Tinnitus Overview and Examination

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Questions and Answers

Which of the following is a key characteristic of Meniere's Disease?

Consistent hearing loss without episodes of vertigo

Fluctuating vertigo without other symptoms

Episodes of vertigo lasting between 20 minutes to 12 hours (correct)

Permanent hearing loss in the affected ear

What is recommended for a patient diagnosed with Meniere's Disease during an acute episode?

Consume high-sodium foods

Rest with eyes closed and prevent falls (correct)

Engage in physical activity

Take vestibular suppressants for long-term relief

Which medication is not typically used as a treatment to prevent attacks in Meniere's Disease?

Meclizine (correct)

Betahistine

Intratympanic dexamethasone

Diuretics

Which dietary modification is advised for patients with Meniere's Disease?

Restrict sodium intake Signup and view all the answers

Which of the following conditions must be ruled out for diagnosing Meniere's Disease?

Vestibular neuritis Signup and view all the answers

What common risk factor is NOT associated with Meniere's Disease?

Regular exercise Signup and view all the answers

Which of the following maneuvers is specifically mentioned for canalith repositioning?

Epley Maneuver Signup and view all the answers

What is the common cause of tinnitus?

Changes in peripheral auditory nerve function Signup and view all the answers

What is a potential safety precaution for patients experiencing symptoms of Meniere's Disease?

Educating on fall precautions Signup and view all the answers

What is a common misconception regarding Meniere's Disease symptoms?

They consistently lead to permanent damage Signup and view all the answers

What should be included in the physical exam when evaluating tinnitus?

Gross hearing tests Signup and view all the answers

What should patients with Meniere's Disease avoid to manage their condition effectively?

Tobacco use Signup and view all the answers

What is considered a primary risk factor for developing tinnitus?

Chronic exposure to noise Signup and view all the answers

Which of the following is NOT a treatment option for tinnitus?

Surgical intervention Signup and view all the answers

What characterizes Benign Paroxysmal Positional Vertigo (BPPV)?

Short episodes of vertigo induced by changes in head position Signup and view all the answers

Which assessment maneuver is used to diagnose BPPV?

Dix Hallpike maneuver Signup and view all the answers

Which of the following is associated with BPPV?

Absence of neural deficits Signup and view all the answers

What should be avoided if a patient has BPPV?

Sudden head movements Signup and view all the answers

What is a common symptom of Meniere’s disease?

Sudden, severe vertigo episodes Signup and view all the answers

Which medication type is particularly noted to exacerbate tinnitus?

Ototoxic medications Signup and view all the answers

What is the recommended course of action if diagnostic tests for tinnitus indicate possible tumors?

Order imaging like CT or MRI Signup and view all the answers

What lifestyle change is suggested for patients experiencing tinnitus?

Stop smoking Signup and view all the answers

Which of the following diagnoses must be differentiated from vertigo?

Cervical vertigo Signup and view all the answers

Study Notes

Tinnitus

Characterized by the perception of persistent sound in the ear.
Ranges in severity from minor irritation to complete debilitation.
May be associated with ear fullness, itching, hearing loss, headache, numbness, nausea, vomiting, vertigo, and nystagmus.
Can be either primary (idiopathic) or secondary (with an underlying cause).
Important to identify the underlying cause of the tinnitus.
Can be subjective or objective.
Risk factors include hearing loss, hearing and balance disorders, ear infections, ear canal blockage, blood pressure changes, head trauma, thyroid disorder, allergies, chronic exposure to noise, anemia, and medications.

Physical Examination for Tinnitus

Head, neck, and ear exam:
- Gross hearing tests
- Weber and Rinne tuning fork tests
- Rule out ear infections, cerumen impaction, and temporomandibular joint (TMJ) disorders.
Cardiovascular evaluation (for pulsatile tinnitus):
- Examination of the heart, carotid arteries, and thyroid to assess for murmurs, venous hums, and bruits.
- Rule out intracranial hypertension and vascular disorders.
Neurological examination:
- Rule out neoplasms and nervous system deficits.

Diagnostics for Tinnitus

Refer to an audiologist for a comprehensive evaluation.
Laboratory tests: CBC, CMP, thyroid labs, lipid panel, B12, and zinc.
Culture drainage from the ear.
Imaging for unilateral or pulsatile tinnitus (CT or MRI).
- MRI indicated for patients with asymmetric hearing loss or sudden sensorineural hearing loss (SNHL) to detect tumors.

