facial nerve injury

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symptom

physical signs

examine

Cause treatment

medical treatement

Surgical treatment

Slowly progressive hearing loss and low-key tinnitus occur in both ears at the same time or one after another without any inducement, but without ear fullness or otorrhea; some may have dizziness; the progression of the disease accelerates in women during pregnancy and childbirth.

Phenomenon of enhanced self-hearing: speaking softly to oneself and articulating words clearly

Willis paracusia: Perception of hearing improvement in a noisy environment

Otoscope: The ear canal is clean; the tympanic membrane is intact, has good position/function, and has normal luster (but some may have Schwartze's sign: a translucent area can be seen in the upper posterior quadrant of the tympanic membrane, which is a reflection of mucosal congestion in the active lesion area of ​​the promontory)

Listening function check

Tympanic function test

Imaging examination

Stapes type otosclerosis: Mainly treated with surgery; those with contraindications to surgery or those who refuse surgery can wear hearing aids

Labyrinth otosclerosis: wear hearing aids, try sodium fluoride, sodium carbonate treatment, vitamin D treatment

Stapes surgery: stapediolysis, stapedectomy (partial resection, total resection)

Fenestration of inner ear: suitable for those who have difficulty with stapes surgery

Episodic vertigo: Sudden rotational vertigo, lasting for a short period of time (usually 2 to 3 hours before entering the remission period, but there may be a sense of imbalance during the remission period), accompanied by nausea and vomiting, pale complexion, cold sweats, slow pulse, high blood pressure Decreases; worsens when eyes are opened and turned, alleviates when lying still with eyes closed; conscious throughout the process; can relapse, the more recurrences, the longer the duration, and the shorter the intermission period

Hearing loss: noticeable after multiple attacks; often unilateral, fluctuating (increasing during attacks, lessening during intermittent periods), rarely total deafness; early stage, mainly low-frequency decline; sometimes both ears can hear the same pure tone as a tone Two sounds with completely different timbres (diplaccusis)

Tinnitus: often occurs before an attack of vertigo; it starts out as a low-pitched tone and then turns to a high-pitched tone; it worsens during the attack and eases but does not disappear during the intermittent period.

Aural fullness: A feeling of fullness, heaviness, and pressure in the ears/head during the attack

Tumarkin’s otolithic crisis/drop attacks: refers to a patient who suddenly collapses and becomes conscious, sometimes with dizziness.

Lermoyez attack/Lermoyez syndrome: The patient first experiences tinnitus and hearing loss, and after an episode of vertigo, the tinnitus and vertigo resolve spontaneously.

Otoscope: Tympanic membrane normal

Acoustic immittance test: Tympanogram is normal Eustachian tube: Functions well

vestibular function test

Auditory function test: sensorineural deafness; the pure tone audiogram is rising in the early stage and flat/falling in the late stage. Dehydration agent test (glycerin test): often positive (the average hearing threshold increases by ≥15dB or the speech recognition rate improves after taking glycerin) ≥16%), but negative during the interval

Imaging: Temporal bone CT showed poor pneumatization around the vestibular aqueduct and the aqueduct was short and straight; MRI imaging of the membranous labyrinth showed that the vestibular aqueduct became thinner and straighter.

Paroxysmal rotational vertigo ≥ 2 times, each lasting 20 minutes to several hours; often accompanied by autonomic nervous system dysfunction and balance disorder; unconsciousness disorder

Fluctuating hearing loss, mostly low-frequency hearing loss in the early stage, which gradually worsens as the disease progresses; at least 1 pure tone audiometry test is sensorineural hearing loss, and auditory revitalization may occur

With tinnitus and/or ear swelling

Rule out dizziness caused by other diseases

Choose 1 from 3: ① Only one vertigo attack, pure tone audiometry showed sensorineural hearing loss, accompanied by tinnitus and ear distension; ② Episodic vertigo ≥ 2 times, each lasting 20 minutes to several hours; hearing normal, without tinnitus and ear swelling; ③ fluctuating low-frequency sensorineural hearing loss, auditory revitalization may occur; no obvious vertigo attack

Suspicious patients should undergo further glycerol test, cochlear electrogram, otoacoustic reflex, and vestibular function tests according to conditions.

Benign paroxysmal positional vertigo (BPPV): brief (a few seconds) paroxysmal vertigo induced by specific head positions, accompanied by nystagmus; no cochlear symptoms

Vestibular neuritis: sudden vertigo, spontaneous nystagmus to the unaffected side, nausea and vomiting, vestibular dysfunction but no tinnitus or deafness

Vestibular drug poisoning: a history of using ototoxic drugs; vertigo has a slow onset, mild degree, long duration, and is non-episodic

Recurrent vestibulopathy: similar episodic vertigo without cochlear symptoms Labyrinthitis: history of suppurative otitis media and middle ear surgery

Sudden deafness: may be accompanied by vertigo but rarely recurring; hearing loss is rapid, mainly high frequency without fluctuations

Hunt syndrome: may be accompanied by mild vertigo, tinnitus, hearing loss but herpes zoster on the auricle and surrounding skin, and peripheral facial paralysis.

Cogan syndrome: dizziness, tinnitus, and deafness may occur, but non-syphilitic keratitis and vasculitis may also occur; glucocorticoid treatment is effective

Delayed endolymphatic hydrops: hearing loss occurs first, followed by episodic vertigo one to several years later

Perilymph fistula (perilymph fistula): fluctuating hearing loss and dizziness; if suspicious, window membrane exploration can be performed

Others: Trauma, acoustic neuroma, superior semicircular canal cleft syndrome, etc.

Regulate autonomic nervous function, improve inner ear microcirculation, and relieve membranous labyrinth hydrops.

Bed rest and nutritional support during the attack (low-salt diet, avoid tobacco, alcohol and stimulating drinks); pay attention to psychological treatment

Symptomatic treatment

Middle ear drug treatment: intratympanic injection of drugs (gentamicin, dexamethasone)

Meniett low-voltage pulse therapy: short-term/longer-term control of vertigo symptoms

Surgical treatment

Non-hearing preserving surgery: such as labyrinthectomy

Indications: Those who have undergone chemical or surgical labyrinthectomy