Deafness Tinnitus And Vertigo

Clinical examination

Examination of the external auditory meatus, tympanic membrane and eye movements (for nystagmus) and Weber's and Rinne's tests (page 16) provide valuable information, but more detailed neuro-otological tests (pages 60, 61) are usually required to determine the exact nature of the auditory or vestibular dysfunction and to locate the lesion site. The results of these tests may indicate the need for further investigation (e.g. CT/MR scan) Causes of deafness

Conductive

Cochlear

Sensorineural

Retrocochlear

Infection -Trauma -

otitis media* cholesteatoma tympanic membrane rupture ossicular disruption

Otosclerosis

Tumours - carcinoma

- glomus jugulare

Congenital* - e.g. aplastic anaemia maternal rubella Infection - mumps*, measles* meningitis*

- suppurative labyrinthitis* Trauma - petrous temporal fracture

- 'acoustic' trauma Drugs- streptomycin, quinine, salicylates

Meniere's disease Presbyacusis - prominent in the elderly Tumours - carcinoma, glomus jugulare Sudden onset -? viral,? vascular

Cerebellopontine angle tumour

- acoustic neuroma

- meningioma

- epidermoid/dermoid Brain stem disease (associated with other brain stem symptoms and signs)

- demyelination

- syringobulbia

- herpes zoster

- vascular insufficiency

- tumours - astrocytoma

* Prominent in childhood

* Prominent in childhood

Causes of Vertigo:

Causes of Vertigo:

| Trauma i Infection - suppurative labyrinthitis viral

Benign positional vertigo - transient attacks of vertigo, associated with a change in head position. Self-limiting Menière's disease - episodic attacks of vertigo occurring in middle age, later accompanied by unilateral deafness Drugs - streptomycin, quinine, salicylates

Causes of tinnitus

Any lesion causing deafness may also cause tinnitus. Occasionally patients perceive a vibratory noise inside the head, transmitted from an arteriovenous malformation or carotid stenosis.

In addition, patients with non-specific disease, e.g. anaemia, fever, hypertension, occasionally complain of tinnitus.

Vestibular neuronitis - probable viral infection. Sudden onset followed by gradual improvement with time.

Cerebellopontine angle tumours

- acoustic neurilemmoma

- meningioma

- epidermoid/dermoid

(associated with other brain stem symptoms and signs) Demyelination Vertebrobasilar insufficiency Tumour - astrocytoma Syringobulbia

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