Otology and Neurotology
Core concepts
You must be fluent in the classification of hearing loss (conductive, sensorineural, mixed), the tuning-fork tests and their limitations, and the interpretation of pure-tone audiometry, tympanometry, and acoustic reflex testing. Know the natural history and audiometric pattern of otosclerosis (Carhart notch, normal tympanometry), the staging of cholesteatoma, and the principles of tympanoplasty and mastoidectomy. For vertigo, distinguish peripheral from central causes using timing, triggers, and associated signs, and know the Dix-Hallpike and head-impulse tests.
Traps
A common trap is over-reading a Carhart notch as sensorineural loss; it is a conductive-appearing artifact at 2 kHz. Another is assuming all vertigo with hearing loss is Ménière disease; sudden sensorineural hearing loss with vertigo may be a vascular or infectious event and is an emergency. Questions on acoustic neuroma often hinge on asymmetric sensorineural loss with disproportionately poor speech discrimination. Do not confuse vestibular neuritis (no hearing loss) with labyrinthitis (hearing loss present).
Worked example
A patient has episodic vertigo lasting hours, fluctuating low-frequency hearing loss, and tinnitus. The combination of episodic vertigo with fluctuating sensorineural loss points to Ménière disease; a key differentiator is that BPPV lasts seconds and is positional, while vestibular migraine often has photophobia and no hearing loss.