oreilles

Question 1

types of hearing loss

Answer 1

conductive hearing loss
sensorineural hearing loss
mixed hearing loss

Question 2

rinne test

Answer 2

512 Hz tuning fork is struck and held firmly on mastoid process to test BC (bone conduction); the tuning fork is then placed beside the pinna to test AC (air conduction)

Question 3

rinne normal

Answer 3

if AC > BC → positive Rinne (normal)

Question 4

weber test

Answer 4

◆ 512 Hz tuning fork is held on vertex of head and patient states whether it is heard centrally (Weber negative) or is lateralized to one side (Weber right, Weber left)
◆ can place vibrating fork on patient’s chin while they clench their teeth, or directly on teeth to elicit more reliable response

Question 5

weber test : lateralize if …

Answer 5

lateralize if difference in HL between ears is >6 dB

Question 6

Weber test lateralization

Answer 6

ipsilateral CHL (conductive hearing loss) or contralateral SNHL (sensorineural hearing loss)

Question 7

The Weber test is more sensitive in detecting ____ than the Rinne test

Answer 7

CHL

Question 8

vertigo

Answer 8

illusion of rotational, linear, or tilting movement of self or environment

Question 9

Peripheral vs. Central Vertigo : peripheral -> imbalance

Answer 9

moderate-severe

Question 10

Peripheral vs. Central Vertigo : peripheral -> auditory symptoms

Answer 10

common

Question 11

Peripheral vs. Central Vertigo : peripheral -> nausea and vomiting

Answer 11

severe

Question 12

Peripheral vs. Central Vertigo : peripheral -> neurologic symptoms

Answer 12

rare

Question 13

Peripheral vs. Central Vertigo : peripheral -> compensation

Answer 13

rapid

Question 14

Peripheral vs. Central Vertigo : peripheral -> nystagmus

Answer 14

unidirectional
horizontal or rotatory

Question 15

Peripheral vs. Central Vertigo : central -> imbalance

Answer 15

mild-moderate

Question 16

Peripheral vs. Central Vertigo : central -> nausea and vomiting

Answer 16

variable

Question 17

Peripheral vs. Central Vertigo : central -> auditory symptoms

Answer 17

rare

Question 18

Peripheral vs. Central Vertigo : central -> neurologic symptoms

Answer 18

common

Question 19

Peripheral vs. Central Vertigo : central -> compensation

Answer 19

slow

Question 20

Peripheral vs. Central Vertigo : central -> nystagmus

Answer 20

bidirectional
horizontal or vertical

Question 21

Differential Diagnosis of Vertigo Based on History : Benign Paroxysmal Positional Vertigo (BPPV) -> duration

Answer 21

seconds

Question 22

Differential Diagnosis of Vertigo Based on History : Ménière’s Disease -> duration

Answer 22

Minutes to hours

Question 23

Differential Diagnosis of Vertigo Based on History : Ménière’s Disease -> hearing loss

Answer 23

Uni/bilateral, fluctuating

Question 24

Differential Diagnosis of Vertigo Based on History : Ménière’s Disease -> tinnitus

Answer 24

+

Question 25

Differential Diagnosis of Vertigo Based on History : Ménière’s Disease -> aural fullness

Answer 25

pressure/warmth

Question 26

Differential Diagnosis of Vertigo Based on History : Labyrinthitis/Vestibular Neuronitis -> duration

Answer 26

hours to days

Question 27

Differential Diagnosis of Vertigo Based on History : Labyrinthitis/Vestibular Neuronitis -> hearing loss

Answer 27

unilatéral

Question 28

Differential Diagnosis of Vertigo Based on History : Labyrinthitis/Vestibular Neuronitis -> tinnitus

Answer 28

± Whistling

Question 29

Differential Diagnosis of Vertigo Based on History : Labyrinthitis/Vestibular Neuronitis -> other features

Answer 29

may have recent AOM (acute otitis media)

Question 30

Differential Diagnosis of Vertigo Based on History : acoustic neuroma -> duration

Answer 30

chronic

Question 31

Differential Diagnosis of Vertigo Based on History : acoustic neuroma -> hearing loss

Answer 31

progressive

Question 32

Differential Diagnosis of Vertigo Based on History : acoustic neuroma -> tinnitus

Answer 32

+

Question 33

Differential Diagnosis of Vertigo Based on History : acoustic neuroma -> other features

Answer 33

ataxia CN VII palsy

Question 34

what is the most common cause of episodic vertigo ?

