1. 1 What are the important problems that Mr. Mott is having? Be specific. vertigo whistling episodic louder in left ear nausea/vomiting hearing loss – high frequency timing

2. 2 What are the potential causes of these problems? 1.stereocilia damage – noise induced, aminoglycoside antibiotics 2.alcohol and tobacco 3.furosemide 4.toxins(?) 5.genetics 6.trauma 7.otosclerosis 8.Meniere’s disease 9.“other” neurological problem – tumour etc. 10.internal carotid artery (atherosclerosis) 11.high blood pressure

3. 3 What part(s) of the nervous system is(are) involved and why? semicircular canals “auditory processing” center vestibular nuclei cochlea cerebellum middle ear in common? endolymphatic duct?

4. 4 What physical exam procedures are you going to perform to test your hypotheses? Rinne/Weber audiogram (whisper test, wristwatch) neurological exam otoscope blood pressure