LecturePatient will present as → a 23-year-old female PA student with unilateral hearing loss and tinnitus that began yesterday. She describes a sensation of the room "spinning" around her. She feels extremely nauseous and has vomited already one time this morning. On physical exam, horizontal nystagmus is observed. You excuse her from her histology exam later that afternoon.
To watch this and all of Joe Gilboy PA-C's video lessons you must be a member. Members can log in here or join now.
Labyrinthitis presents with acute onset, continuous vertigo, hearing loss, and tinnitus of several days to a week.
- Often preceded by a viral respiratory illness
- There is an absence of neurologic deficits
- Vertigo associated with labyrinthitis progressively improves over a few weeks, but the hearing loss may or may not resolve
"Sometimes vestibular neuritis is used synonymously with viral labyrinthitis. However, vestibular neuronitis only presents with vertigo, while viral labyrinthitis is also accompanied by tinnitus, unilateral hearing loss, or both.Labyrinthitis is associated with CONTINUOUS vertigo along with unilateral hearing loss +/- tinnitus and is usually associated with an upper respiratory infection. This differentiates it from Meniere’s syndrome, which is EPISODIC and not typically associated with a viral infection."
Vestibular neuritis is an inflammation of the vestibular nerve. Vestibular neuritis presents with continuous vertigo, nausea and vomiting, but NOT hearing loss or tinnitus. It is related to viral URIs and develops over several hours, with symptoms worse on the first day, with gradual recovery over several days. The symptoms of vestibular neuritis are the same as labyrinthitis minus tinnitus and/or hearing loss.
- “Auditory function is preserved; when the symptoms and signs of vestibular neuritis are combined with unilateral hearing loss, the condition is called labyrinthitis.” – (UpToDate)
Ménière syndrome is a disorder of the endolymphatic compartment with the classic triad of episodic vertigo, unilateral low-frequency sensorineural hearing loss, and tinnitus. Labyrinthitis is similar to Meniere’s disease except that labyrinthitis causes continuous symptoms (vs. the episodic symptoms of Meniere’s disease).
Benign paroxysmal positional vertigo (BPPV) is generally thought to be due to debris that has collected within a part of the inner ear. BPPV occurs with changes in position, especially rapid movements of the head. Nausea may occur, but vomiting is not significant. It causes episodic vertigo without hearing loss.
Acoustic neuroma is a benign tumor of the Schwann cells (the cells which produce myelin sheath). Patient will present with an insidious unilateral hearing loss, tinnitus, headache, facial numbness, continuous disequilibrium (unsteadiness), +/- vertigo.
Labyrinthitis is a clinical diagnosis in the absence of neurologic deficits
- May have a positive Romberg test - fall to the side of the affected ear
- Rule out other etiologies with imaging, audiograms, TSH levels
- MRI is required for patients with acute sustained vertigo whose examination is not entirely consistent with labyrinthitis, or in patients who are older (>60 years), or have a headache, any focal neurologic signs, or vascular risk factors
Vestibular suppressants (meclizine) and antiemetics (ondansetron) to limit symptoms in the first 24 to 48 hours
- A 10-day course of prednisone; 60 mg daily on days 1 through 5, 40 mg on day 6, 30 mg on day 7, 20 mg on day 8, 10 mg on day 9, and 5 mg on day 10
- Antibiotics are indicated with associated fever or signs of bacterial infection
Question 1 |
vestibular neuronitis Hint: See B for explanation | |
acute labyrinthitis | |
positional vertigo Hint: See B for explanation | |
orthostatic hypotension Hint: See B for explanation | |
Meniere disease Hint: See B for explanation |
Question 2 |
avoidance of caffeine and alcohol Hint: See D for explanation | |
a thiazide diuretic Hint: See D for explanation | |
endolymphatic surgery Hint: See D for explanation | |
rest and antiemetics | |
none of the above Hint: See D for explanation |
|
List |
References: Merck Manual · UpToDate
