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ENT > Balance > Flashcards

Balance Flashcards

(59 cards)

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1
Q

What controls balance and what does it contain

A

Vestibular system
3 semicircular canals which contain hair cells that activated by movement of endolymph
Otolith organs

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2
Q

What movement do semicircular canals detect

A

Roational

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3
Q

How do they do this

A 
Hair cells stuck on matrix in ampulla at bottom of canals 
Fluid in canal moves as you down 
Pushes cilia
Opens ion channels
Message sent along vestibular nerve
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4
Q

What makes up otolith organs

A

Utricle

Saccule

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5
Q

How does otolith organ work

A

Hair cells in cilia sit in matrix with K bicarb crystals on top
Difficult to move
Hair moves in direction of head

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6
Q

What type of movement does utricle an saccule detect

A 
Utricle = horizontal 
Saccule = vertical
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7
Q

What is the vestibulo-ocular reflex

A

Stabilises gaze by moving eyes in order to compensate for head and body movement
Fixes image on retina for clear sight

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8
Q

What is vertigo

A

Hallucination of movement in the absence of movement
Usually rotatory
Always ask what patient means

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9
Q

What is associated with vertigo

A 
Difficulty walking or standing
Relief lying or sitting still 
N+V
Pallor
Sweating
Hearing loss
Tinnitus 
Nystagmus
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10
Q

If hearing loss or tinnitus as well what does this suggest

A

Labyrinth or VIII nerve involvement

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11
Q

What are the 4 categories of vertigo

A

Spontaneous acute
Spontaneous chronic
Movement provoked
Positional

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12
Q

What causes acute and chronic spontaneous vertigo

A

Acute
Vestibular neuritis
Labyrinthiits
Neuro event although rare - posterior stroke or MS

Chronic 
Migraine = most common
Meniere's
Vestibular neuritis
Hyperventilation
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13
Q

What causes movement provoked vertigo

A

Central brain stem or cerebellar
Visual
Vestibular system issue

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14
Q

What causes positional vertigo

A

BPPV

Vertebrobasilar ischaemia - elderly on neck extension but BBV more common

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15
Q

When should you consider posterior stroke

A

If other posterior / cerebellar signs
Numbness
Diplopia
Dysarthria

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16
Q

What is peripheral nystagmus (caused by problem with ear NOT brain)

A

Always accompanied with vertigo
Disappears within 2 days of acute vestibular episode
NEVER vertical
Does not change with direction

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17
Q

If patient with dizzy spell suggestive of vertigo what should you ask / examine

A 
If pain or discharging ear
If deafness or tinnitus
Oscillopsia
Sensory impairment
DM 
Full neuro exam
Asses CN and ears
Test cerebellar function and reflexes 
Look for abnormal eye movement / nystagmus 
Assess gait 
Romberg test
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18
Q

What does painful ear suggest

A

Middle ear disease

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19
Q

What does deafness or tinnitus suggest

A

Inner ear disease

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20
Q

What should you do if deafness or tinnitus

A

Refer to exclude Schwannoma

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21
Q

What is important to know about the episode of vertigo

A 
Constant
Single episode
Multiple episodes
Spontaneous
Movement provoked 
Positional
Duration of attack 
Important to work out DDX
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22
Q

What is other common causes of recurrent and chronic dizzy which is NOT vertigo

A 
Orthostatic hypo 
Arrhythmia
Drugs
Prochlorperazine
Hypotensive
Anti-depressant 
Anaemia 
Anxiety 
Motion sickness
Epilepsy 
Alcoho
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23
Q

