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ENT > Vertigo > Flashcards

Vertigo Flashcards

1
Q

what are the two types of vertigo?

A

peripheral or central

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2
Q

what are the clinical features of peripheral vertigo?

A

Severe, accompanied by loss of balance, nausea, vomiting, reduced hearing, tinnitus, nystagmus (usually horizontal) and diaphoresis

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3
Q

what are the clinical features of central vertigo?

A

• Hearing loss and tinnitus are less common, less severe, nystagmus may be horizontal or vertical

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4
Q

what are the causes of peripheral vertigo?

A

Menieres disease, BPPV, vestibular failure, labyrinthitis, superior semi-circular canal dehiscence

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5
Q

what are the causes of central vertigo?

A

acoustic neuroma, MS, head injury, migraine, vertebrobasilar insufficiency

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6
Q

what is the duration of BPPV?

A

Mins

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7
Q

what is the duration of Meniere’s

A

Hours

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8
Q

what is the duration of Labyrinthitis?

A

Days-weeks

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9
Q

what is the duration of VN?

A

Days-weeks

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10
Q

is there associated HL or Tinnitus in BPPV?

A

No

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11
Q

is there associated HL or Tinnitus in Meniere’s?

A

Yes

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12
Q

is there associated HL or Tinnitus in Labyrinthitis?

A

Yes

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13
Q

is there associated HL or Tinnitus in VN?

A

No

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14
Q

is there aural fullness in BPPV?

A

No

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15
Q

is there aural fullness in Meniere’s?

A

Yes

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16
Q

is there aural fullness in labyrinthitis?

A

No

17
Q

is there aural fullness in VN?

A

No

18
Q

is there a clear positional trigger to BPPV?

A

Yes

19
Q

is there a clear positional trigger to Meniere’s?

A

No

20
Q

is there a clear positional trigger to Labyrinthitis?

A

No

21
Q

is there a clear positional trigger to VN?

A

No

22
Q

what are the causes of BPPV?

A

head trauma, ear surgery, idiopathic

23
Q

What is the pathophysiology of BPPV?

A

otolith material from utricle displaced into the semi-circular canals (crystals float into fluid, displaced on movement)

24
Q

what are the clinical features of BPPV?

A

o Induced by change in position
o Episodes – a few seconds to a few minutes
o No associated hearing loss, tinnitus, aural fullness
o nausea + vomiting
o May have visual disturbance – torsional nystagmus

25
Q

how is BPPV diagnosed?

A

Hallpike Test

26
Q

what is the management of BPPV?

A

Epley Manoeuvre
Brandt-Daroff
Drugs – antihistamines and anticholinergic
Surgery – vestibular nerve section

27
Q

what is the cause of Menieres Disease?

A

unknown

28
Q

what is the pathophysiology of Meniere’s disease

A

o Inner ear
o Inflammatory causes that contribute to the development of endolymphatic hydrops
= excess fluid in the inner ear leads to dilation of the endolymphatic spaces of the membranous labyrinth

29
Q

what are the clinical features

A

o History of recurrent, spontaneous, rotational vertigo with at least 2 episodes > 20mins
o nausea and vomiting
o Recurrence +/- worsening of tinnitus on affected side
o aural fullness on affected side
o SNHL – lower frequencies, gets progressively worse
o Rare – drop attacks – falls without loss of consciousness

30
Q

how is Meniere’s disease diagnosed?

A

through exclusion, electrocochleography, posterior fossa MRI

31
Q

how is Meniere’s disease managed?

A

o Acute Attack: Prochlorperazine (vestibular sedative)
o Prophylaxis – betahistine
o Also: grommet insertion of gentamicin, labyrinthectomy

32
Q

What is the cause of vestibular neuronitis?

A

viral – link to herpes, prior URTI

33
Q

what is the difference between pathophysiology of VN and labyrinthitis?

A

VN - infection of vestibular nerve

Labyrinthitis - affects ear or 8th nerve as a whole

34
Q

what are the clinical features of VN?

A
  • Sudden onset, prolonged vertigo – days to weeks
  • Associated Nausea/vomiting
  • Causes horizontal nystagmus
  • Vestibular Neuritis – no associated tinnitus/hearing loss
  • Labyrinthitis – may have associated tinnitus/hearing loss
  • Viral prodromal symptoms
35
Q

what is the management of VN and labyrinthitis?

A
  • Generally self limiting
  • Vestibular sedatives – prochloperazine (dopamine rector antagonist)
  • If prolonged – further investigations, rehab

ENT (13 decks)

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