Inner Ear Disorders: Tinnitus & Vertigo

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Questions and Answers

What is a potential consequence of suppurative labyrinthitis?

Permanent sensorineural hearing loss (correct)

Improved hearing ability

Complete hearing restoration

Reduction in vertigo symptoms

Which pathogen is the most common cause of diffuse suppurative labyrinthitis?

Staphylococcus aureus

S.pneumoniae (correct)

H.influenzae

Neisseria meningitides

Which syndrome is associated with the activation of latent herpes zoster infection?

Ramsay Hunt syndrome (correct)

Acute otitis media syndrome

Cholesteatoma syndrome

Acoustic neuroma syndrome

What is one of the typical features of Ramsay Hunt syndrome besides vertigo and hearing loss?

Facial paralysis Signup and view all the answers

Which condition is associated with direct bacterial invasion of the labyrinth?

Cholesteatoma Signup and view all the answers

What is defined as any sound perceived by the listener that does not originate from an external source for more than five minutes?

Tinnitus Signup and view all the answers

Which type of tinnitus can only be heard by the patient?

Subjective tinnitus Signup and view all the answers

What percentage of patients with sensorineural hearing loss (SNHL) also experience tinnitus?

80% Signup and view all the answers

Which examination method may reveal glomus tumors or tympanal hemangioma?

Otoscopy/Otomicroscopy Signup and view all the answers

What type of tinnitus is often described as pulsatile and can be heard by an examiner?

Objective tinnitus Signup and view all the answers

Which physical examination technique may help reduce tinnitus of venous origin?

Palpation of the jugular vein Signup and view all the answers

Which condition is NOT typically associated with hearing loss?

Asthma Signup and view all the answers

What is the primary basis for diagnosing inner ear diseases?

Patient history Signup and view all the answers

What term describes the sound quality of tinnitus that is often tonal, hissing, or buzzing?

Tinnitus characteristics Signup and view all the answers

Which investigation method may indicate conductive hearing loss secondary to vascular lesions in the middle ear?

Pure tone audiometry Signup and view all the answers

In performing a Romberg's test, which sense is NOT directly assessed?

Auditory perception Signup and view all the answers

What patient condition might indicate a labyrinthine lesion if observed during the Unterberger test?

Patient rotating to one side Signup and view all the answers

Which factor does NOT need to be excluded before diagnosing inner ear diseases?

Allergies Signup and view all the answers

What is a key symptom to differentiate true vertigo from dizziness?

Sensation of motion Signup and view all the answers

A positive Romberg's test indicates dysfunction in what sensory system?

Proprioceptive receptors Signup and view all the answers

Which symptom is least associated with diagnosing inner ear conditions?

Chest pain Signup and view all the answers

What is the first-line therapy for BPPV?

Repositioning manoeuvre Signup and view all the answers

Which of the following is a characteristic symptom of Meniere's disease?

Unilateral hearing loss Signup and view all the answers

Which dietary restriction is recommended for managing Meniere's disease?

Restriction of caffeine Signup and view all the answers

What is the result of the Epley manoeuvre?

Moving particles within the canal Signup and view all the answers

Which of the following is NOT an essential diagnosis feature for vestibular neuritis?

Hearing loss Signup and view all the answers

What type of therapy has a 10% risk of worsening hearing loss when used for Meniere's disease?

Aminoglycoside therapy Signup and view all the answers

What is a common cause of secondary endolymphatic hydrops?

Allergic reactions Signup and view all the answers

Which statement regarding labyrinthitis is accurate?

It is typically viral-induced. Signup and view all the answers

What is the primary symptom experienced by patients with a patulous Eustachian tube?

Autophony Signup and view all the answers

Which of the following is NOT a typical management strategy when the cause of tinnitus is unknown?

Surgical intervention Signup and view all the answers

Which method can help in masking tinnitus for patients with hearing loss?

Traditional hearing aids Signup and view all the answers

What distinguishes vertigo from dizziness according to the information provided?

Vertigo includes the illusion of movement Signup and view all the answers

Which of the following is a cause of vertigo that lasts for seconds?

Benign paroxysmal positional vertigo (BPPV) Signup and view all the answers

What duration of dizziness is often associated with a CNS disorder?

Weeks Signup and view all the answers

What is a common characteristic of vertigo when it is caused by a vestibular lesion?

