Ear, Nose, and Throat Problems

Chapter 54 Ear, Nose, and Throat Problems




Clinical Case Problem 1 A 38-Year-Old Woman with a Feeling of Dizziness and Imbalance


A 38-year-old woman comes to your office with a 1-year history of episodic dizziness, ringing in both ears, a feeling of aural fullness, and hearing loss. The symptoms come on every 1 or 2   weeks and usually last for 12 hours. Nausea and vomiting are present. When asked to describe the dizziness, the patient says, “The world is spinning around me.”


On physical examination, the patient has horizontal nystagmus. The slow phase of the nystagmus is to the left, and the rapid phase is to the right. Audiograms reveal bilateral sensorineural hearing loss in the low frequencies.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. vestibular neuronitis

b. acute labyrinthitis

c. positional paroxysmal vertigo

d. orthostatic hypotension

e. Meniere disease

2. The treatment of this disorder includes each of the following except


a. decreased caffeine intake

b. decreased alcohol intake

c. use of a thiazide diuretic

d. salt restriction

e. Epley maneuvers

3. All except which of the following are true regarding this disease?


a. it is also known as endolymphatic hydrops

b. surgery is a treatment option

c. there is low-frequency sensorineural hearing loss

d. steroids are a treatment option

e. vertigo can be treated with benzodiazepines


Clinical Case Problem 2 A 23-Year-Old Woman Who Is Dizzy


A 23-year-old woman comes to your office with a 6-month history of dizziness. She “feels dizzy” when she stands up (as if she is going to faint). The sensation disappears within a minute.


She has a history of major depression. She started taking doxepin 6   months ago, and her depression has improved much since that time.


The patient’s blood pressure is 140/90   mm Hg sitting and decreases to 90/70   mm Hg when she stands. There is no ataxia, nystagmus, or other symptoms.



4. What is the most likely diagnosis in this patient?


a. vestibular neuronitis

b. acute labyrinthitis

c. benign positional paroxysmal vertigo

d. orthostatic hypotension

e. Meniere disease

5. What is the best treatment for this patient?


a. an antiemetic

b. increase antidepressant dose

c. education and reassurance

d. Epley maneuvers

e. prednisone


Clinical Case Problem 3 A 30-Year-Old Man Who Becomes Dizzy When He Rolls Over


A 30-year-old man comes to your office for assessment of dizziness. The dizziness occurs when he rolls over from the lying position to either the left side or the right side. It also occurs when he is looking up. He describes a sensation of “the world spinning around” him. The episodes usually last 10 to 15 seconds. They have been occurring for the past 6   months and occur on average one or two times per day.





6. What is the most likely diagnosis in this patient?


a. vestibular neuronitis

b. acute labyrinthitis

c. positional paroxysmal vertigo

d. orthostatic hypotension

e. Meniere disease

7. What is the treatment of choice for this patient?


a. avoidance of alcohol and caffeine

b. dimenhydrinate

c. a thiazide diuretic

d. reassurance and simple exercises

e. endolymphatic surgery


Clinical Case Problem 4 A 39-Year-Old Woman with Unrelenting Dizziness Associated with Nausea and Vomiting


A 39-year-old woman comes to your office with a 2-day history of “unrelenting dizziness.” The room feels like it is spinning, and there is associated nausea and vomiting. There has been no hearing loss, tinnitus, or sensation of aural fullness. The patient has just recovered from an upper respiratory tract infection.


The patient is afebrile. On examination, nystagmus is present. The slow phase of the nystagmus is toward the left, and the rapid phase of the nystagmus is toward the right. There is a significant ataxia present.



