Diseases » Ménière's disease » Causes

Causes of Ménière's disease

Ménière's disease Causes: Book Excerpts

• Differential Diagnosis - Dizziness/Lightheadedness & Vertigo
• Differential Diagnosis - Fever – Recurrent
• Differential Diagnosis - Vertigo
• Medical causes - Earache
• Medical causes - Vertigo
• Causes and incidence - Ménière's disease
• Medical causes - Earache [Otalgia]
• Medical causes - Vertigo
• Differential Overview - Chronic/Recurrent Abdominal Pain
• Medical causes - Earache
• Medical causes - Vertigo
• Principal Causes of Earache - Earache
• Principal Causes of Recurrent Infection - Recurrent Infection
• Principal Causes of Vertigo - Vertigo
• Medical causes - Earache [Otalgia]
• Medical causes - Vertigo

Related information on causes of Ménière's disease:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Ménière's disease may be found in:

• Hidden causes of Ménière's disease

Causes of Ménière's disease: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Ménière's disease.

Dizziness/Lightheadedness & Vertigo: Differential Diagnosis
(In a Page: Signs and Symptoms)

Dizziness/lightheadedness

• Transiently decreased cerebral blood flow
  –Hyperventilation
  –Vasovagal response
  –Congestive heart failure
  –Aortic stenosis
  –Hypertrophic cardiomyopathy
  –Hemorrhage
  –Dehydration or hypotension
  –Carotid sinus pressure
  –Cerebral artery thrombosis or embolism
  –Cardiac arrhythmia
  –Autonomic dysfunction (e.g., Shy-Drager syndrome)
  –TIA
  –Hypoxemia
  –Anemia

• Primary CNS dysfunction not associated with decreased blood flow
  –Migraine
  –Seizure
  –Severe electrolyte disturbance
  –Elevated intracranial pressure
• Panic attack
• Hyperventilation and/or anxiety
• Ictal aura
• Basilar migraine
• Drug intoxication (e.g., alcohol, sedatives, centrally-acting α-blockers)
• Allergic reactions
• Postconcussion syndrome
• Carbon monoxide poisoning
  Vertigo
• Peripheral vertigo (inner ear pathology)
  –Benign positional vertigo (>20% of cases)
  –Ménière's disease
  –Labyrinthine trauma
  –Labyrinthitis (viral)
  –Nonspecific or recurrent vestibulopathy
  –Bilateral vestibular loss
  –Acoustic neuroma
  –Autoimmune inner ear disease
• Central vertigo (CNS pathology)
  –Multiple sclerosis
  –Brainstem tumors
  –Labyrinthine trauma
  –Epileptic vertigo
  –Vertebrobasilar insufficiency
  –Tabes dorsalis
  –Friedreich's ataxia

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Fever – Recurrent: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Repeated viral infections
  –Most common cause of recurrent febrile episodes in childhood
  –Start of day care or change of geographic location may be related
• Urinary tract infection (UTI)
  –May be self-limited but recur especially if underlying anomaly exists
• Epstein-Barr virus (EBV)
  –May present with recurrent febrile episodes due to one initial infection
• Other specific viral syndromes
  –Parvovirus B19
  –CMV
• Immunodeficiency
  –Repeated bacterial infections should lead to investigation of immune status
• Dental abscess (non-dental abscesses typically present with prolonged daily fever)
• Chronic meningococcemia
• Acute rheumatic fever
• Inflammatory bowel disease (IBD)
• Juvenile rheumatoid arthritis (JRA)
• Behçet disease
• Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) or Hibernian Fever
  –Autosomal dominant disease with fever, myalgias with migratory pattern, conjunctivitis and rash
• Familial cold autoinflammatory syndrome or familial cold urticaria
  –Rash, fever, arthralgia, and conjunctivitis
  –Precipitated by exposure to cold
• Muckle-Wells syndrome
  –Similar presentation to familial cold urticaria
  –Symptoms not triggered by cold
• Brucellosis
  –Most prevalent around the Mediterranean and Arabic countries, also present in South America and India
• Yersiniosis
• Typhoid fever
• Rat-bite fever
• Malaria
• Factitious fever

