Differentiating Conditions of the Ear
A patient presents to the clinic with complaints of inner ear disturbance. How would you differentiate between labyrinthitis, benign paroxysmal positional vertigo, and Meniere’s disease? Include pathophysiology, clinical presentation, physical examination, diagnostics, and treatment. Finally, select only one of the ear complaints to provide a brief patient SOAP note on at the end of your write-up.
The ear is one of the most delicate organs in the human body, with numerous health adversities that can affect its functional performance of hearing. Some adverse health conditions include Labyrinthitis, Meniere’s disease, and benign paroxysmal positional vertigo. The three conditions are very close in the superficial descriptions and thus can mainly be differentiated through the pathophysiological, diagnostic, and treatment descriptions.
Labyrinthitis is an adverse ear condition caused by the inflammation of the ear labyrinth, leading to the feeling of spinning or vertigo and hearing loss. The inflammation is caused by a viral or bacterial infection on the labyrinth, with only one nerve mostly being affected, causing the condition (Barkwil and Arora, 2021). The condition is characterized by loss of hearing, dizziness, headache, fever, lack of balance, odds in eye movements, lack of eye focus, and pain in the ear, among others. The condition is majorly diagnosed through the symptoms and CT scans, treated using corticosteroids, antivirals, antibiotics, and surgery. Meniere’s disease is caused by fluid changes in the inner ear caused by allergies, autoimmune diseases, or genetic factors (Van Steekelenburg et al., 2020). Like Labyrinthitis, Meniere’s disease affects one ear and leads to hearing loss, spinning feeling, and tinnitus. Meniere’s disease may have an additional symptom of diarrhea, unlike Labyrinthitis, while Labyrinthitis affects the eye, unlike Meniere’s disease (Osborn, 2020). The frequency of attack in Maniere’s does not exceed 12 hours, while in Labyrinthitis, the condition is continuous. Apart from medications, Meniere’s patients undergo endolymphatic sac decompression, while Labyrinthitis includes surgery.
Calcium crystals cause benign Paroxysmal Positional Vertigo (BPPV) from the utricle loosely flowing into the inner ear (Johns Hopkins Medicine, 2020). BPPV patients may experience dizziness lasting 2 to 3 weeks, thus differentiating it from Meniere’s disease. Like Labyrinthitis, BPPV symptoms are loss of balance, nausea, vomiting, and spinning, but the acute episodes in BPPV may last less than a minute while Labyrinthitis is continuous. BPPV differs from the other adverse ear conditions in the diagnosis process since it is diagnosed using the Dix-Hallpike maneuver. The condition may recover on its own in days, but the physician may increase the healing process by treating the patient using the canalith repositioning strategy (Viper, 2020).
The patient’s chief complaint is “ear disturbance .”D.R is a 42-year-old male African American patient and has been experiencing ear disturbance within the last one week, which has exacerbated in the last three hours. For the HEENT assessment, he reports headache, pain in the ear, loss of hearing in one ear, watery eyes, blurred vision, and dizziness. He stays with his wife and works in a metal-recycling company.
The patient is not comfortable, showing discomfort and feeling of pain. He rarely maintains positive eye contact and can hardly concentrate during the encounter. Body temperature is 100 0 F. the ear canal is obstructed with pus oozing out. The pus is a bacterial infection in the interior of the ear.
The patient is diagnosed with Labyrinthitis, a viral or bacterial infected condition associated with internal disturbance, pain in the ear, headache, and eye problems. This condition may have been caused by the insertion of infectious pads into the ear in the cleaning process and exacerbated by the noisy condition in the workplace. Other differential diagnoses include Benign Paroxysmal Positional Vertigo and Meniere’s disease since they share most of the symptoms except the inflammation of the inner ear due to infections.
Further lab tests include an ear CT scan to establish the level of damage and for the proper treatment process. The patient should avoid ear pads and noise in enhancing the healing process of the ear.
Barkwill, D., & Arora, R. (2021). Labyrinthitis. StatPearls [Internet].
Johns Hopkins Medicine. (2020). Benign Paroxysmal Positional Vertigo (BPPV). Johns Hopkins
Osborn, R. (2020, October 23). Meniere’s Disease and Labyrinthitis. Difference Between. http://www.differencebetween.net/science/health/difference-between-menieres-disease-and-labyrinthitis/
Van Steekelenburg, J. M., Van Weijnen, A., De Pont, L. M. H., Vijlbrief, O. D., Bommeljé, C. C., Koopman, J. P., … & Hammer, S. (2020). Value of endolymphatic hydrops and perilymph signal intensity in suspected Ménière disease. American Journal of Neuroradiology, 41(3), 529-534.
Viper, R. (2020, August 18). Benign paroxysmal positional vertigo (BPPV) – Diagnosis and treatment – Mayo Clinic. Mayo Clinic.