DISEASES OF INNER EAR

Clinical Presentation of Inner Ear Diseases and Basics of Management

The inner ear is responsible for both hearing and balance, and diseases affecting this area can lead to a variety of clinical presentations. Common symptoms include:

1. Hearing Loss: This can be conductive or sensorineural. Sensorineural hearing loss is often associated with inner ear disorders.
2. Tinnitus: A perception of noise or ringing in the ears that is not caused by external sound.
3. Vertigo: A sensation of spinning or dizziness that occurs due to disturbances in the vestibular system.
4. Balance Issues: Difficulty maintaining balance, which may lead to falls.
5. Aural Fullness: A feeling of pressure in the ear.

Management strategies depend on the specific diagnosis but generally include:

• Medications: Corticosteroids may be used for inflammatory conditions, while diuretics might be prescribed for Meniere’s disease.
• Rehabilitation: Vestibular rehabilitation therapy can help patients with balance issues.
• Surgery: In cases like acoustic neuroma or severe Meniere’s disease, surgical intervention may be necessary.
• Hearing Aids: For those with significant hearing loss, amplification devices can improve quality of life.

Appropriate Investigations for Inner Ear Problems

To diagnose inner ear diseases accurately, several investigations may be employed:

1. Audiometry: This test assesses hearing ability and helps determine the type and degree of hearing loss.
2. Vestibular Testing: Includes tests such as electronystagmography (ENG) or videonystagmography (VNG) to evaluate balance function.
3. Imaging Studies:
   • MRI (Magnetic Resonance Imaging): Useful for visualizing soft tissues and detecting tumors like acoustic neuromas or other structural abnormalities.
   • CT (Computed Tomography): Can help assess bony structures and detect fractures or anomalies in the temporal bone.
4. Blood Tests: To rule out infections or autoimmune conditions that could affect the inner ear.

Distinguishing Inner Ear Diseases

Several diseases affect the inner ear, each with distinct characteristics:

1. Meniere’s Disease:
   • Symptoms include episodic vertigo, tinnitus, fluctuating hearing loss, and aural fullness.
   • Caused by abnormal fluid accumulation in the inner ear.
2. Vestibular Neuritis/Labyrinthitis:
   • Characterized by sudden onset vertigo without auditory symptoms (neuritis) or with hearing loss (labyrinthitis).
   • Often follows a viral infection.
3. Acoustic Neuroma (Vestibular Schwannoma):
   • Presents with unilateral hearing loss, tinnitus, and possibly imbalance.
   • A benign tumor on the vestibulocochlear nerve.
4. Ototoxicity:
   • Hearing loss and balance issues due to exposure to certain medications (e.g., aminoglycosides).
5. Sudden Sensorineural Hearing Loss (SSNHL):
   • Rapid onset hearing loss typically occurring over 72 hours without an obvious cause.

When to Refer the Patient

Referral to an otolaryngologist (ENT specialist) should be considered in several scenarios:

1. If there is sudden sensorineural hearing loss without an identifiable cause lasting more than 24 hours.
2. Persistent vertigo lasting more than a week or associated with neurological symptoms such as weakness or changes in vision.
3. Unilateral tinnitus accompanied by unilateral hearing loss which raises suspicion for acoustic neuroma.
4. Patients who do not respond to initial management strategies after a reasonable trial period should also be referred for further evaluation.

In summary, understanding the clinical presentation of inner ear diseases is crucial for effective management and timely referral when necessary.