It subsides over days or weeks Signup and view all the answers

Which condition is characterized by variable duration of vertigo?

Migraine-associated vertigo Signup and view all the answers

What does the walking with eyes closed test reveal in patients with a vestibular deficit?

Gait deviation toward the weak side Signup and view all the answers

What indicates a positive Dix-Hallpike test?

Latent period of 1-5 seconds followed by symptoms Signup and view all the answers

What does the head thrust test assess?

Chronic peripheral vestibular loss Signup and view all the answers

In BPPV, which semi-circular canal is most frequently affected?

Posterior semi-circular canal Signup and view all the answers

What is a characteristic feature of nystagmus?

Rhythmical oscillation of the eyes Signup and view all the answers

Which factor does NOT predispose a person to BPPV?

Frequent exercise Signup and view all the answers

What is typically observed in patients suffering from BPPV as a result of Canalithiasis?

Sudden vertigo triggered by specific head positions Signup and view all the answers

Which test is used to check for nystagmus and symptoms when perilymph fistula is suspected?

Fistula test Signup and view all the answers

Study Notes

Inner Ear (Tinnitus & Vertigo)

Tinnitus is any sound perceived by a listener that does not originate from an external sound source for more than five minutes.
Tinnitus is often not originating from an external source for a time period of more than five minutes.
Two types of tinnitus exist:
- Subjective: only the patient can hear it (95%).
- Objective: even examiners can hear, often pulsatile (synchronous with heartbeat).
Disturbing tinnitus affects 3-5% of individuals.
Causes of subjective tinnitus can be:
- Otologic: impacted wax, middle ear fluid, acute/chronic otitis media, Ménière's disease, presbycusis, noise-induced hearing loss, acoustic neuroma, idiopathic sudden SNHL
- Metabolic: hypothyroidism, hyperthyroidism, obesity, hyperlipidaemia, vitamin deficiency (e.g., B12)
- Neurologic: head injury (labyrinthine concussion), temporal bone fractures, whiplash injury, multiple sclerosis, postmeningitic, brain haemorrhage, brain infarct
- Cardiovascular: hypertension, hypotension, anaemia, cardiac arrhythmias, arteriosclerosis
- Pharmacologic: certain drugs, ototoxic drugs
- Psychogenic: anxiety and depression.
Causes of objective tinnitus can be:
- Vascular: arteriovenous (AV) shunts, AV malformations, glomus tumor of middle ear, arterial bruit, carotid aneurysm, carotid stenosis, vascular loop pressing on VII nerve, high-riding carotid artery, venous hum, dehiscent jugular bulb
- Temporomandibular joint (TMJ) disorders
- Palatal myoclonus
- Foreign objects (e.g. insects) in the ear
- Dental: clicking of TM joint
Causes of tinnitus relating to some change in the auditory system:
- 80% of patients with sensorineural hearing loss (SNHL) have tinnitus.
- Hearing loss impacts neural activity within the auditory system, leading the brain to interpret the activity for sound.
- Areas of the cochlea with hair cell damage cease to amplify sound. Phantom sounds can be perceived in damaged regions by the brain.
Vertigo is defined as an illusion of movement, either of the patient or of their surroundings.
Patients with vestibular system damage typically experience dizziness, not vertigo.
Often, vertigo isn't a permanent, constant symptom. The central nervous system adapts to vestibular lesions, eventually causing it to subside over days or weeks.
Constant dizziness that lasts for months likely isn't a vestibular-related condition.
Causes of vertigo by duration:
- Seconds: Benign paroxysmal positional vertigo (BPPV)
- Minutes: Migraine, Vertebrobasilar insufficiency
- Hours: Meniere's disease, Otic syphilis
- Weeks: CNS disorder, Multiple sclerosis, Acoustic neuroma, Autoimmune
- Variable duration: Inner ear fistula, Lyme disease, Labyrinthine concussion, Blast trauma, Barotrauma, Superior semi-circular canal dehiscence syndrome
- Days: Vestibular neuritis, Labyrinthitis

Vertigo Types

Peripheral: More severe, short-lived, symptoms include tinnitus, diminished hearing, ear discharge, otalgia. Associated with peripheral nystagmus.
Central: Milder, long-lived and chronic, symptoms include diplopia, slurred speech, dysarthria, and dysphoria. Associated with central nystagmus.

