PANCE Blueprint EENT (7%)

Inner ear (PEARLS)

Acoustic neuroma Benign tumor of the Schwann cells (the cells which produce myelin sheath) – most commonly affects the vestibular division of the 8'th cranial nerve.

  • Slowly progressive unilateral hearing loss, tinnitus, and disequilibrium
  • Diagnose with MRI

TX: Surgery or stereotactic radiation therapy

Barotrauma Barotrauma presents with ear pain and hearing loss that persists past the inciting event, associated with pressure changes

  • A common injury in divers or while flying, sudden onset of pain that may resolve with a "pop"

TX: Supportive (anti-inflammatories) then consider prophylaxis

  • Pseudoephedrine or Afrin can be good for prophylaxis – you must be careful when recommending this to divers, depending on dive times
Dysfunction of the eustachian tube Ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, fluctuating conductive hearing loss, tinnitus.

  • All children < 7 years old have some ET dysfunction (based on the angle of the eustachian tube) will resolve with age

TX: Often no treatment is necessary

  • Ibuprofen prn pain
  • Nasal steroids can be prescribed in more severe cases
  • Systemic decongestants, such as pseudoephedrine or phenylephrine, may be helpful for nasal congestive symptoms
  • Surgery is generally indicated when medical management fails
Labyrinthitis Acute onset, vertigo + hearing loss, tinnitus of several days to a week.

  • Usually viral, an absence of neurologic deficits.

TX: Diazepam or meclizine vertigo, promethazine for nausea

Vertigo (ReelDx) Duration and presence of hearing loss/nystagmus can help with diagnosis

Central vertigo - more gradual onset and vertical nystagmus. Unlike peripheral vertigo, it does not present with auditory symptoms. Romberg Sign.

Peripheral vertigo (inner ear) - sudden onset, nausea/vomiting, tinnitus, hearing loss, and horizontal nystagmus

  • Labyrinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (Ménière syndrome), vestibular neuritis, and head injury.
  • Benign Positional VertigoDix Hallpike for diagnosis, treat using Epley's maneuver
Disease Characteristics Symptoms Diagnostic Test Treatment
Benign positional vertigo Changes with position Vertigo without hearing loss, tinnitus, or ataxia MRI of internal auditory canal Diagnosis: Dix-Hallpike maneuver

Treatment: Epley maneuver

Meclizine

Vestibular neuritis Vertigo without position changes Vertigo but no hearing loss or tinnitus(inflammation of vestibular portion of CN VIII)  MRI of internal auditory canal Meclizine
Labyrinthitis Acute, self-resolving episode Vertigo

Hearing loss

Tinnitus

Self-limited

 MRI of internal auditory canal Meclizine + steroids
Meniere's disease Chronic remitting and relapsing episodes Vertigo

Hearing loss

Tinnitus in achronic remitting and relapsing manner

 MRI of internal auditory canal Diuretics

Salt restriction

Unilateral CN VIII ablation (severe cases)

Perilymph fistula History of trauma Vertigo from Trauma  MRI of internal auditory canal Fix damage surgically
Acoustic neuroma Ataxia

Neurofibromatosis type II

MRI findings

Vertigo

Hearing loss

Tinnitus AND ataxia

 MRI of internal auditory canal Surgical intervention
Otitis externa (Prev Lesson)
(Next Lesson) Acoustic neuroma
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