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Vertigo: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Benign paroxysmal positional vertigo (BPPV)
  –Each episode lasts seconds to minutes
• Vestibular neuritis
  –Viral infection of the vestibular nerve
• Otitis media
• Migraine
  –Vertigo may precede, follow, or present with the headache and aura
• Acute labyrinthitis
  –Acute onset with nausea and vomiting
  –Lasts for days and slowly resolves
  –45% cluster with viral infections
• Posttraumatic
  –Perilymphatic fistula
  –Labyrinthine concussion
  –Associated with postconcussive syndrome
  –Worsened by change in head position, cough, sneeze, swallow, straining, and airplane travel
• Cerebellar tumors
  –Tumors may be associated with tinnitus, facial weakness, and nystagmus
• Toxins/drugs: Antibiotics (aminoglycosides), salicylates, alcohol, phenytoin, quinine, arsenic, tricyclic antidepressants
• Autoimmune: Collagen vascular disease, Wegener granulomatosis
• Posterior circulation dissection
  –Often associated with a history of neck extension or rotational injury
• Cerebellar hemorrhage: Acute onset of vertigo, headache, nausea, and vomiting
• Multiple sclerosis
  –Vertigo is the presenting symptom in 5%
  –Hearing loss rare
  –Most common in young women
• Temporal lobe or complex partial seizures
• Ménière disease
• Familial periodic ataxia syndromes
  –Recurrent bouts of vertigo brought on by emotional stress or physical exertion
• CNS infection: Syphilis, Lyme disease
• Motion sickness
• Vertigo mimics: Presyncope, disequilibrium from decreased vision or proprioception
• Psychogenic
  –Panic or anxiety disorder

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Earache: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Abscess (extradural)

Severe earache accompanied by a persistent ipsilateral headache, malaise, and a recurrent mild fever characterizes an abscess, which is a serious complication of middle ear infection.

Barotrauma (acute)

Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn't perforated.

Cerumen impaction

Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.

Herpes zoster oticus (Ramsay Hunt syndrome)

Herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.

Keratosis obturans

Mild ear pain is common with keratosis obturans, along with otorrhea and tinnitus. Inspection reveals a white glistening plug obstructing the external meatus.

Mastoiditis (acute)

Mastoiditiscauses a dull ache behind the ear accompanied by a low-grade fever (99 to 100 F [37.2 to 37.87 C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.

Ménière's disease

Ménière's disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.

Otitis externa

Earache characterizes acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by a low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104 F (40 C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.

Malignant otitis externa abruptly causes ear pain that's aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, a fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.

Otitis media (acute)

Otitis media is middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.

Severe, deep, throbbing ear pain; hearing loss; and a fever that may reach 102 F (38.9 C) characterize acute suppurative otitis media.

The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.

Chronic otitis media usually isn't painful except during exacerbations. Persistent pain and discharge from the ear suggest osteomyelitis of the skull base or cancer.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Vertigo: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Acoustic neuroma

Acoustic neuroma is a tumor of the eighth cranial nerve that causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and — with cranial nerve compression — facial paralysis.

Benign positional vertigo

With benign positional vertigo, debris in a semicircular canal produces vertigo on head position change, which lasts a few minutes. It’s usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia

Brain stem ischemia produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma

Persistent vertigo, occurring soon after injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased (LOC). Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster

Infection of the eighth cranial nerve produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis

Severe vertigo begins abruptly with labyrinthitis, an inner ear infection. Vertigo may occur in a single episode or may recur over months or years. Associated findings include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière’s disease

With Ménière’s disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, any sudden motion of the head or eyes can precipitate nausea and vomiting.

Multiple sclerosis (MS)

Episodic vertigo may occur early and become persistent. Other early findings include diplopia, visual blurring, and paresthesia. MS may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Seizures

Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures.

