Otology, Neurotology, and Skull Base
Core concepts
Anchor on the audiogram: distinguish conductive (air-bone gap, normal bone) from sensorineural (no gap, both reduced) hearing loss. Know the tuning fork tests-Rinne and Weber-and their limitations. Master the differential of sudden sensorineural hearing loss (SSNHL) as an emergency requiring prompt steroids and MRI to exclude retrocochlear pathology such as vestibular schwannoma. Understand vertigo localization: peripheral causes (BPPV, vestibular neuritis, Meniere disease) versus central causes (stroke, vestibular migraine), with the HINTS exam helping distinguish. Know that BPPV is diagnosed by Dix-Hallpike and treated with canalith repositioning. For skull base, recognize that pulsatile tinnitus and unilateral hearing loss warrant imaging.
Traps
A common trap is treating SSNHL as benign or waiting for spontaneous recovery-prompt steroid therapy matters. Another is mislabeling central vertigo as peripheral; direction-changing nystagmus or skew deviation suggests central disease. Questions also confuse Meniere disease (episodic vertigo, fluctuating hearing loss, tinnitus, aural fullness) with vestibular neuritis (single prolonged attack without hearing loss).
Worked example
A patient reports episodic vertigo lasting hours with fluctuating hearing loss and tinnitus. This fits Meniere disease. Rule of thumb: Meniere involves hearing symptoms; vestibular neuritis does not.