Tempo Tells You: Vertigo, Sudden Deafness and the Ototoxic List
Match the tempo to the diagnosis and you never have to memorise a symptom list. Seconds of positional spinning is one disease, hours with fluctuating hearing loss is another, days without hearing loss is a third — and a 30-decibel drop within 72 hours is a steroid emergency. Start by asking what the patient actually means by dizzy, because a third of them are not describing vertigo at all.
1 · What does the patient actually mean by dizzy?
2 · How long does each episode last?
3 · What sets it off?
4 · Hearing
5 · Screen for the causes that kill
The call you will actually getA 46-year-old woke with the hearing gone in his right ear, plus fullness and ringing. He assumes it is wax and asks whether he should come in next week. Move the dial to where he really is.
Hours since he noticed the loss
Time elapsed10 h
What the tuning forks show
The definition to hold on to: a loss of 30 decibels or more across three contiguous frequencies developing within 72 hours, usually in one ear, often noticed on waking, often with aural fullness and tinnitus.
Bed 9 · an 84-year-old with pneumoniaBuild the medication list and the clinical picture, then read the monitoring plan. One combination on this list is synergistic and it is the one you will meet on every medical floor.
On the medication administration record
Clinical picture today
Cerumen impaction is the easiest fix in the buildingIt is also the most common cause of conductive hearing loss in an older adult. But irrigation is not a free action. Confirm all four before a drop of water goes in.
Confirm before irrigating
During the procedure
What the tempo is telling you
Disorder
Episode length and trigger
Hearing
BPPV
Seconds to under a minute, triggered by rolling over, lying down, looking up
Normal
Ménière disease
20 minutes to 12 hours, spontaneous, clustered then quiescent