What symptoms suggest not vertigo

A

LOC - think epilepsy or syncope
Fainting
Lightheaded
Palpitations

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24
Q

What are red flags

Study These Flashcards
A 
Unilateral tinnitus or hearing loss
Unilateral otorrhoea
Neuro S+S
Nystagmus has central features
Spontaneous nystagmus >48 hours
Positional vertigo or nystagmus not BPPV
Significant vertigo / imbalance >1 month 
Any suspicion of central disorder
25
What are causes of vertigo
``` Vestibular Migraine BPPV Meniere's Vestibular neuritis Viral labrynthitis Acoustic neuroma Posterior circulation stroke Trauma MS Ototoxicity Ramsay hunt ```
26
What is migrainous vertigo
``` Recurrent spontaneous vertigo which varies duration minutes to days May have associated symptoms Headache Photophobia Hearing loss Tinnitus NO neuro FH or history of migraine ```
27
What is it misDx as
BPPV - the most common cause of peripheral vertigo
28
What causes BPPV
Otoconia in semi-circular canals Idiopathic Head injury
29
What are the symptoms
``` Vertigo precipitated by changes in head position Duration = seconds Often notice if turn head fast May have associated nausea May have nystagmus ``` No other Sx e/.g. tinnitus / headache / ataxia / dysphagia/ palsy / no vertical nystagmus
30
How do you Dx
+ve Dix-Hallpike test | Fatiguable nystagmus
31
How do you treat
Vestibular physio for Epley manoeuvre to remove otoconia
32
When do you refer
If Sx persist after 3-4 weeks | Rx not successful
33
What is Meniere's disease
Raised pressure in inner ear caused by endolymphatic hydrops
34
What are the symptoms
Attacks of spontaneous recurrent vertigo >20mins - hours Occurs regularly Hearing loss - Fluctuating progressive unilateral sensorineura Horizontal nystagmus ALWAYS present Tinnitus Sensation of aural fullness +ve Romberg
35
How do you Rx acutely
``` ENT to confirm Inform DVLA Bed rest and reassurance Anti-histmaine Buccal proclorphreazine as vestibular sedative in acute Vestibular physio ```
36
What do you give to prevent
Anti-histmaine Betahistine to improve blood supply Bendofluazide - reduce pressure as diuretic Vestibular rehab Intratympanic dexamethasone - for inflammatory response
37
What is last resort
Intratymapnic gentamicin Kills nerve cells Will already have hearing loss so saving patient from dizzy is good
38
What causes ototoxicity
Aminoglycoside Loop diuretic NSAID / aspirin
39
What does this cause
Vertigo | Sensorineural deafness
40
What is vestibular neuritis
Inflammation of the vestibular nerve Usually due to viral infection - HSV Can be vascular
41
When is it not neuritis
If >3 in a year | More likely migraine
42
What are the symptoms
Spontaneous vertigo lasting hours to days Horizontal nystagmus N+V No deafness or tinnitus
43
How do you Rx acute
Prochlorperazine / anti-histamine if mild in acute phase Vestibular sedative Anti-emetic AX if bacterial
44
How do you Rx chronic
Vestibular rehab | Promotes compensation of brain
45
What is viral labrynthitis
Inflammation of labyrinth - both vestibular and cochlear nerve Viral = most common Can get bacterial after middle ear infection Systemic disease
46
What are the symptoms
``` Sensorineural hearing loss Tinnitus + symptoms of vestibular neuritis - sudden attack of unilateral vertigo and vomiting May have URTI proceeding Nystagmus away from affected side ```
47
How do you Dx and Rx
Clinical Exclude hypoglycaemia Rx = bed rest + vestibular suppressants
48
If Dx if uncertain or suspecting sinister cause what do you do
Full neuro exam - rule out cerebellar stroke Pure tone audiometry FBC + culture Temporal bone CT or MRI to look for shcwannoma
49
What is acoustic neuroma
Schwannoma from vestibular nerve (not cochlear)
50
What does it cause
``` Unilateral hearing loss Tinnitus Vertigo if vestibular becomes involved Facial nerve may become involved - Absent corneal reflex Headache Raised ICP = late sign and suggests a large tumour ```
51
How do you dx
MRI
52
What is Ramsay hunt
Reactivation of HSV. in seventh cranial nerve
53
What are the features
``` Auricular pain Facial nerve palsy Vestibular rash around ears / tongue Deafness Tinnitus Vertigo ```
54
How do you Rx
Acyclovir | Corticosteroid
55
What does balance assessment involve
``` History Tympanography Hearing test Videonystagmography Caloric test to test R+L balance organ separately by putting different temps of water ```
56
What causes peripheral vertigo i.e. vestibular
Migraine Meniere's BPPV Labrynthitis
57
What causes central vertigo
``` Acoustic neuroma MS Head injury Migraine Vertebrobasillar insufficiency ```
58
What is less associated with central vertigo
Hearing loss | Tinnitus
59
If unilateral sensorineural hearing loss
Pure tone audioemtry | MRI to exclude schwannoma

ENT (14 decks)

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