Dizziness

Question 1

What are 5 complaints associated with dizziness?

Answer 1

1. Disequilibrium
2. syncope
3. lightheaded
4. ataxia
5. vertigo

Question 2

Disease processes that cause true vertigo (illusion of motion) are mainly assoc with what?

Answer 2

Balance organs of the inner ear (peripheral vestibular disorders)

Question 3

Central or peripheral vertigo?

BPPV, cholesteatoma, Ramsay Hunt Syndrome, Meniere’s disease, otosclerosis?

Answer 3

Peripheral

Question 4

Central or peripheral vertigo?

Cerebellopontine angle tumor, TIA, migraine, multiple sclerosis,

Answer 4

Central

Question 5

Differentiate central vs peripheral vertigo.

Answer 5

Etiology for central relates to CNS; PNS for peripheral. central impairs gait and posture more bc involves balance and posture pathway.

Question 6

If pt doesnt have true vertigo, what should you evaluate for?

Answer 6

Syncope or episodic hypotension

Neoplasm, demyelinating disease or vascular abnormality

Question 7

What are 4 parts of the electronystagmography test to evaluate vestibular (balance) part of the inner ear?

Answer 7

1. Calibration test
2. Tracking test
3. positional test
4. caloric test

Question 8

Which part of the ENG test measures responses to warm and cold water introduced to the ear canal.

Answer 8

Caloric test

Question 9

What is the gold standard to test unilateral peripheral vestibular disorders?

Answer 9

ENG (electronystagmography)

Question 10

Which part of the ENG test measures response due to head mvt?

Answer 10

Positional test

Question 11

Which part of the ENG test evaluates ability for eyes to track a moving target?

Answer 11

Tracking test

Question 12

Which part of the ENG test measures rapid eye movements?

Answer 12

Calibration test

Question 13

What is the gold standard to diagnose bilateral vestibular weakness

Answer 13

Rotatory chair testing - pt spun slowly in a chair and test dizziness w/optokinetic testing and fixation test

Question 14

What test is most useful in quantifying balance improvement after tx for a particular problem and can help ID functional dizzy pt. But shouldnt be used alone to dx vestibular disorders

Answer 14

Moving platform posturography

Question 15

What is a useful test to evaluate Meniere’s dz but doesnt really test the vestibular system?

Answer 15

electrocochleography - variant of brainstem audio-evoked response. Best performed during Meniere’s attack

Question 16

most common causes of vertigo seen by otolaryngologists

Answer 16

Benign paroxysmal positional vertigo (BPPV)

Question 17

BPPV is caused by sediment, such as ___ (calcium carbonate crystals) that have become free floating within the ___ ear.

Answer 17

1. otoconia

2. inner

Question 18

What is the balance canal fluid in the inner ear that stimulates the vestibular division of the 8th CN?

Answer 18

Endolymph

Question 19

What type of vertigo lasts 24-48hrs and gets less intense over this time with hearing unchanged?

Answer 19

Vestibular neuronitis - nausea common

Question 20

What type of vertigo lasts 30min-4hrs?

Answer 20

Meniere’s disease

Question 21

What type of vertigo lasts less than 1 min?

Answer 21

BPPV

Question 22

BPPV is commonly seen after what events?

Answer 22

Significant head trauma or episode of vestibular neuronitis

Question 23

Tx for BPPV?

Answer 23

1. Canolith reposition maneuver (Epley or Semont) - 80% effective
2. Meds INEFFECTIVE
3. Bradnt-Daroff exercises at home
4. Severe cases: Transtympanic gentamycin injections, posterior semicircular canal plugging, vestibular nerve sectioning, sacculotomy, and labyrinthectomy

Question 24

What is another name for vestibular neuronitis? Cause?

Answer 24

Labyrinthisis
inflammation, secondary to a viral infection, of the vestibular portion of the 8th CN or of the inner ear balance organs (vestibular labyrinth). Freq assoc w/URI

Question 25

How do you tx vestibular neuronitis?

Answer 25

Symptomatically 1. vestibular supressant meds 2. antiemetics 3. tapering oral steroids 4. Vestibular rehab if persist for mo to yrs

Question 26

What is this condition? Patients develop intense, episodic vertigo, usually lasting 30 min - 4 hrs, and assoc w/fluctuating hearing loss, roaring tinnitus, and the sensation of aural fullness. Even after the episode is over, some hearing loss often remains

Answer 26

Meniere's dz

Question 27

Possible cause of Meniere's dz?

Answer 27

Symptoms are believed to be secondary to a distention of the endolymphatic space within the balance organs of the inner ear.

Question 28

What are tx strategies to dec endolymphatic fluid pressure w/in the vestibular portion of the inner ear for Meniere's dz (6)?

Answer 28

1. salt restriction 2. thiazide diuretics 3. vestibular ablation by instillation of ototoxic meds (gentamicin) 4. endolymphatic sac decompression into mastoid cavity 5. vestibular nerve section 6. labryinthectomy - destroys hearing