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ENT > Dizziness > Flashcards

Dizziness Flashcards

1
Q

is menieres common

A

no

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2
Q

what are the different causes of dizziness

A 
cardio problems 
haematological and metabolic 
anxiety 
neurological conditions 
drugs side effects/ interactions 
migraine
otological 
trauma
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3
Q

what is dizziness

A

non-specific term, covers vertigo, pre-syncope (state before fainting), disequilibrium

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4
Q

what is vertigo

A

sensation of movement, usually spinning

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5
Q

what conditions that causes dizziness affect the vestibular contribution to the central pathway

A

BPPV
menieres
venstibular neuronitis

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6
Q

what conditions that causes dizziness affect the cardiovascular contribution to the central pathway

A

arrhythmias

postural hypotension

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7
Q

what conditions that causes dizziness affect the visual contribution to the central pathway

A

cataracts

DM

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8
Q

what conditions that causes dizziness affect the proprioceptive contribution to the central pathway

A

DM, arthritis, neurology

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9
Q

what conditions that causes dizziness affect the central pathways

A

stress
migraine
space occupying lesion
MS

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10
Q

what are the signs of a cardiac dizziness

A

lightheadedness, syncope, palpitation

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11
Q

what are the features of a neuro dizziness

A

blackouts, visual disturbance, paraesthesia, weakness, speech and swallow problems

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12
Q

what are the vestibular causes of dizziness

A

vertigo; feeling of spinning, falling or being pushed

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13
Q

what dizziness lasts seconds

A

BPPV

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14
Q

what dizziness lasts hours

A

menieres

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15
Q

what dizziness lasts days

A

vestibular neuritis/ labyrinthitis

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16
Q

what causes of dizziness are variable in length

A

migraine associated vertigo

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17
Q

what are the symptoms of a vestibular migraine

A

dizziness, variable duration, mostly occur without headaches, nausea, vomiting, sweating, flushing, diarrhoea, visual changes (blurring), flashing lights, difficulty focusing
bright light and loud sounds are uncomfortable, most feel need to sleep

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18
Q

what does dizziness with hearing loss, tinnitus and aural pressure suggest

A

inner ear problems- meineres

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19
Q

quick diagnosis:

gets dizzy rolling over in bed

A

BPPV

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20
Q

quick diagnosis:

first attack was severe, lasting hours with nausea and vomiting

A

vestibular neuritis

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21
Q

quick diagnosis:

get light sensitive during the dizzy spells

A

vestibular migraines

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22
Q

quick diagnosis:

one ear feels full/ get hearing loss before/ during the dizzy spell

A

menieres

23
Q

what should you include in an exam of a dizzy patient

A 
otoscopy 
neurological 
BP when lying and standing 
balance system 
audiometry 
dix hallpike test
24
Q

what causes of dizziness need an urgent referral

A

AOM or cholesteatoma

25
Q

what are the vestibular end organs

A

ampullae of lateral, posterior and superior canals (swelling containing cupulas)
maculae of the urticle and saccule (respond to changes in the head position with respect to gravity)

26
Q

when turning right the cupula on which side will be most excited

A

the right side

27
Q

in a nystagmus caused by a dead ear is the fast phase away from or towards the affected side

A

away from- slow to affected side, fast away from

28
Q

where is the lesion in a bi directional nystagmus

A

central

29
Q

where is the lesion in a vertical nystagmus

A

central, can be stroke

30
Q

what investigations into someone with postural dizziness

A

Hb, Na, BP lying + standing

31
Q

is BPPV common

A

yes very

32
Q

what is BPPV

A

benign positional paroxysmal vertigo

the commonest cause of vertigo when looking up

33
Q

what causes BPPV

A

head trauma, ear surgery, idiopathic

happens with otolith material (crystals) from urticle are displaced into semicircular canals (most commonly posterior SCC) causing perceived movement

34
Q

what can BPPV be confused with

A

vertebrobasilar insufficiency (when bending head back blocks off the arteries)

35
Q

what are the features of vertebrobasilar isufficiency

A

visual disturbance
weakness
numbess
vertigo

36
Q

when do you get vertigo in BPPV

A 
looking up 
turning in bed 
laying down at night 
first getting up in morning 
bending forward 
rising from bending
moving head quickly
37
Q

what is the dix hallpike test

A

sit up, eyes open
turn head 45 degrees to the right
lay down, doesnt have to be fast
short delay (wait up to ten seconds) and looking for symptoms and nsytagmus
eyes tell you which canal the crystals are in
in BPPV eye will bounce up and down and there will be twisting
patient will feel dizzy and might be sick

38
Q

in BPPV how can you tell what canal the crystal is in

A

eye twisting towards the ground (geotrophic)

9/10 times BPPV will be in the posterior canal

39
Q

how do you treat BPPV

A

epley manoeurve
or semont manoeuvre if the patient cant tolerate epley
brandt-daroff exercises

40
Q

what do the posterior and superior semicircular canals join to form

A

crus commune

41
Q

where do you want to get the crystals to end up after the epley manoeuvre

A

out of the semicircular canals

42
Q

what is vestibular neuronitis

A 
prolonged vertigo (days) with no associated tinnitus or hearing loss 
caused by an infection of the vestibular nerve within the inner ear (probably viral)
43
Q

what is labryinthitis

A

another name for vestibular neuronitis

44
Q

what is the treatment for vestibular neuronitis

A

supportive management with vestibular sedatives
generally self limiting
if prolonged may need exercises(looking at thumb and moving head will improve VOR)/ further investigation

45
Q

what is menieres disease

A

endo lymphatic hydrops = high pressure within the endolymph system

46
Q

what are the symptoms of menieres

A

episodic sudden onset of vertigo, sensorineural hearing loss (low frequency), tinnitus, and sensation of fullness in the affected ear, at least two episodes >20 mins (often lasting hours)

47
Q

what is the management of menieres

A

supportive treatment during episodes (intratympanic steroids or gentamicin)
tinnitus therapy
hearing aids
prevention (salt restriction, betahistine, caffeine, acohol, stress)
grommet insertion
surgery

48
Q

what is the most common auditory symptom of migraine

A

phonophobia

49
Q

what is a migraine

A

abnormal electrical activity

50
Q

what causes of dizzyness have associated hearing loss or tinnitus

A

menieres disease, labyrinthitis

51
Q

what causes of dizzyness has aural fullness

A

menieres

52
Q

what tumour can cause dizzyness

A

vestibular schwannoma

53
Q

describe the nystagmus in BPPV

A

rotary nystagmus in posterior canal BPPV.

Purely horizontal nystagmus suggests horizontal canal BPPV.

A short latency period of a few seconds should be expected.

Nystagmus (fast component) will be upbeat and in the direction of the affected ear.

This has a limited duration, lasting <30 seconds (adaption).
On sitting, there is more vertigo, experienced as the room spinning in the opposite direction (with reversal of the nystagmus).

54
Q

is BPPV is nystagmus towards or away from the affected ear

A

the fast phase is towards the affected ear

ENT (27 decks)

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