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Chapter 36: Neurotology & Ear Disorders

A 75-year-old man was turning over in bed one night to turn off his reading light. He experienced a brief spell of rotational vertigo lasting about 20 seconds. He decided to go to sleep. In the morning, as he was arising from bed, he had a recurrence of the vertigo, again lasting about 20 seconds. After the vertigo subsided, he got out of bed. His gait was not impaired, and he was able to perform his usual morning activities. However, when he reached for his cereal box in the cupboard above him, he had a recurrence and nearly fell over. There were no auditory, motor, sensory, or coordination problems otherwise. What is the most likely diagnosis?

A. Benign paroxysmal positional vertigo (BPPV)

B. A brainstem stroke

C. Vestibular neuritis

D. Ménière disease

A. The patient exhibits the classic phenomenon of head motion–triggered spells of vertigo that are typical of BPPV. Age is the major risk factor for BPPV. Spells are brief and are triggered by vertical head movements because they are due to the movement of otoliths that have fallen into the semicircular canal that migrate as the head is moved in relation to gravity.

A 20-year-old woman presents with a constant feeling like her ears are plugged and frequently hears a popping or crackling sound in her ears. She notices that when she takes a deep breath she can hear the sound of her breathing, and she finds this very distracting. She is constantly sniffling. She notes having had frequent ear infections as a child. What is the most likely diagnosis?

A. Otitis media

B. Eustachian tube dysfunction

C. Chondritis

D. Mastoiditis

B. This patient has eustachian tube dysfunction, with her major risk factor being recurrent childhood ear infections. She likely has patulous eustachian tubes (ie, tubes that stay persistently open). Thus, the sound and pressure from the nasopharynx are transmitted into the middle ear. The patient may sniff or perform the Valsalva maneuver repeatedly in order to clear her ears.

An 18-year-old man presents with bilateral ear pain. He is a swimmer on his high school swim team and is in the water every day. In the winter, he puts a ski cap on over his head after his morning swim. He has noticed that an unpleasant smell is coming from his ears. On exam, the external canals are red and narrowed. He winces when the pinna ...

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