Vestibular neuritis

With vestibular neuritis, severe vertigo usually begins abruptly and lasts several days, without tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests

Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol

High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures

Ear surgery may cause vertigo that lasts for several days. Also, administration of overly warm or cold eardrops or irrigating solutions can cause vertigo.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Ménière's disease: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The exact cause of Ménière’s disease is unknown. It may result from overproduction or decreased absorption of endolymph, which causes endolymphatic hydrops or endolymphatic hypertension, with consequent degeneration of the vestibular and cochlear hair cells. This condition may also stem from autonomic nervous system dysfunction that produces a temporary constriction of blood vessels supplying the inner ear. In some cases, Ménière’s disease may be related to otitis media, syphilis, or head injury. Risk factors include recent viral illness, respiratory infection, stress, fatigue, use of prescription or nonprescription drugs (such as aspirin), and a history of allergies, smoking, and alcohol use. There also may be genetic risk factors: In some women, premenstrual edema may precipitate attacks of Ménière’s disease.

In the United States, about 100,000 people per year develop Ménière’s disease.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Earache [Otalgia]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Abscess (extradural)

Severe earache accompanied by a persistent ipsilateral headache, malaise, and recurrent mild fever characterizes this serious complication of middle ear infection.

Barotrauma (acute)

Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn’t perforated.

Cerumen impaction

Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.

Chondrodermatitis nodularis chronica

Chondrodermatitis nodularis chronica produces small, painful, indurated areas along the auricle’s upper rim.

Ear canal obstruction by an insect

An insect lodged in the ear canal may cause severe pain and distressing noise.

Frostbite

Prolonged exposure to cold may cause burning or tingling pain in the ear, followed by numbness. The ear appears mottled and gray or white; it turns purplish blue as it’s warmed.

Furunculosis

Infected hair follicles in the outer ear canal may produce severe, localized ear pain associated with a pus-filled furuncle (boil). The pain is aggravated by jaw movement and relieved by rupture or incision of the furuncle. Pinna tenderness, swelling of the auditory meatus, partial hearing loss, and a feeling of fullness in the ear canal may also occur.

Herpes zoster oticus (Ramsay Hunt syndrome)

Herpes zoster oticus causes burning or stabbing ear pain that’s commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transient ipsilateral facial paralysis, partial loss of taste, tongue vesicles, and nausea and vomiting.

Keratosis obturans

Mild ear pain, otorrhea, and tinnitus are common in keratosis obturans. Inspection reveals a white glistening plug obstructing the external meatus.

Mastoiditis (acute)

Mastoiditis causes a dull ache behind the ear accompanied by low-grade fever (99° F to 100° F [37.2° C to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.

Ménière’s disease

Ménière’s disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.

Middle ear tumor

Deep, boring ear pain and facial paralysis are late signs of a malignant tumor.

Myringitis bullosa

Myringitis bullosa is a rare bacterial infection that causes sudden, severe ear pain that radiates over the mastoid and lasts for up to 48 hours. Small serous or blood-filled vesicles may dot the reddened tympanic membrane. Transient hearing loss and a serosanguineous discharge may also occur.

Otitis externa

Earache characterizes both acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104° F (40° C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.

Malignant otitis externa causes sudden ear pain that’s aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.

Otitis media (acute)

Otitis media is a middle ear inflammation that can be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber colored, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.

Acute suppurative otitis media is characterized by severe deep, throbbing ear pain; hearing loss; and fever that may reach 102° F (38.9° C).The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.

Chronic otitis media usually isn’t painful except during exacerbations. Persistent pain and discharge from the ear suggest cancer or osteomyelitis of the skull base.

Perichondritis

Perichondritis can cause ear pain accompanied by warmth and tenderness in the outer ear and a reddened, doughlike auricle.

Petrositis

The result of acute otitis media, this infection produces deep ear pain with headache and pain behind the eye. Other findings are diplopia, loss of lateral gaze, vomiting, sensorineural hearing loss, vertigo and, possibly, nuchal rigidity.

