Inner ear disease

Question 1

describe BPPV and its symptoms

Answer 1

transient (seconds) feeling of movement
caused by loose calcium carbonate crystals within the ear

can follow head trauma or inner ear disease but most often spontaneous

Question 2

what is the treatment of BPPV

Answer 2

normally self limiting

Epley manouver

Question 3

what is the investigation for BPPV

Answer 3

Halpike manouver

Question 4

describe vestibular neuronitis (labyrinthitis) and its symptoms

Answer 4

caused by inflammation of the vestibular nerve

sudden severe attack of vertigo, normally lasting 2-3 days

Question 5

what is the treatment for vestibular neuronitis

Answer 5

often self limiting

vestibular sedatives - can use prochlorperazine/cinnarzine for short term periods

physiotherapy

Question 6

how does Menieres disease present

Answer 6

causes episodes of vertigo lasting minutes-hours with associated fluctuating hearing loss and tinnitus

patients often describe a feeling of aiural presure

Question 7

what is thought to cause Menieres disease

Answer 7

thought to be due to an increase in pressure in one of the fluid compartments in the ear

Question 8

how do you treat menieres disease

Answer 8

normally self limiting, but hearing loss can start to become permanent

• low salt and caffeine diet
• betahistine - reduces pressure
• intratympanic injections

Question 9

how does a vestibular migraine present

Answer 9

similar to menieres disease - attacks of vertigo lasting minutes to hours, but without hearing loss/tinnitus

• headache
• visual disturbance
• numbness

Question 10

what should you do in unilateral tinnitus

Answer 10

MRI to exclude CPA tumour

Question 11

what is a vestibular schwannoma and when should you exclude it

Answer 11

a slow growing but benign tumour, occurs in 1% of patients with unilateral symtpoms

do a MRI