Benign Paroxysmal Positional Vertigo (BPPV)

A disorder of the inner ear that causes repeated short episodes of vertigo induced by changes in head position.
Caused by loose canaliths in the semicircular canals.
Episodes typically last 30-60 seconds, with a maximum duration of 2 minutes.
Symptoms range from mild to intense and may include nausea, vomiting, disequilibrium, and nystagmus.
Commonly triggered by head nodding, rolling over, turning the head side to side, or sudden head movements.
Not associated with hearing loss, aural fullness, tinnitus, or migraines.
Patients often describe the feeling of the room spinning or themselves spinning or whirling, as well as unsteadiness.

Physical Examination for BPPV

Neurological exam to assess cranial nerves.
Head, neck, and ear exam.
In patients with BPPV, the neurological exam is typically normal, and there are no ear exam findings.
Dix-Hallpike maneuver: used to check for nystagmus.
- Contraindicated in patients with recent neck surgery, severe rheumatoid arthritis, carotid sinus syncope, cervical myelopathy/radiculopathy, and vascular dissection syndrome.
Supine head roll: performed if no nystagmus is noted on the Dix-Hallpike maneuver to evaluate the lateral semicircular canal.

Diagnostics for BPPV

Diagnosis is based on the patient's history, physical exam, and a positive result on the Dix-Hallpike or supine head roll test.
No imaging or laboratory tests are needed for diagnosis.
Vestibular testing is not recommended if the patient meets the criteria for BPPV.

Treatment for BPPV

Canalith repositioning procedures (CRPs) and treatment: described in Dunphy, Tables 22.5 and 22.6.
Online resources for demonstrations of Dix-Hallpike maneuver, Epley maneuver, and Lempert maneuver:
- Dix Hallpike Maneuver: https://www.youtube.com/watch?v=wgWOmuB1VFY
- Epley Maneuver: https://www.youtube.com/watch?v=o4GV-EbnMfI
- Lempert Maneuver: https://www.youtube.com/watch?v=mwTmM6uF5yA
Refer to a provider with expertise if needed.
Re-evaluate the patient in one month to assess for resolution of symptoms.

Meniere's Disease

Defined as two or more episodes of spontaneous vertigo lasting 20 minutes to 12 hours, accompanied by fluctuating hearing loss, roaring tinnitus, and aural fullness in the affected ear.
May also present with sudden attacks of nausea, vomiting, pallor, diaphoresis, and dizziness.
Etiology is unclear, but it is associated with increased endolymphatic fluid in the cochlea.
Risk factors include stress, allergies, high salt intake, caffeine, alcohol, hormonal changes, barometric pressure changes, and exposure to loud noise over several years.

Physical Examination and Diagnostics for Meniere's Disease

Head, neck, and ear exam:
- Ear exam is typically normal.
Neurological assessment.
No specific diagnostic testing exists.
Diagnostic criteria:
- Two distinct episodes of rotational vertigo lasting at least 20 minutes to 12 hours each.
- Along with: Low-frequency fluctuating sensorineural hearing loss (SNHL), roaring tinnitus, or a perception of aural fullness.

Differentials for Meniere's Disease

Diagnosis of exclusion based on symptoms.
Rule out:
- Otitis media, vestibular neuritis, secondary or tertiary syphilis, neurologic tumors, acoustic neuromas, degenerative nerve disorders (multiple sclerosis, Alzheimer's disease), hypothyroidism, benign paroxysmal positional vertigo (BPPV), hypoglycemic disorders, lipid disorders, drug toxicity, and psychiatric disorders.

Treatment for Meniere's Disease

Rule out other causes.
Carefully monitor for hearing loss.
Bed rest during acute episodes with eyes closed and protection from falling.
Vestibular suppressants (effective only during acute attacks):
- Meclizine, Dramamine, Benadryl, Valium, Ativan, Klonopin, Scopalamine, and Atropine.
Medications to prevent attacks: Betahistine 16mg PO 3x/day.
Dietary modifications: restrict sodium, caffeine, and alcohol.
Diuretics.
Intratympanic dexamethasone.
Streptomycin/Gentamycin inner ear ablation therapy.
Surgical interventions for disabling symptoms.

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Description

This quiz covers the essential aspects of tinnitus, including its definition, symptoms, and the importance of identifying underlying causes. It also addresses the physical examination process, focusing on head, neck, ear exams, and cardiovascular evaluations related to tinnitus. Test your knowledge on this complex auditory condition.