Temporomandibular joint infection

Typically unilateral, temporomandibular joint infection produces ear pain that’s referred from the jaw joint. The pain is aggravated by pressure on the joint with jaw movement; it commonly radiates to the temporal area or the entire side of the head.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Vertigo: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acoustic neuroma

This tumor of the eighth cranial nerve causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and—with cranial nerve compression—facial paralysis.

Benign positional vertigo

In this disorder, debris in a semicircular canal produces vertigo lasting a few minutes when the patient changes head position. This type of vertigo is usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia

This condition produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma

Persistent vertigo, occurring soon after a head injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased level of consciousness. Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster

Infection of the eighth cranial nerve produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis

Severe vertigo begins abruptly in this inner ear infection. Vertigo may occur in a single episode or may recur over months or years. Associated findings include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière’s disease

In this disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, any sudden motion of the head or eyes can precipitate nausea and vomiting.

Motion sickness

This condition is characterized by vertigo, nausea, vomiting, and headache in response to rhythmic or erratic motions.

Multiple sclerosis (MS)

Episodic vertigo may occur early and become persistent in MS. Other early findings include diplopia, visual blurring, and paresthesia. MS may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Posterior fossa tumor

This type of tumor may produce positional vertigo that lasts for a few seconds as well as papilledema, headache, memory loss, nausea, vomiting, nystagmus, apneustic or ataxic respirations, and increased blood pressure. The patient may also fall sideways.

Seizures

Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures.

Vestibular neuritis

In this disorder, severe vertigo usually begins abruptly, lasts several days, and isn’t accompanied by tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests

Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol

High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures

Ear surgery may cause vertigo that lasts for several days. Administration of overly warm or cold eardrops or irrigating solutions can also cause vertigo.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Chronic/Recurrent Abdominal Pain: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Irritable bowel syndrome

❑ Peptic ulcer disease

❑ Cholecystitis

❑ Chronic pancreatitis

❑ Inflammatory bowel disease

❑ Intermittent mesenteric ischemia

❑ Pancreatic cancer

❑ Gastric cancer

❑ Endometriosis

❑ Recurrent intestinal obstruction

❑ Sickle cell anemia

❑ Radiculopathy

❑ Adrenal insufficiency

❑ Lead poisoning

❑ Porphyria

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Earache: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Abscess (extradural)

Severe earache accompanied by persistent ipsilateral headache, malaise, and recurrent mild fever characterizes extradural abscess, a serious complication of middle ear infection. The patient may also experience hearing loss.

Barotrauma (acute)

Earache associated with acute barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn’t perforated.

Cerumen impaction

Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness and ringing in the ear.

Chondrodermatitis nodularis chronica

Chondrodermatitis nodularis chronica produces small, painful, indurated areas along the upper rim of the auricle. The lesion may have a central core with scaly discharge.

Frostbite

Prolonged exposure to cold may cause burning or tingling pain in the ear, followed by numbness. The ear appears mottled and gray or white; it turns purplish blue as it’s warmed.

Furunculosis

Infected hair follicles in the outer ear canal may produce severe, localized ear pain associated with a pus-filled furuncle (boil). The pain is aggravated by jaw movement and relieved by rupture or incision of the furuncle. Pinna tenderness, swelling of the auditory meatus, partial hearing loss, and a feeling of fullness in the ear canal may also occur.

Herpes zoster oticus

Also known as Ramsay Hunt syndrome, herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.

Mastoiditis (acute)

Acute mastoiditis causes a dull ache behind the ear accompanied by low-grade fever (99° F to 100° F [37.2° C to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.

Ménière’s disease

Ménière’s disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.

Middle ear tumor

Deep, boring ear pain and facial paralysis are late signs of a malignant tumor. Hearing loss and facial nerve dysfunction may accompany middle ear tumors.

