Common Diseases of Inner Ear

Gunawan Ali

Symptoms of Inner Ear Diseases

Hearing Loss (sensorineural) Tinnitus Vertigo

Common diseases
Drug-induced ototoxicity Sudden hearing loss Presbycusis Herpes Zoster Oticus Benign Paroxsymal Positional Vertigo Menieres disease

Drug induced ototoxicity

Definition
Ototoxic: Any drug with the potential to cause toxic reaction to structures of inner ear (cochlea, vestibule, semicircular canals, otolith)

Etiology
Ototoxic drugs Type Examples Antibiotics Aminoglycoside Erythromycin Diuretics Furosemide Chemotherapeutic Cisplatin drugs Other Quinine Salicylate

Drug induced ototoxicity

Patophysiology
degeneration of stria vascularis degeneration of epithelial sensory cell degeneration of ganglion cell

Symptoms
Tinnitus: Loud, high pitch Hearing loss: sensorineural, mostly bilateral and symmetrical, with unpredictable onset Vertigo

Natural history
reversible hearing loss: salicylates, quinine irreversible hearing loss

Drug induced ototoxicity

Treatment
irreversible hearing loss: incurable rehabilitative: hearing aid, cochlear implant

Prevention
Make sure the tympanic membrane is intact before giving topical otic drugs Check renal function before giving aminoglycosides, erythromycin, loop diuretics

Sudden Hearing Loss

Definition
30 dB decrease of sensorineural hearing in three serial frequency, last in less than 3 days

Etiology
ischemia of cochlea: spasm, thrombosis, hemorrhage viral infection: parotitis, measles, influenza B, mononucleosis

Management
total bed rest Vasodilator, corticosteroid, vitamins, oxygen

Presbycusis
Definition
Age-related hearing loss (>65 years old)

Etiology
degeneration process, with risk factors: hereditary, diet, metabolism, noise, lifestyle

Symptoms
Hearing loss: slowly, progressive, symmetric, insidious onset tinnitus: high pitch cocktail party deafness: difficulty in hearing speech with noisy background recruitment: otalgia when hearing increasing intensity sound

Treatment: hearing aid, speech therapy

Herpes Zoster Oticus

Definition
infection of vestibulocochlear nerve ganglion and geniculate ganglion of the facial nerve by the herpes zoster virus = Ramsay Hunt Syndrome

Symptoms
otalgia facial paralysis vertigo hearing loss (transient/resolve partially/resolve completely) vesicles

Treatment: Corticosteroid, antiviral

Benign Paroxsymal Positional Vertigo

Etiolgy
displacement of otoconial crystal (Ca carbonate in saccule/utricle

Symptoms
brief period (<60s) of vertigo occur with certain head positions, peak in morning nausea nystagmus no hearing loss, no tinnitus

Management
Canalith repositioning maneuver: Epleyss, Semonts

Menieres Disease
= Endolymphatic hydrops

Etiology
Endolymphatic fluids buildup Risk factor:
Age 20-50 Trauma Family history

Symptoms
Trias: vertigo, tinnitus, sensorineural hearing loss
vertigo (sudden, up to 24 hour) tinnitus: low pitch hearing loss: typically affecting low pitch

nausea, vomit sense of fullness or pressure in ear

 Diagnostic criteria
intermittent vertigo: two or more episodes of vertigo, lasting at least 20 minutes each fluctuating sensorineural hearing loss exclusion of central vertigo etiology (sense of fullness or pressure in ear)

Treatment: Symptomatic
anticholinergic, antihistamine, benzodiazepine