NR 603 Questions with Correct Answers

NR 603

Vestibular neuritis/labyrinthitis - answerAcute unilateral labryinthine dysfunction

Sx: severe vertigo, nausea, vomiting and disequilibrium lasting few days, unbalance
with rapid head movement; lasts weeks to months; probs w/ walking/balance

Causes: by viral infection in vestibular nerve, otitis media sometimes another cause;
HSV-1 of vestibular ganglia

Assessment:
-Thorough ear, nose throat exam
-Neuro exam (including balance testing with Romberg)
-Hearing screen should be normal
-Abnormal neuro exam should suggest a central cause and referred to Neuro

Diagnostics:
Labs: CBC with diff
Imaging: MRI or CT

Differential dx:
-BPPV
-Meniere disease
-Migranous vertigo
-Vascular d/o
-Trauma
-Toxins
-Demyelinating disease (MS)
-Ramsay Hunt Syndrome
-Cerebellar disorder
-Tumors

Tx:
-Symptom relief - use only for 3 days (more than that can just mask sx): anticholinergics
(first line), antihistamines(first line), long acting benzos (reserved for pts who cant take
anticholinergics) or antiemetics (added to relieve vomiting)
-Acute treatment: Methylpredisone taper (100mg every 3 days)

Meniere's disease - answerExcessive fluid and pressure in labyrinth of inner ear;
autoimmune process

Sx: Vertigo that last min to hours, a/w nausea and vomiting, accompanied by pressure
in ear; low-pitched = unilateral hearing loss; hearing loss is constant in later stages

, Assessment:
-Head and neck exam to exclude acute otitits media
-Neuro exam
-Weber test - sound will laterlize to unaffected ear
-Rinne test - air conduction > bone conduction

Diagnostics:
-Initial: Audiogram
-Labs- TSH, serum glucose, RPR, lyme serologies
-Imaging: MRI (rule out neuroma)

Differential:
-BPPV
-Vestibular neuritis
-Vertebrobasilar insufficiency
-Acoustic neuroma
-Migraine HA
-Head Trauma
-Thyroid dysfunction
-Anemia
-Diabetes
-MS
-Cerebellar tumor
-Cogan syndrome

Tx: Refer to otolaryngologist, there is no cure
-Symptomatic relief: meclizine and antiemetics (Phenergan)

Tinnitus - answerRinging or buzzing in ears

High pitched, ocntinous sounds: a/w sensorineural loss
Low pitched: idiopathic tinnitus or Meniere disease
Pulsing or rushing: vascular
Ocean: eustachian tube dysfunction
Clicking: somatic, maybe TMJ or spasms of muscles or middle ear structures

Diagnostics:
-Initial: Audiology
-Labs: lyme serologies, RPR, CBC with diff, ESR, Serum glucose, TSH
-Imaging: MRI or CT scan

Tx:Intermittent tinnitus not serious, but unilateral a/w vestibular schwannoma (get MRI
or CT)
Pulsatile also serious-- refer otoryngologist or neurologist