Answer 34

BPPV

Question 35

BPPV : patients are often symptomatic when ...

Answer 35

rolling over in bed or moving their head to a position of extreme posterior extension (such as looking up at a tall building or getting their hair washed at the hairdresser)

Question 36

BPPV

Answer 36

acute attacks of transient rotatory vertigo lasting seconds to minutes, initiated by certain head positions, accompanied by torsional (i.e. rotatory) nystagmus (geotropic = fast phase towards the floor)

Question 37

Ménière’s Disease (Endolymphatic Hydrops) : définition

Answer 37

episodic attacks of tinnitus, HL, aural fullness, and vertigo lasting min to h

Question 38

Ménière’s Disease (Endolymphatic Hydrops) : etiology

Answer 38

inadequate absorption of endolymph leads to endolymphatic hydrops (over accumulation) that distorts the membranous labyrinth

Question 39

Diagnostic Criteria for Ménière’s Disease Definite Ménière’s Disease

Answer 39

* **Two or more spontaneous episodes** of vertigo lasting from **20 min to 12 h** * **Audiometric** confirmation of SNHL (low to mid frequency) * **Fluctuating tinnitus** and/or aural fullness

Question 40

Diagnostic Criteria for Ménière’s Disease Probable Ménière’s Disease

Answer 40

* **Two** or more **spontaneous** episodes of vertigo or dizziness lasting from **20 min to 24 h** * Fluctuating **tinnitus** and/or aural fullness

Question 41

treatment Ménière's disease

Answer 41

bed rest, antiemetics, antivertiginous drugs (e.g. betahistine (Serc®), meclizine, diphenhydramine), and anticholinergics * long-term management may include low salt diet, diuretics

Question 42

Vestibular Neuronitis (Labyrinthitis) : definition

Answer 42

**acute onset** of **disabling vertigo** often accompanied by **N/V** and imbalance without HL that **resolves over days**, leaving a residual imbalance that lasts days to weeks

Question 43

vestibular neuronitis : definition

Answer 43

inflammation of the vestibular portion of CN VIII

Question 44

labyrinthitis : definition

Answer 44

inflammation of both vestibular and cochlear portions

Question 45

Vestibular Neuronitis (Labyrinthitis) : etiology

Answer 45

* thought to be due to a **viral infection** (e.g. measles, mumps, herpes zoster) or post-viral syndrome * labyrinthitis may occur as a **complication** of acute and chronic otitis media, bacterial meningitis, cholesteatoma, and temporal bone fractures

Question 46

Vestibular Neuronitis (Labyrinthitis) : clinical features acute phase

Answer 46

■ severe **vertigo** with **N/V** and imbalance lasting 1-5 d ■ **irritative nystagmus** (fast phase **towards the offending ear**) ■ **ataxia**: patient tends to veer towards affected side ■ **tinnitus and HL** in **labyrinthitis**

Question 47

Vestibular Neuronitis (Labyrinthitis) : treatment acute phase

Answer 47

■ bed rest, antivertiginous drugs ■ corticosteroids (methylprednisolone) ± antivirals ■ bacterial infection: treat with IV antibiotics, drainage of middle ear, ± mastoidectomy

Question 48

Vestibular Neuronitis (Labyrinthitis) : Before proceeding with gentamicin treatment, perform ...

Answer 48

a gadolinium-enhanced MRI to rule out CPA tumour as the cause of symptoms

Question 49

Acoustic Neuroma (Vestibular Schwannoma) : definition

Answer 49

chwannoma of the vestibular portion of CN VIII

Question 50

Acoustic neuroma is the most common ...

Answer 50

intracranial tumour causing SNHL and the most common CPA tumour

Question 51

Acoustic Neuroma (Vestibular Schwannoma) : clinical features

Answer 51

* usually presents with **unilateral SNHL** (chronic) or **tinnitus** * **dizziness** and unsteadiness may be present, but **true vertigo is rare** as tumour growth occurs slowly, allowing for compensation to occur * **facial nerve palsy and trigeminal (V1) sensory deficit** (corneal reflex) are late complications

Question 52

Acoustic Neuroma (Vestibular Schwannoma) : diagnosis

Answer 52

MRI with gadolinium contrast (gold standard)

Question 53

In the elderly, unilateral tinnitus or SNHL is...

Answer 53

acoustic neuroma until proven otherwise