs

C) Asymmetric high-frequency SNHL

D) Abnormal CT temporal bone

A

A 41-year-old man describes ringing in the ears after years of noise exposure. Which description is most consistent with tinnitus?

A) Brief vertigo lasting seconds

B) Buzzing or roaring sound

C) Unilateral conductive hearing loss

D) Facial numbness

B

A 29-year-old patient develops vertigo, nausea, and vomiting. Prednisone and meclizine are prescribed. Which condition is being treated?

A) Ménière disease

B) Labyrinthitis

C) BPPV

D) Acoustic neuroma

B

A 65-year-old woman experiences recurrent vertigo and tinnitus, worsened by stress and high salt intake. What is the most appropriate long-term pharmacologic option?

A) Betahistine

B) Prednisone

C) Ibuprofen

D) Antibiotics

A

A 39-year-old man presents with acute labyrinthitis. Which is the best reason for urgent ENT referral?

A) To confirm audiogram results

B) To rule out other causes of vertigo

C) To arrange immediate surgery

D) To provide long-term diuretics

B

A 72-year-old man describes short episodes of vertigo when looking up or turning his head. Which condition is most likely?

A) Acoustic neuroma

B) Ménière disease

C) BPPV

D) Labyrinthitis

C

A 59-year-old woman has progressive hearing loss, vertigo, and right-sided facial weakness. Which diagnosis best explains these findings?

A) Ménière disease

B) Acoustic neuroma

C) Labyrinthitis

D) BPPV

B

A 46-year-old man with Ménière disease asks about acute management of his vertigo episodes. Which medication is appropriate?

A) Hydrochlorothiazide

B) Clonazepam

C) Betahistine

D) Prednisone

B

A 37-year-old patient with tinnitus seeks treatment. What is the main treatment goal?

A) Eliminate the condition entirely

B) Lessen awareness and impact on quality of life

C) Prevent all future ear infections

D) Restore conductive hearing

B