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ENT · Ear and audiology: autoimmune inner ear disease
Sample itemA 34-year-old woman develops bilateral sensorineural hearing loss that worsens over six weeks. Examination of the ears is normal and tympanometry is normal. Which treatment is the first to try?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. High-dose oral corticosteroids
Rapidly progressive, usually asymmetric bilateral sensorineural loss over weeks to months suggests autoimmune inner ear disease. It often responds, at least initially, to a trial of high-dose corticosteroids, with cytotoxic or biological agents for steroid-dependent cases. Hearing aids and implants are for loss that has stabilised.
Option by option
A. High-dose oral corticosteroids (correct)
Correct. A steroid trial is the standard first treatment and is also a diagnostic test.
B. Immediate cochlear implantation
Implantation is reserved for stable profound loss that no longer benefits from aids.
C. Intratympanic gentamicin
Gentamicin is ablative and would destroy hearing in an ear that may recover.
D. Hearing aids alone with no drug therapy
Rehabilitation alone ignores a potentially reversible immune process.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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