ENT - Lecture #2

Definition: Perception of noise or ringing in the ear
Click the card to flip 👆
1 / 53
Terms in this set (53)
Definition: Perception of noise or ringing in the ear
Tinnitus
Three Types of Tinnitus
-Persistent tinnitus
-Pulsatile tinnitus
-"Clicking" tinnitus
This type of tinnitus can vary in pitch; low roar to a high squeal. It's common and is usually associated with sensorineural hearing loss
Persistent tinnitus
This type of tinnitus is described as "listening to one's own heart beat". Usually associated with conductive hearing loss (serous otitis)
Pulsatile tinnitus
Localized enlargement of an artery caused by a weakening of the artery wall
Aneurysm
This vascular tumor appears as a red mass on the TM and its pulsation pressure on ossicles, distorting their movement
Glomus Tumor
This vascular anomaly is an abnormal connection between arteries & veins.
-Most commonly located in the CNS
Arteriovenous Malformation (AVM)
This type of tinnitus is due to a middle or inner ear muscle spasm. It produces a rapid series of popping noises and lasts seconds to minutes.
-Fluttering sensation in the ear.
"Clicking" Tinnitus
What types of treatment are available for tinnitus?
-Avoid loud noises & ototoxic drugs
-Quinine, ASA, Loop diuretics, and Aminoglycosides

-Tx vascular condition

-White noise machines, music or hearing aids (masks tinnitus)

-TCA if severe (nortriptyline (Pamelor) or Amitriptyline (Elavil))