Otitis externa (acute)

Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104°F [40° C]. Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.

Otitis media (acute)

Acute otitis media is a middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber colored, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.

Severe, deep, throbbing ear pain, hearing loss, and fever that can reach 102°F (38.9° C) characterize acute suppurative otitis media.The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.

Petrositis

The result of acute otitis media, petrositis is an infection that produces deep ear pain with headache and pain behind the eye. Other findings include diplopia, loss of lateral gaze, vomiting, sensorineural hearing loss, vertigo and, possibly, nuchal rigidity.

Temporomandibular joint infection

Typically unilateral, temporomandibular joint (TMJ) infection produces ear pain that’s referred from the jaw joint. The pain is aggravated by pressure on the joint with jaw movement; it commonly radiates to the temporal area or the entire side of the head.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Vertigo: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Acoustic neuroma

Acoustic neuroma is a tumor of the eighth cranial nerve that causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and — with cranial nerve compression — facial paralysis.

Benign positional vertigo

With benign positional vertigo, debris in a semicircular canal produces vertigo on head position change, which lasts a few minutes. It’s usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia

Brain stem ischemia produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma

Persistent vertigo, occurring soon after injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased level of consciousness (LOC). Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster

Infection of the eighth cranial nerve with herpes zoster produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis

Severe vertigo begins abruptly with this inner ear infection. Vertigo may occur in a single episode or may recur over months or years. Associated findings of labyrinthitis include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière’s disease

With Ménière’s disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, any sudden motion of the head or eyes can precipitate nausea and vomiting.

Motion sickness

Motion sickness is characterized by vertigo, nausea, vomiting, and headache in response to rhythmic or erratic motions. Headache, dizziness, fatigue, diaphoresis, hypersalivation, and dyspnea may also occur.

Multiple sclerosis

Episodic vertigo may occur early in multiple sclerosis and become persistent. Other early findings include diplopia, visual blurring, and paresthesia. Multiple sclerosis may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Seizures

Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures. The seizures may be heralded by an aura and followed by several minutes of mental confusion.

Vestibular neuritis

With vestibular neuritis, severe vertigo usually begins abruptly and lasts several days, without tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests

Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol

High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures

Ear surgery may cause vertigo that lasts for several days. Also, administration of overly warm or cold eardrops or irrigating solutions can cause vertigo.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Earache: Principal Causes of Earache
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Externalear including external auditory canal
   1. Infection/inflammation
      1. Otitisexterna
      2. Cellulitis
      3. Furuncle or abscess
      4. Perichondritis of the pinna
   2. Cerumen impaction
   3. Trauma
   4. Foreign body
   5. Neoplasm
2. Middle ear, eustachian tube, and mastoiddisorders
   1. Infection/inflammation
      1. Acuteand chronic otitis media
      2. Otitis media with effusion
      3. Mastoiditis
   2. Trauma
   3. Neoplasm
3. Referred ear pain from cranial nerves(V, VII, IX, X) or cervical nerves (C2, C3)
   1. Cranialnerve V
   2. Cranial nerve VII
   3. Cranial nerve IX
   4. Cranial nerve X
   5. Cervical nerves (C2 and C3)
4. Psychogenic

