Chapter 66: Inner Ear Disturbances Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis?

a. Facial palsy and vertigo b. Fluctuating hearing loss and tinnitus c. Spontaneous horizontal nystagmus d. Vertigo with changes in head position

ANS: C a. Audiogram b. Auditory brainstem testing c. Electrocochleography d. Vestibular testing

Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary nystagmus, away from the affected ear. Facial palsy with vertigo occurs with Ramsay Hunt syndrome, caused by herpes zoster. Fluctuating hearing loss with tinnitus is common in Meniere’s disease. Tinnitus may occur with vestibular neuritis but hearing loss does not occur. Patients with benign paroxysmal positional vertigo will exhibit vertigo associated with changes in head position.

2. A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial diagnostic workup for this patient?

ANS: A

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An audiogram and magnetic resonance imaging (MRI) are part of basic testing for Meniere’s disease. The other testing may be performed by an otolaryngologist after referral.

Multiple Response

1. Which symptoms may occur with vestibular neuritis? (Select all that apply.)

a. Disequilibrium b. Fever c. Hearing loss d. Nausea and vomiting e. Tinnitus

ANS: A, D, E

Vestibular neuritis can cause severe vertigo, disequilibrium, nausea, vomiting, and tinnitus, but not fever or hearing loss.