8. What is the most likely diagnosis in this patient?


a. vestibular neuronitis

b. acute labyrinthitis

c. positional vertigo

d. orthostatic hypotension

e. Meniere disease

9. What is the treatment of choice for this patient?


a. avoidance of alcohol and caffeine

b. a thiazide diuretic

c. endolymphatic surgery

d. reassurance and antiemetics

e. antibiotics

The patient returns to your office the next day saying her ear hurts and she cannot taste anything in her mouth. The vertigo has not improved. On examination, you notice crops of vesicles on the pinna of the left ear and a subtle left facial droop.



10. What is the most likely diagnosis?


a. Lyme disease

b. impetigo

c. otitis externa

d. Ramsay Hunt syndrome

e. lacunar stroke

11. What is the treatment for the diagnosis?


a. oral antibiotics

b. prednisone

c. acyclovir

d. prednisone and acyclovir

e. hospitalization and intravenous antibiotics


Clinical Case Problem 5 A 26-Year-Old Woman with Severe Dizziness, Ataxia, and Hearing Loss


A 26-year-old woman comes to your office with a 6-day history of severe dizziness associated with ataxia and right-sided hearing loss. She had an upper respiratory tract infection 1   week ago. At that time, her right ear felt plugged.


On examination, there is fluid behind the right eardrum. There is horizontal nystagmus present, with the slow component to the right and the quick component to the left. Ataxia is present.



12. What is the most likely diagnosis in this patient?


a. vestibular neuronitis

b. acute labyrinthitis

c. positional vertigo

d. orthostatic hypotension

e. Meniere disease

13. What is the treatment of choice for this patient?


a. avoidance of caffeine and alcohol

b. a thiazide diuretic

c. endolymphatic surgery

d. rest and antiemetics

e. none of the above

The patient returns to your office 2   days later stating that she had fever throughout the night. She continues to have all the symptoms she had before but overall feels worse and woke this morning in a sweat. On examination, her temperature is 39.5° C, pulse is 122 beats/minute, and blood pressure is 96/60   mm Hg. She appears ill.



14. What is the likely reason for the change in symptoms?


a. misdiagnosed sinusitis

b. conversion to bacterial labyrinthitis

c. acute otitis media

d. worsening of her viral illness

e. viral meningitis

15. What is the current treatment of choice?


a. education and reassurance

b. hospitalization and intravenous antibiotics

c. lumbar puncture

d. prednisone

e. anticholinergics

16. What is the most common cause of sensorineural hearing loss in the adult population?


a. Meniere disease

b. chronic otitis media

c. presbycusis

d. otosclerosis

e. mastoiditis

17. What is the most common cause of conductive hearing loss in adults who have normal-appearing tympanic membranes?


a. Meniere disease

b. chronic otitis media

c. presbycusis

d. otosclerosis

e. mastoiditis


Clinical Case Problem 6 A 37-Year-Old Woman with Intermittent Hearing Loss


A 37-year-old woman comes to your office for assessment of hearing loss. She has had problems intermittently for the past 12   months.


On examination, the Weber tuning fork test lateralizes to the right ear, and the Rinne tuning fork test is negative in the right ear (bone conduction is greater than air conduction [BC > AC]).



18. This suggests which of the following?


a. a right-sided conductive hearing loss

b. a left-sided conductive hearing loss

c. a right-sided sensorineural hearing loss

d. a left-sided sensorineural hearing loss

e. a or d


Clinical Case Problem 7 A 43-Year-Old Man with Hearing Loss Lateralized to the Left Ear


A 43-year-old man comes to your office for assessment of hearing loss. He has had hearing difficulties for the past 4   years.


On examination, the Weber tuning fork test lateralizes to the left ear. The Rinne tuning fork test is normal bilaterally (AC > BC).



19. This suggests which of the following?


a. a right-sided conductive hearing loss

b. a left-sided conductive hearing loss

c. a right-sided sensorineural hearing loss

d. a left-sided sensorineural hearing loss

e. b or c

20. Which of the following statements is (are) true regarding the condition of acute mastoiditis?


a. it is a complication of acute otitis media

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Ear, Nose, and Throat Problems

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