-TCA = Tri-cyclic-antidepressants
Vertigo
Sensation of motion when there is none or exaggerated sense of motion in response to body movement
Differentiating etiology of vertigo (two types)Peripheral --> Otologic origin Central --> CNS originVertigo - peripheral vestibular etiology-Benign paroxysmal positional vertigo (BPPV) -Labyrinthitis -Vestibular Neuronitis -Traumatic Vertigo -Meniere's Disease -Perilymphatic Fistula -Migrainous VertigoVertigo - CNS etiology-Acoustic neuroma -Vascular compromise (CVA) -Multiple sclerosisThese episodes can be described as a "spinning", "tumbling", "falling backward or forward". The duration of the episodes can last secs, mins, days, wks Associated symptoms are nausea & vomitingVertigoNystagmusInvoluntary jerking motion of the eyeDix-Hallpike ManeuverThis test for vertigo is repeated three on each side to try and observe a nystagmus. -A positive test would mean that the patient had a nystagmusRomberg TestPatient stands erect with feet together & eyes closed. Swaying of body --> (+) Romberg. This test confirms vertigo. Positive test = more central origin Negative test = more peripheralPronator Drift TestHave the patient extend their arms and close their eyes. If their arms/hands begin to pronate, they have a positive test.(+) Dix-Hallpike ManeuverPeripherally located nystagmus. This type of nystagmus will be fatigable and have more of a horizontal &/or rotational nystagmus.Centrally located nystagmusThis type of nystagmus will not be fatigable and will have more of a vertical nystagmusWhat signs will be observed by someone who has vertigo due to peripheral vestibular disease?(+) Romberg test (+) Dix-Hallpike maneuver -Horizontal &/or rotational nystagmus -Can be suppressed by visual fixation (having someone look at your finger) -FatigableWhat symptoms will a patient have if they have vertigo due to peripheral vestibular disease?-Acute onset -Difficulty walking or standing -Episodes last seconds --> minutes -Associated with nausea/vomitingWhat signs and symptoms are associated with benign paroxysmal positional vertigo (BPPV)?-Recurring vertigo spells in clusters of several days -Associated with position changes of head -Episode subsides w/in 60 secondsWhat non-medicated treatment would be available for patients who are suffering from BPPV?Epley maneuver - exercise to reposition otoconia (canaliths) of the inner earOtoconiaCalcium deposits in inner earWhat medicated treatment would be available for patients who are suffering from BPPV?Meclizine (Antivert) -Benzodiazepine -Diazepam (Valium)What is the etiology and epidemiology of labyrinthitis?Etiology: -Usually viral -Follows URI -Latent varicella-zoster -Bacterial -Secondary to meningitis -Idiopathic Epidemiology -30-60 yr -Bact. meningitis < 2 yr -Increased risk -Cholesteatoma -Untreated AOMWhat are some signs and symptoms of labyrinthitis?-Severe vertigo lasting several days --> 1 wk -Hearing loss & tinnitus -Hearing loss may be permanent (bact. or meningitis) -Recovery --> weeks to monthsWhat are some diagnostic studies that you can perform for labyrinthitis?-Clinical Dx -If indicated -MRI -R/O acoustic neuroma, stroke, brain abscess -Lumbar puncture -CBC & blood cultures if systemic inf.What are some labyrinthitis treatments?Vestibular suppression -Meclizine (Bonine, Dramaine, Antivert) Antihistamines Antiemetic -Prochlorperazine (Compazine) Benzodiazepine -Diazepam (Valium) Corticosteroids -Oral -Intratympanic steroids Antiviral -Acyclovir (Zovirax) Abx if OME/meningitisWhat symptom does vestibular neuronitis usually lack?Hearing loss. Patients who suffer from vestibular neuronitis almost never have hearing loss.What is the etiology, age, and treatment of Vestibular NeuronitisVestibular neuronitis will have no hearing loss. Etiology -Idiopathic -Viral (?) -Latent HSV 1 Mean age = 41 yr Treatment = supportive and Meclizine (Antivert)Traumatic Vertigo Summary-Usually secondary to concussion -Sx's improve over several days; can last months -Presents like BPPV -Treatment -Supportive -Diazepam (Valium) or Meclizine (Antivert)Meniere's Disease - signs and symptoms-Episodic vertigo that lasts ~20 minutes -Low freq. sensorineural hearing loss -Tinnitus -Pressure sensation deep in ear Primary risk factors = idiopathic and 5th-6th decadesPathophysiology of Meniere's DiseaseDistended endolymph compartment of labyrinth causes an increase in pressure. Symptoms wax & wane as endolymph pressure gradients varyPatients with this disease will not have a thermally induced nystagmusMeniere's DiseaseDiagnostic studies for Meniere's Disease-Audiometry -MRI, CT, auditory brainstem response test to R/O tumors -Electronystagmogram (ENG) -Balance & nystagmus testWhat is the first line of treatment for Meniere's Disease?-Low salt diet -DiureticsPerilymphatic Fistula Summary-Perilymphatic fluid leak from inner ear to TM via round or oval window -Associated with hearing lossEtiology of perilymphatic fistula-Slap to the ear -Blunt head trauma -BarotraumaCervical Vertigo Summary-Cervical proprioception dysfunction triggered by neck movements -DDD/whiplash injury of spine could induce distorted sensations of head motion -Controversial --> unable to confirm Dx. No specific lab test. Discrepancy between pts w/ neck pain w/ & w/o vertigoMigrainous Vertigo Summary-Episodic vertigo assoc. w/ migraine -NO hearing loss or tinnitus Treatment = anti-migraine meds --> triptans (imitrex/sumatriptan), caffeineMigrainous Vertigo - ProphylaxisDiet, TCA, Beta Blockers, CCB, Anti-seizure medsVertigo due to CNS etiology - signs and symptoms-Gradual onset -Progressive vertigo (-) Dix-Hallpike maneuver -VERTICAL nystagmus (no rotation!!) -Not suppressed by visual fixation -NonfatigablePatient presents with a vertical nystagmus with no rotation. The nystagmus is non-fatigable and is not suppressed by visual fixation. Is this centrally or peripherally located?Centrally. Peripherally will fatigue, has a horizontal nystagmus with rotation, and can be suppressed by visual fixation.If a patient has unilateral tinnitus, what are they most likely suffering from?Acoustic NeuromaSigns, symptoms, and diagnostics of a acoustic neuroma-Unilateral hearing loss -As tumor grows --> tinnitus, vertigo, ataxia -Diagnostics = enhanced MRI of internal auditory canalWhat kind of diagnostic study would you order to diagnose a acoustic neuroma?MRI. Will give you a view of CN VIIIAcoustic Neuroma TreatmentPosterior fossa (retrosigmoid) approachVascular Compromise - SummaryVertebrobasilar insufficiency (VBI) -Common cause of vertigo in ELDERLY -Triggered by rotation/extension of neck -Dec. blood flow through vertebral & basilar arteriesVertebrobasilar Insufficiency - signs, symptoms, and risk factorsSigns/symptoms -Partial or complete vision loss -Diplopia (double vision) -Vertigo Risk factors -Smoking, HTN, old ageVertebrobasilar Insufficiency - Diagnostics and treatmentsDiagnostics -Transcranial Doppler USN -CTA -MRI/MRA Treatment -Vasodilators (CCB, Nitrates) + ASA -Chol. lowering agents -Anticoagulants -Angioplasty w/ stentMultiple Sclerosis - Summary-Patients may have episodic vertigo & chronic imbalance -Demyelination of white matter (brain/SC) -Damaged nerve fibers -Damaged myelin sheath can't conduct APs **May be associated with rapid onset of unilateral hearing loss -Spontaneous recovery of hearing may occur