PANCE Blueprint EENT (7%)

Inner ear (PEARLS)

PANCE Blueprint EENT (7%)

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. Brainstem vascular disease, arteriovenous malformations, tumors, multiple sclerosis, and vertebrobasilar migraine 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 Vertigo: Dix 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

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