Answer : USMLE step 2 Mcq 59:A 9 year old boy develops severe dizziness, nausea and vomiting three days following an upper respiratory tract infection


Correct Answer: D
The symptoms of labyrinthitis include dizziness, an abnormal sensation of movement which may be may be accompanied by nausea and vomiting and may be severe and may be continuous for up to a week at a time . The affected child demonstrates falling toward the affected side and hearing loss in the affected ear (especially with bacterial labyrinthitis) . The symptoms caused by serous labyrinthitis may be very mild at first. If the infection is not treated, however, symptoms can become more severe and eventually end in total loss of hearing and vestibular function. The symptoms associated with suppurative labyrinthitis are similar to those of serous labyrinthitis, but they are usually pronounced from the beginning and rapidly become very severe. Suppurative labyrinthitis often results in permanent loss of hearing and vestibular function. Regardless of the type of bacterial infection, the treatment consists of destroying the bacteria by means of antibiotics. If the labyrinthitis is caused by a break in the membranes separating the middle and inner ears, surgery may also be required to repair the membranes to prevent a recurrence of the disease. Bacteria may cause damage to the labyrinth in two different ways. Bacteria that infect the middle ear or the bone surrounding the inner ear can produce toxins that inflame the cochlea or the vestibular system or both. This sort of inflammation is called serous labyrinthitis. Alternatively, bacteria may invade the labyrinth itself, causing what is called suppurative labyrinthitis. Serous labyrinthitis is most frequently caused by chronic, untreated middle ear infections (chronic otitis media) and is the more common type of bacterial inner ear infection. The bacteria that cause suppurative labyrinthitis can enter the inner ear as a result of bacterial meningitis, which is an inflammation of the protective sheath surrounding the brain. Bacteria can also enter the labyrinth if the membranes that separate the middle ear from the inner ear are ruptured by a disease, like otitis media, or by an injury, as in the case of perilymph fistula


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