Question

A patient presents to the clinic with complaints of inner ear disturbance. How would you differentiate between labyrinthitis, benign paroxysmal positional vertigo, and Meniere’s disease? Include pathophysiology, clinical presentation, physical examination, diagnostics, and treatment.

Answer 1

Labyrinthitis:-
It is an inner ear disorder..
Pathophysiology:
   There two vertibular nerves in inner ear...It send brain information about spatial navigation and brain control..When one of these nerves becomes inflamed it cause this disease..
Clinical presentation:-
    This condition will not cause any pain but symptoms include:
-dizziness,vertigo,loss of balance
-Nausea and vomiting
-Tinnitis,hearing loss in one ear..
-difficulty focusing eyes..
Physical examination:-
   doctors use an otoscope they will look throat,nasal passage and ears..
Pneumatic otoscope:
   This instrument used by doctor to determine whether fluid present behind the eardrum..
Eye movement test:
this test performed to see the eye movement to detect acquired nystagmus it can cause inner ear infection..this involuntary eye movement can affect the vision..
Vertigo test:
Romberg test can be conducted to find the balance with standing position to detect inner ear infection..
Diagnosis:-
   Doctors can order for some test to diagnose the condition
   -hearing test,blood test,CT,MRI scan head
-Electroencephalogram(EEG)
-Electronystagmography(ENG) eye movement rest..
Treatement:-
   sympatamatic releives by adding these medication like antihistamine,antivert,sedatives,corticosteroids..Doctors will prescribe antibiotics in case of active infection,pateint must follow some techniques to avoid vertigo..
-Avoid quick change of position
-Get up slowly after wakeup..
-Avoid television,computer and bright lights during vertigo..
-when you have vertigo while in your resting time in bed,get up and sit with head still..
-when you have vertigo avoid driving and machinery works..
Benign Paroxysmal Positional Vertigo:-
   It is a disorder comes from problem with inner ear..
Pathophysiology:-
   There will some blow to the head..This disorder happen during ear surgery.viral infection or during prolonged positioning on the back..It can come with migraines also..
Clinical presentation:
   -Dizziness,a sense like moving surrounding(vertigo),
-Loss of balance
-Nausea and vomiting
Pathophysiology:-
   Neurological examination doctors will conduct..Head impulse test,
   Dix-Hallpike test -Prior to this test patient must be asymptamatic..Lateral nystagmus that beats towards the ground or the ceiling is considered a positive test,
Supine head roll test
Diagnosis:
   ENG and MRI head and body..
Treatement:-
   Canalith repositioning will be conducted by doctor..The aim of this procedure to move particles from the fluid filled semicircular canals of inner ear into a vestibule..Where there is particles won't give troubles and absorb easily
   -Each position should be maintained for 30seconds..
-Canal plugging surgery
-At home sit down as soon as feel dizzy..
-Walk with stability
Meniere's disease:
   This condition affect the inner ear..for this no permanent cure..
Pathophysiology:
Endolymphatic hydrops include functional or anatomic obstruction of endolymphatic flow,malabsorption of endolumph,genetic anamalies,vaso dilation,allergy,viral infection and autoimmunity..
Clinical presentation:-
   -Vertigo,hearing loss,
-ringing sensation,fullness feeling in the ear
-Loss of balance,head aches
-Nausea and vomiting,sweating
Physical examination:-
Audio metry hearing test,balance assessment test for balance fuction by associating eye movement,
Auditory brainstemresponse test to checking functions of hearing nerves..
Diagnosis:-
   -MRI for any abnormal physical condition in head..
   -Transtympanic electro cochleo graphy(ECOG test)..this test for detecting inner ear fluid pressure..
   -ENg test for measuring eye movement reaction,
   -EEG and cranial CT scan..
Treatement:
-Medication for nausea and vomiting doctors will prescribe antiemetics..If fluid in inner ear doctor will go for prescribing diuretics..
-Physical therapy: vestibular rehabilitation exercises,hearing aids..
-surgery::endolymphatic sac procedure they will perform..
- Patient should avoid,salt,coffee,alcohol and only 6 to 8glasses of eater per day is permitted..