Podcast: Play in new window | Download
<< Click here to get 23 ENT questions straight from my book, The Final Step >>
Acoustic Neuroma (Vestibular Schwannoma)
- Slow growing benign tumor of the vestibulocochlear nerve, CN VIII
- Occurs in males and females equally
- Most often found in those between the ages of 50 and 60.
- The are the most common intracranial tumor
Clinical Presentation
- Sudden onset of unilateral hearing loss that is then slowly progressive
- Episodic or continuous vertigo
- Tinnitus
- Headache
Labs, Studies and Physical Exam Findings
- Demonstration of unilateral sensorineural hearing deficit
- Diagnosis is confirmed with an MRI with contrast
Treatment
- Observation with annual MRI
- Surgical excision
- Radiotherapy
Barotrauma
- Trauma to the eardrum secondary to pressure difference between the inside and the outside of the eardrum
- Sudden changes in pressure
- Airplane flights
- Scuba diving
Clinical Presentation
- Unilateral or bilateral pain
- Feeling of pressure in ears
- Dizziness
Labs, Studies and Physical Exam Findings
- Clinical diagnosis
- May clinically look like an otitis media
Treatment
- Prevention by opening the eustachian tube
- Autoinflation – forcefully exhale while the mouth is closed and holding the nostrils
- Chew gum
- Yawn
- Swollowing – suck on hard candy
- Decongestants if sinus congestion
Dysfunction of the Eustachian Tubes – Narrowed tubes
Clinical Presentation
- Fullness in the ears
- Decreased hearing
- Popping or crackling with yawning or swallowing
Labs, Studies and Physical Exam Findings
- Retraction of the tympanic membrane
- Decreased tympanic membrane motility with pneumatic otoscope
Treatment
- Decongestants
- pseudoephedrine orally
- oxymetazoline spray
- Intranasal steroids
- Surgical insertion of a tympanostomy tube
Dysfunction of the Eustachian Tubes – Overly Patent Tubes
Clinical Presentation
- Mild hearing impairment
- Exaggerated ability to hear yourself breathe and speak
- Feels better during a URI
Labs, Studies and Physical Exam Findings
- Clinical diagnosis
Treatment
- Do not take decongestants
- Surgical narrowing of the tube
Labyrinthitis
Inflammation of the inner ear
Causes/Predisposing Factors
- Upper respiratory infection
- Allergies
- Fatigue
- Alcohol consumption
- Smoking
- Stress
- Drugs
Clinical Presentation
- Acute onset of vertigo
- Involuntary eye movements
- Unilateral hearing loss
- Nausea and vomiting
- Tinnitus
Labs, Studies and Physical Exam Findings
- History and physical
Treatment
- Diazepam for the acute vertigo
- Streriods
- Antihistamines
Vertigo
- An inappropriate sensation of movement
Causes
- Benign paroxysmal positional vertigo
- Meniere’s disease
- Labyrithitis
- Drugs
- Antibitocs
- Analgesics
- Hypnotics
- etc
Clinical Presentation
- Sensation of moving or spinning while not moving
- Nausea and vomiting
Labs, Studies and Physical Exam Findings
- Usually a clinical diagnosis
- MRI may be helpful for a further workup
- Complete audiologic evaluation
Treatment
- Control triggers
- Diet
- Stress
- Fatigue
- Bright light
- Diazepam for acute vertigo
- Antihistamines
- Compazine or Zofran for nausea
Benign Paroxysmal Positional Vertigo
- Sesnsation of spinning or moving
- Typically lasts less than 60 seconds
- Believed to be caused by displacement of small calcium carbonate crystals in the inner ear
Clinical Presentation
- Episodes of veritgo
Labs, Studies and Physical Exam Findings
- Dix-Hallpike maneuver
Treament
- Canilith repositioning maneuvers
Meniere Disease
- May be caused by inflammation and excess fluid production in the inner ear
Clinical Presentation
- Episodic vertigo lasting 1-6 hours
- Low frequency hearing loss
- Tinnitus
- Unilateral ear pressure
Labs, Studies and Physical Exam Findings
- History and physical
- MRI to rule out other diagnosis
Treatment
- benzodiazepines for acute vertigo
- Antihistamines
- Low salt diet
- Diuretics
- Intratympanic steroid injection
- Labyrinthectomy or ablation
Tinnitus
A high pitched ringing in the ears
Clinical Presentation
- There is a high pitched ringing in my ears driving me nuts!
- I can hear my heartbeat in my ears
- This is pulsatile tinnitus usually caused by conductive hearing loss
- I hear a clicking in my ears
Labs, Studies and Physical Exam Findings
- Think about getting an MRI
Treatment
- Prevention!!
- Avoid excessive noise
- Ototoxicity of some medications
- Masking the sound with music
- Stimulation of the auditory system
Mastoiditis
Causes
- Secondary to otitis media
Clinical Presentation
- Redness and swelling behind the ear
- High fever
- Ear pain
- Drainage from the ear
- Loss of hearing
Labs, Studies and Physical Exam Findings
- Typically a clinical diagnosis
- CT may give more information
Treatment
- Prevention!! Treat the ear infection with antibiotics
- IV antibiotics – Cephalosporins
- Surgery
- myringotomy (whole to drain the middle ear)
- removal of the mastoid may be necessary
Hearing Impairment
- Conductive – The problem is with conducting sound waves through the structures of the ear
- Sensory – This is a problem with the inner ear and usually is related to loss of hair cells
- Neural hearing loss – The problem is with damage to the vestibulocochlear nerve, CN VIII. This is the least common form of hearing loss.
Most Common Causes
- Conductive loss
- Cerumen impaction
- Osteosclerosis
- Sensory loss
- Age related hearing loss due to loss of the hair cells
- Head trauma
- Significant noise exposure
- Neural loss
- Acoustic neuroma
- Multiple sclerosis
Clinical Presentation
- People keep telling me I can’t hear
Labs, Studies and Physical Exam Findings
- Weber test – Tuning fork placed against the forehead equidistant from both ears. A patient without hearing loss will hear the tuning fork equally in both ears.
- Rinne test – Place the tuning fork on the mastoid process and then remove it and place it next to the ear. Normal hearing or a positive test will be louder with air conduction rather than bone conduction
- Conductive
- Weber test – Patient will report the sound louder in the affected ear.
- Rinne test – The sound will be louder on the mastoid with bone conduction than when near the ear. This is referred to as a negative Rinne’s test
- Sensorineural
- Weber test – Louder in unaffected ear
- Rinne test – The sound will be louder off the mastoid with air conduction. This is referred to as a positive Rinne’s test
- Conductive
- Formal hearing test by an audiologist
Treatment
- Prevention
- Avoid excessive noise
- Quit smoking
- Don’t put things like q-tips in your ears
- Conductive hearing loss is the most treatable form of hearing loss
- Removal of cerumen
- Hearing Aid
- Cochlear implant
<< Click here to get 23 ENT questions straight from my book, The Final Step >>