Symptom of vestibular dysfunction - Sensation of motion w no motion or an exaggerated sense of motion

3a - Inner Ear (vertigo) Flashcards by michael english

Fluids in the inner ear

Perilymph

Endolymph

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Perilymph is?

Chemically similar to CSF

Surrounds membranous labyrinth

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Endolymph is?

Found w/in membranous labyrinth

High level of K

Role in generating auditory signals

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What is vertigo?

Symptom of vestibular dysfunction

Sensation of motion w no motion or an exaggerated sense of motion

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With vertigo you must differentiate between? How to differentiate them

Peripheral:

sudden onset
w tinnitus/hearing loss

Central:

gradual onset
no auditory symptoms

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Is Vertigo a disease?

No - its a symptom of vestibular disease not a diagnosis

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types of dizziness

Vertigo
Presyncope/syncope
Disequilibrium
Non-specific lightheadedness

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Causes of peripheral vs central vertigo?

Peripheral (80% of cases)

BPPV
vestibular neuritis
meniere disease

Central (big deal)

vestibular migraine
vascular etiologies

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Otolaryngologist focus primarily on?

Peripheral causes

Central is prob neuro

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Clinical approach to diagnosing vertiog?

duration
quality
triggers
associated sx
med hx

HEENT exam

ears
eye motion (w head turning)
CN exam
Romberg

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Meds that often cause vertigo?

Aminoglycosides
Anti-HTN drugs
Vasodilators
Phenothiazines
Tranquilizers
Antidepressants
Anticonvulsants
Hypnotics 
Analgesics
Alcohol
Caffeine
Tobacco

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To differentiate central from peripheral evaluate?

Brainstem symptoms

diplopia
facial numbness
weakness
hemiplegia
dysphasia

Lack of these does not r/o central

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Tests to run for suspected central vertigo?

Audiogram
ENG - electronystagmography
VNG - videonystagmography
Brain MRI
Caloric stimulation 
- (COWS - cold opposite Warm Same)

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Peripheral vertigo nystagmus?

Fatiguable
Horizontal w rotary component
Latency
Suppressed by visual fixation

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Peripheral causes of vertigo?

Meniere disease
Vestibular neuritis/labryinthitis
Benign positional vertigo
Traumatic vertigo
Perilymphatic fistula
Migrainous vertigo
Semicircular canal dehiscence

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Inner ear digarm?

Slide 20

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Endolymphatic hydrops is aka?

Meniere syndrome

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Endolymphatic hydrops cause?

Idiopathic - consider chronic condition

Also could be:

syphilis
head trauma

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Classic diagnosis of endolymphatic hydrops (meniere syndrome)

Episodic vertigo - 20min-hrs
SNHL - fluctuating and lower freq
Tinnitus - low tone, blowing
Sensation of unilateral aural fullness

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Eval for endolymphatic hydrops?

Audiometry: SHL

Caloric testing: loss/impairment on involved side

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Tx for endolymphatic hydrops?

Symptomatic

Acute: meclazine/valium
Primary: low salt and diuretics

Refractory:

intratympanic cortoicosteroids
endolymphatic sac decompression
vestibular ablation (gentamicin, nerve section or surgical)

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With endolymphatic hydrops pts should avoid?

High salt
MSG
Caffeine 
Nicotine
ETOH

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Vestibular neuronitis is aka?

Study These Flashcards

Labrynthitis (when unilateral HL is present)

Vestibular neuritis

Acute peripheral vestibulopathy

Symptoms of vestibular neuronitis?

Study These Flashcards

Acute onset, persistent and severe 
N/V
Hearing is preserved
Unilateral SHL 
Tinnitus (+/-)

Pt will awaken w room-spinning vertigo that will continue but gradually get better over days/weeks

What causes labrynthitis?

Idiopathic - may be inflammation of the labyrinth - poss following URI

PE for labrynthitis?

Spontaneous horizontal nystagmus, suppressed w visual fixation Positive head thrust test

Tx for vestibular neuronitis?

Symptomatic - antihistamines/benzos ``` Vestibular therapy (rehab) - should begin after acute symptoms subside ```

BPPV - benign paroxysmal positioning vertigo

Otoconia (calcium carbonate crystals) or other sediment become free floating and enter one of the semicircular canals

Key word for BPPV?

Sudden onset vertgo lasting less than one minute - Triggered by change in head position - quick movements - goes away as sediment settles They have a precise movement that cause it

What test is key to diagnosing BPPV

Dix-hallpike maneuver (DHM)

How is dix-hallpike maneuver conducted?

33-35 - moving head around and laying them down - nystagums and vertigo appear w a latency of few seconds and last <30 sec

Tx for BPPV?

Meds dont work Epley particualr repositioning maneuver - moves debris toward common crus and out of the auricular cavity (Pic on 36)

Lsit of meds for vertigo?

Slide 38

Traumatic causes of vertigo?

Labyrinth concussion Basilar skull fx | Chronic posttraumatic vertigo from cupulolithiasis

MC cause of verticgo s/p head injury?

Labyrinth concussion | - diminish over days/month

What is a perilymphatic fistula?

Rare - leaking of perilymphatic fluid into middle ear Vertico is worse w/ straining and SHL

Causes of perilymphatic fistula?

Physical injury Extreme barotrauma Vigorous valsalva maneuvers Post surgical (stapedectomy)

Key word for perilymphatic fistula?

Worse with straining

Tx for perilymphatic fistula?

Bed rest Avoid straining Failure of tx - surgery/graft

What is migranous vertigo?

Mixed peripheral/central etiology - episodic vertigo w HA - migraine symptoms - hx of motion intolerance

Tx of migrainous vertigo?

Dietary and lifestyle changes migraine meds

Semicircular canal dehiscence?

Deficiency in bony covering of the superior semicircular canal Causes vertigo from lout nosies Conductive hearing loss is present

Central vertigo etiologies?

``` Brainstem vascular disease A/V malformation Tumor MS Vertebrobasilar migraine ``` Send them to neuro

Differentation of vertigo chart?

Slide 46

Lesions of CN VIII and central audiovestibular pathways can cause?

Neural HL and vertigo Deterioration of speech discrimination Auditory adaptation

Eval for CN VIII lesion?

Brainstem auditory evoked response (BAER) MRI

Disorders associated w CN VIII lesion?

Vestibular schwannoma (acoustic neuroma) Vascular compromise MS

What is acoustic neuroma?

Aka vestibular schwannoma - MC intracranial tumor - nerve sheath tumor of 8th CN - unilateral

Keyword for acoustic neuroma?

Unilateral sensory hearing loss

Preferred imaging for acoustic neuroma?

MRI w gandolinium

Tx for acoustic neuroma?

Its a space occupying lesion Asymptomatic - observation, annual MRI Symptomatic - excision, radiation, annual MRI

MS can present?

Symptoms identical to meniere’s disease

MS is a?

Inflammatory and degnerative d/o involving CNS Vertigo is sometimes the presenting symptom

MS is commonly associated with (s/s)

Hyper/hypoacusis Facial numbness Diplopia

Vertebrobasilar insufficiency is?

Elderly pts w arteriosclerosis - reduced blood flow in vertebrobasilar system Triggered by change in posture/extension of neck

Tx for vertebrobasilar insufficiency?

Vasodilators Aspirin Vestibular rehab (mainstay of tx)

What would bears be with bees?

Ears

3a - Inner Ear (vertigo) Flashcards

(57 cards)