Otology and Neuro-otology
Core concepts
Master the tonogram pattern-to-pathology map: conductive loss with a normal bone line and air-bone gap suggests middle-ear disease (effusion, ossicular fixation, tympanic membrane perforation); sensorineural loss with no gap localises to cochlea or retrocochlear pathway. Know tuning-fork logic (Rinne, Weber) as a bedside correlate, not a replacement, for audiometry. Vertigo requires separating peripheral (horizontal-torsional nystagmus suppressed by fixation, positive head-impulse test, unidirectional) from central (vertical or direction-changing nystagmus, not suppressed by fixation, normal head impulse). Know BPPV (posterior canal, Dix-Hallpike, Epley), vestibular neuritis (acute prolonged vertigo, positive head impulse, no hearing loss), Meniere (episodic vertigo, fluctuating low-frequency SNHL, tinnitus, aural fullness), and vestibular schwannoma (asymmetric SNHL, tinnitus, absent acoustic reflex, MRI gold standard).
Traps
Questions conflate "dizziness" with vertigo; insist on the symptom description. A normal CT does not exclude schwannoma - MRI with contrast is the test. HINTS exam is only valid in acute continuous vertigo, not episodic. Cholesteatoma is a clinical/radiological diagnosis: marginal attic perforation with keratin debris, not simply chronic discharge. Beware the "steroid-responsive" distractor for sudden SNHL - treat as emergency, but recovery is not guaranteed.
Rule of thumb
For sudden unilateral SNHL: act within 72 hours, start high-dose corticosteroids, and image if asymmetric or refractory. For any asymmetric SNHL with tinnitus, exclude retrocochlear disease before reassuring the patient.