Diagnosis

Diagnosis primarily depends on a patient's history (onset, character, duration, relationship to head movements, other symptoms such as tinnitus or hearing loss), along with physical examination.
The diagnosis of inner ear diseases is by exclusion, beginning by excluding central causes first.
Neurological symptoms, such as loss of consciousness, weakness, numbness, dysarthria, and diplopia, may be considered.

Diagnostic Tests

Tympanometry (tests middle ear function) may show myoclonic activity and a patent Eustachian tube.
Pure tone audiometry may detect conductive hearing loss, secondary to vascular lesions affecting the middle ear.
Imaging using gadolinium-enhanced CT and MRI (in many cases) is necessary to diagnose the root cause.

Management

Treat tinnitus by identifying and treating the underlying cause.
Reassurance and psychotherapy (especially if no cause can be found), relaxation, and biofeedback techniques.
Sedation and tranquillizers may be needed initially to help patients adapt to tinnitus.
Masking (using noise to cover up tinnitus) can be a useful technique (especially when traditional hearing aids are insufficient).
Consider sound machines or white noise generators for masking during the night.

BPPV (Benign paroxysmal positional vertigo)

Characterized by sudden vertigo, lasting seconds, triggered by specific head positions.
No associated hearing loss.
Characteristic nystagmus present on the Dix-Hallpike test.
Most commonly involves the posterior semicircular canal (PSC).
Typically affects patients in their 50s.
Recurrence rates are 10-15% a year.
May involve canalithiasis (ear stones).

Predisposing Factors of BPPV & Dix-Hallpike Test

Circumstances in which the head is placed in an inverted position (dental procedures).
Age, inactivity, and family history.
Head trauma/vestibular neuritis.
Other ear diseases/Meniere's syndrome.
Lateral positioning/lying/getting up/looking up/bending.
Dix-Hallpike test: 1-5 seconds latent period with minimal symptoms, followed by acute vertigo with rotatory nystagmus towards the affected side. The nystagmus typically lasts 10-40 seconds.

Treatment of PSC BPPV

Repositioning is the first-line therapy.
Use gravity to reposition ear stones (canalith debris) from the affected canal into the vestibule.
Epley maneuver is the most common repositioning technique. This is repeated until no nystagmus occurs. (90% effective at treatment).

Meniere's Disease

Excessive endolymph buildup.
Associated with episodic vertigo (lasting hours), fluctuating hearing loss, tinnitus and aural pressure.
Characteristically starts unilaterally, but approximately 25% of cases are bilateral. 
Idiopathic (unknown cause). 
Often associated with other inner-ear disorders, systemic conditions, or allergies.

Meniere's Disease Management

Stabilize fluid and electrolyte levels in the body (hydrops diet regimen).
Minimize the intake of solutes and sugars.
Adequate fluid intake (6-8 glasses daily).
Caffeine and alcohol restriction.
Potential for diuretic prescriptions to identify and treat underlying conditions.
Creating safe and quiet physical environments to mitigate symptoms.  
Manage persistent symptoms (e.g. aminoglycoside and intratympanic gentamicin therapy) but these have a risk of worsening hearing loss (10%).

Vestibular Neuritis

Characterized by vertigo lasting days after an upper respiratory infection.
No hearing loss. 
May experience postural instability towards the infected ear, but typically able to walk. 
Potential etiologies include viral infection, vascular occlusion and/or immunologic mechanisms.

Labyrinthitis

Often linked to viral causes and is usually not life-threatening. 
Secondary to middle ear infection can be fatal if suppurative labyrinthitis/meningitis occur.  
Characterized by vertigo, severe vertigo, (and hearing loss occurring simultaneously), may need to rule out middle ear problems in emergencies. 
Post-stapes surgery may weaken the oval window membrane, and congenital abnormalities may cause dehiscent oval windows.  
Spread is possible through an abnormal cholesteatoma from the middle ear. (e.g., a cholesteatoma can cause a semi-circular canal fistula).

Diffuse Suppurative Labyrinthitis

Likely related to suppurative otitis media.
Pathogens are commonly S. pneumoniae, H. influenzae and Neisseria meningitides.
Management includes hospitalization and intravenous antibiotics to prevent the spread and potential intracranial issues.

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Description

Explore the complexities of tinnitus and vertigo in this quiz. Learn about the different types of tinnitus, their causes, and the impact on individuals. Test your knowledge on this important aspect of inner ear health.