Archives

A 76 years old man complains of decreased hearing in his right ear for the past 2 weeks associated with a full feeling in that ear. He has been wearing hearing aids for the past 10 years and tried changing the battery, but his symptoms persisted. He reports occasional sticky yellow drainage from the right east for the last few weeks, which he attempted to clean using cotton-tipped applicators. On physical exam the left tympanic membrane cannot be visualized due to the presence of sticky yellow wax in the ear canal. Only a minimal amount of cerumen is present in the left ear canal. What is the most likely diagnosis?

January 5, 2021 4:27 am Published by

Cerumen impaction

A 65 years old woman presents with a chief complaint of dizziness. She describes it as a sudden and severe spinning sensation precipitated by rolling over in bed onto her right side. Symptoms typically last <30 seconds. They have occurred nightly over the last month and occasionally during the day when she tilts her head back to look upward. She describes no precipitating event prior to onset and no associated hearing loss, tinnitus, or other neurologic symptoms. Otologic and neurologic examinations are normal except for the Dix-Hallpike maneuver, which is negative on the left but strongly positive on the right side. What potential sequelae do you need to be concerned about?

January 5, 2021 4:25 am Published by

Increased likelihood of accidents and hearing loss

A 65 years old woman presents with a chief complaint of dizziness. She describes it as a sudden and severe spinning sensation precipitated by rolling over in bed onto her right side. Symptoms typically last <30 seconds. They have occurred nightly over the last month and occasionally during the day when she tilts her head back to look upward. She describes no precipitating event prior to onset and no associated hearing loss, tinnitus, or other neurologic symptoms. Otologic and neurologic examinations are normal except for the Dix-Hallpike maneuver, which is negative on the left but strongly positive on the right side. What are the most important differential diagnoses?

January 5, 2021 4:24 am Published by

Of the relevant differential diagnoses, it is important to rule out cholesteatoma, Meniere’s disease, labyrinthitis and vestibular neuronitis.

A 65 years old woman presents with a chief complaint of dizziness. She describes it as a sudden and severe spinning sensation precipitated by rolling over in bed onto her right side. Symptoms typically last <30 seconds. They have occurred nightly over the last month and occasionally during the day when she tilts her head back to look upward. She describes no precipitating event prior to onset and no associated hearing loss, tinnitus, or other neurologic symptoms. Otologic and neurologic examinations are normal except for the Dix-Hallpike maneuver, which is negative on the left but strongly positive on the right side. What is the most likely diagnosis?

January 5, 2021 4:24 am Published by

Benign paroxysmal positional vertigo

A 7 years old girl presents with abrupt onset of fever, nausea, vomiting, and sore throat. The child denies cough, rhinorrhea, or nasal congestion. On physical exam, oral temperature is 98.6°F (37°C) and there is an exudative pharyngitis, with enlarged cervical lymph nodes. What are the most important differential diagnoses?

January 5, 2021 4:17 am Published by

Of the relevant differential diagnoses, it is important to rule out epiglottitis, diphtheria, retropharyngeal or peritonsillar abscess and oropharyngeal cancer.