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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Recurrent Infection: Principal Causes of Recurrent Infection
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Normalhost
   1. Upperrespiratory tract infections
   2. Otitis media
   3. Skin infections
   4. Urinary tract infections
   5. Pneumonia
   6. Meningitis
   7. Foreign body
2. Immunologically compromised host
   1. Primaryimmunodeficiency
      1. Primary B-Cell disorders
         1. Transienthypogammaglobulinemia of infancy
         2. X-linked (Bruton) agammaglobulinemia
         3. Common variable immunodeficiency
         4. Selective IgA deficiency
         5. IgG subclass deficiencies
      2. Primary T-cell disorders
         1. Thymichypoplasia (DiGeorge syndrome)
      3. Combined B- and T-cell disorders
         1. Combinedimmunodeficiency
         2. Purine nucleoside phosphorylase deficiency
         3. Severe combined immunodeficiency
         4. Immunodeficiency with thrombocytopeniaand eczema (Wiskott-Aldrich syndrome)
         5. X-linked CD-40 ligand deficiency
         6. X-linked lymphoproliferative disease
         7. Ataxia-telangiectasia
         8. Hyper-IgE syndrome
         9. Cartilage-hair hypoplasia
      4. Disorders of phagocytic function
         1. Congenitalneutropenia
         2. Cyclic neutropenia
         3. Chronic granulomatous disease of childhood
         4. Chediak-Higashi syndrome
      5. Disorders of the complement system
   2. Secondary immunodeficiency
      1. Immunosuppressiveagents
      2. Sickle cell disease
      3. Nephrotic syndrome
      4. Burns
      5. Uremia
      6. Asplenia including splenectomy
      7. Neutropenia
      8. Lymphoid malignancy
      9. Protein-calorie malnutrition
      10. Human immunodeficiency virus infection

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Vertigo: Principal Causes of Vertigo
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Peripheralvestibular dysfunction
   1. Labyrinthitis
   2. Motion sickness
   3. Head trauma
   4. Drugs
   5. Benign paroxysmal vertigo
   6. Vestibular neuronitis
   7. Middle ear and temporal bone masses
   8. Perilymphatic fistula
   9. Ménière disease
2. Central vestibular dysfunction
   1. Head trauma
   2. Intracranial infection
   3. Seizure disorder
   4. Basilar artery migraine
   5. Neoplasm
3. Psychologic disturbance

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Earache [Otalgia]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Abscess (extradural).Severe earache accompanied by a persistent ipsilateral headache, malaise, and a recurrent mild fever characterizes an abscess, which is a serious complication of middle ear infection.

Barotrauma (acute).Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn't perforated.

Cerumen impaction.Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.

Herpes zoster oticus (Ramsay Hunt syndrome).Herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.

Keratosis obturans.Mild ear pain is common with keratosis obturans, along with otorrhea and tinnitus. Inspection reveals a white glistening plug obstructing the external meatus.

Mastoiditis (acute).Mastoiditis causes a dull ache behind the ear accompanied by a low-grade fever (99° to 100° F [37.2° to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.

Ménière's disease.Ménière's disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.

Otitis externa.An earache characterizes acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by a low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104° F (40° C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.

Malignant otitis externa abruptly causes ear pain that's aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, a fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.

Otitis media (acute).Otitis media is middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.

Severe, deep, throbbing ear pain; hearing loss; and a fever that may reach 102° F (38.9° C) characterize acute suppurative otitis media. The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.

Chronic otitis media usually isn't painful except during exacerbations. Persistent pain and discharge from the ear suggest osteomyelitis of the skull base or cancer.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Vertigo: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acoustic neuroma.Acoustic neuroma causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and—with cranial nerve compression—facial paralysis.

Benign positional vertigo.With benign positional vertigo, debris in a semicircular canal produces vertigo with head position change, which lasts a few minutes. It's usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia.Brain stem ischemia produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma.Persistent vertigo, occurring soon after head injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased (LOC). Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster.Herpes infection of the eighth cranial nerve produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis.Severe vertigo begins abruptly with labyrinthitis. Vertigo may occur in a single episode or may recur over months or years. Associated findings include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière's disease.With Ménière's disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, a sudden motion of the head or eyes can precipitate nausea and vomiting.

Multiple sclerosis (MS).With MS, episodic vertigo may occur early and become persistent. Other early findings include diplopia, visual blurring, and paresthesia. MS may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Seizures.Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures.

Vestibular neuritis.With vestibular neuritis, severe vertigo usually begins abruptly and lasts several days, without tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests.Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol.High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures.Ear surgery may cause vertigo that lasts for several days. Administration of overly warm or cold eardrops or irrigating solutions can also cause vertigo.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

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