Answers:
This patient presents and is found to have significant hearing loss. What is the most likely diagnosis?
Vertigo that only lasts seconds and is accompanied by hearing loss is most likely to be?
A) Lyme Disease
B) Labyrinithitis
C) Meniere Disease
D) Perilymphatic Fistula
E) BPPV
A) Pendred Syndrome
B) Stickler Syndrome
C) Treacher Collins Syndrome
D) Jervell-Lange-Neilsen Syndrome
E) Waardenburg
Treacher Collins Syndrome consists of distinct craniofacial
abnormalities and hearing loss due to a malformed cochlear/vestibular
apparatus.
abnormalities and hearing loss due to a malformed cochlear/vestibular
apparatus.
A 2 year old patient with SNHL presents to the ED with a syncopal episode. What diagnose should be suspected and why is it important to diagnose early?
Jervell-Lane-Nielson syndrome. This syndrome consists of SNHL w/ syncopal
attacks due to prolong QTC. Death occurs from arrythmias if not detected and treated early.
MC Questions:attacks due to prolong QTC. Death occurs from arrythmias if not detected and treated early.
Vertigo that only lasts seconds and is accompanied by hearing loss is most likely to be?
A) Lyme Disease
B) Labyrinithitis
C) Meniere Disease
D) Perilymphatic Fistula
E) BPPV
Free Response Question:
What is the most common cause of peripheral vertigo?
Quick Facts:
Benign Paroxysmal Positional Vertigo (BPPV)
-Most common types of peripheral vertigo
-Due to debris in posterior semicircular canal.
-Vertigo lasts seconds, no hearing loss, associated with position.
-Average age of 50.
-10-15% have recent hx of vestibular neuronitis and 20% have hx of recent
trauma.
Pathogenesis
-SCC has debris either in cupula or free floating in endolymph
(cupulolithiasis/canalolithiasis). The canal becomes stimulated when this
debris moves in response to gravity.
-Majority is in posterior canal but can also be in horizontal and superior.
Clinical Findings
-Sudden onset vertigo for 10-20 seconds with particular head positions.
-Rolling over in bed, getting out of bed, looking up and back (top shelf) and bending
over.
-Normal hearing, no spontaneous nystagmus, normal neuro exam.
-Only image if cannot evoke nystagmus, then get MRI to r/o other pathology
-Perform audiogram to r/o retrocochlear path.
-Perform Dix-Hallpike. There is a latency of 1-2 seconds before onset of
nystagmus/vertigo.
-Nystagmus is geotropic (down beating/rotary)
-Increases then decreases within 20 seconds
-Fatigable
-Follows Ewald law for excitation of dependence PSCC
Ewald’s three laws:
1. A stimulation of the semicircular canal causes a movement of the eyes in the
plane of the stimulated canal
2. In the horizontal semicircular canals, an ampullopetal endolymph movement cases a greater stimulation than an ampullofugal one.
3. In the vertical semicircular canals, the reverse is
true.
What is the most common cause of peripheral vertigo?
Quick Facts:
Benign Paroxysmal Positional Vertigo (BPPV)
-Most common types of peripheral vertigo
-Due to debris in posterior semicircular canal.
-Vertigo lasts seconds, no hearing loss, associated with position.
-Average age of 50.
-10-15% have recent hx of vestibular neuronitis and 20% have hx of recent
trauma.
Pathogenesis
-SCC has debris either in cupula or free floating in endolymph
(cupulolithiasis/canalolithiasis). The canal becomes stimulated when this
debris moves in response to gravity.
-Majority is in posterior canal but can also be in horizontal and superior.
Clinical Findings
-Sudden onset vertigo for 10-20 seconds with particular head positions.
-Rolling over in bed, getting out of bed, looking up and back (top shelf) and bending
over.
-Normal hearing, no spontaneous nystagmus, normal neuro exam.
-Only image if cannot evoke nystagmus, then get MRI to r/o other pathology
-Perform audiogram to r/o retrocochlear path.
-Perform Dix-Hallpike. There is a latency of 1-2 seconds before onset of
nystagmus/vertigo.
-Nystagmus is geotropic (down beating/rotary)
-Increases then decreases within 20 seconds
-Fatigable
-Follows Ewald law for excitation of dependence PSCC
Ewald’s three laws:
1. A stimulation of the semicircular canal causes a movement of the eyes in the
plane of the stimulated canal
2. In the horizontal semicircular canals, an ampullopetal endolymph movement cases a greater stimulation than an ampullofugal one.
3. In the vertical semicircular canals, the reverse is
true.
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