Page 993 - TNFlipTest

Toronto Notes 2019
Differential Diagnoses of Common Presentations
Otolaryngology OT7
Hearing Loss
Hearing Loss
Conductive
Sensorineural
External Ear
Impacted cerumen
Otitis externa
Foreign body
Keratosis obturans Exostoses, osteomas Tumour of canal
Congenital stenosis/microtia
Common causes in bold
Middle Ear
Congenital
Acquired
Presbycusis
Noise-induced
Menière’s disease Labyrinthitis
Sudden SNHL
Autoimmune inner ear disease Ototoxic drug exposure Temporal bone trauma Infectious
Postmeningitis
Syphilis
Viral: mumps, CMV, HSV
Neoplastic
Acoustic neuroma
CPA tumours
Vascular occlusion/emboli Auditory neuropathy
Figure 13. Differential diagnosis of hearing loss
Tinnitus
Subjective
Only heard by patient (common)
Otologic
Presbycusis
Noise-induced hearing loss Otitis media with effusion Menière’s disease Otosclerosis
Cerumen
Foreign body against TM Drugs
ASA
NSAIDs Aminoglycosides Antihypertensives Heavy metals
Metabolic Hyper/hypothyroidism Hyperlipidemia
Vitamin A, B, Zinc deficiency
Neurologic
Head trauma Multiple sclerosis CPA tumours
Psychiatric Anxiety
Depression
Figure 14. Differential diagnosis of tinnitus
Tinnitus
AOM Genetic
Otitis media with effusion TM perforation Otosclerosis Tympanosclerosis Eustachian tube dysfunction Cholesteatoma
Ossicular malformations Ossicular discontinuity Hemotympanum Middle ear tumour
Non-syndrome associated
Syndrome associated Intrauterine infections (i.e. TORCH) Teratogens
Perinatal hypoxia Prematurity/low birth weight Hyperbilirubinemia
Objective
Can be heard by others (rare)
Vascular
Benign intracranial hypertension
Arteriovenous malformation Glomus tympanicum Glomus jugulare
Arterial bruits:
High-riding carotid artery Vascular loop
Persistent stapedial artery Carotid stenosis
Tinnitus is most commonly associated with SNHL
Glomus Tympanicum/Jugulare Tumour Signs and Symptoms
• Pulsatile tinnitus
• Hearing loss
• Blue mass behind TM
• Brown’s sign (blanching of the TM with
pneumatic otoscopy)
Venous hum:
High jugular bulb
HTN Hyper/hypothyroidism
Mechanical
Patulous Eustachian tube Palatal myoclonus Stapedius muscle spasm
Common causes in bold