INI-CET 2021 — ENT

Q: A patient presents with vertigo, tinnitus, and head tilt. He underwent myringoplasty for the safe type of chronic suppurative otitis media (CSOM) 6 months back. What is your diagnosis?

Perilymphatic fistula. ***Perilymphatic fistula*** - The combination of **vertigo**, **tinnitus**, and **head tilt** occurring after a **myringoplasty**, even for a safe type of CSOM, suggests a perilymphatic fistula. - Myringoplasty can occasionally involve trauma to the **oval or round window**, leading to a direct communication between the inner ear (perilymph) and the middle ear, causing these symptoms. *Paget disease* - This is a **bone remodeling disorder** that primarily affects the skull, pelvis, and long bones, leading to bone pain and deformities. - While it can cause hearing loss (due to otosclerosis) and a sense of imbalance, it does not typically present with the acute onset of **vertigo** and **tinnitus** following ear surgery. *Labyrinthitis* - **Labyrinthitis** is an inflammation of the inner ear, typically caused by a viral infection, leading to sudden, severe **vertigo**, **nausea**, and often **hearing loss** or **tinnitus**. - While the symptoms of vertigo and tinnitus are present, the history of recent myringoplasty makes a **structural compromise** like a perilymphatic fistula a more specific diagnosis than generalized inflammation. *Vestibular schwannoma* - Also known as an acoustic neuroma, this is a **benign tumor** on the eighth cranial nerve, causing **gradual unilateral hearing loss**, **tinnitus**, and **imbalance**, but rarely sudden, intense vertigo unless very large. - The presentation with a history of myringoplasty and acute symptoms makes a **spontaneous structural defect** more likely than a slowly growing tumor. [Practice more ENT PYQs on OnCourse]

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Questions

A patient presents with vertigo, tinnitus, and head tilt. He underwent myringoplasty for the safe type of chronic suppurative otitis media (CSOM) 6 months back. What is your diagnosis?