Ear Flashcards
(39 cards)
Name some peripheral causes of vertigo?
- Benign paroxsymal positional vertigo (BPPV)
- Vestibular neuritis
- Meniere disease
- Otoscleroris
- Labrynthitis
List some central causes of vertigo?
- MS
- Acoustic neuroma
- Vestibular migraine
- CV disease
- Cerebellopontine angle and posterior fossa meningiomas
How does BPPV present?
-Episodic vertigo • sudden onset • provoked by head turning • last >30 secs • other symptoms rare (NO HEARING LOSS)
How is BPPV diagnosed?
Establish important negatives:
- NOT persistent vertigo
- NO speech, visual, motor or sensory problems
- NO tinnitus, headache, ataxia, facial numbness, dysphagia
Hallpike test +ve
What is the dix hall pike test?
How do you do it?
What is a positive test?
Dix-hallpike test is DIAGNOSTIC for BPPV
- Lower down on coach head turned to 45 degree angle
- Nystagmus=+ve test
What is the Eply manoeuvre?
Eply manoeuvre is TREATMENT for BPPV
-move head 90 degrees (from R>L) then tilt so they are looking at floor
What is an acoustic neuroma?
Usually painless benign subarachnoid tumours that cause problems by local pressure, and then behave as SOL
Rare = 1 / 100,000 / year
Where do acoustic neuromas usually arise?
Superior vestibular Schwann cell layer
Sometimes called vestibular schwannoma
How do acoustic neuromas present?
Acoustic neuroma
-Ipsilateral tinnitus +/- sensorineural deafness
(cochlear nerve vompression)
-Disequilibrium common (wobbly)
-Trigeminal compression may give numb face
-Vertigo rare
What investigations are done for an acoustic neuroma?
What is a key differential?
MRI scan for ALL PATIENTS WITH UNILATERAL TINNITUS/DEAFNESS
Key differential = meningioma
What is the management of an acoustic neuroma?
- Surgery is difficult and not often needed eg if elderly
- Methods of preserving hearing and facial nerve eg stereotactic radiosurgery
What is the symptoms of ototoxicity?
List some ototoxic drugs?
Cause bilateral tinnitis with associated hearing loss
Cisplatin and aminoglycosides (end in mycin) = permanent hearing loss
Aspirin, NSAIDs, quinine, macrolides and loop diuretics are associated with tinnitus and reversible hearing loss
Which ones cause hearing loss? Meniers BPPV Lambrynthitis Vestibular neuritis
- BPPV and Vestibular neuritis DO NOT CAUSE HEARING LOSS
- Meniers and Lambrynthitis DO CAUSE HEARING LOSS
How often is the vertigo? Meniers BPPV Lambrynthitis Vestibular neuritis
BPPV (seconds) and Meniers (minuets) = EPISODIC VERTIGO
Lambrynthitis and Vestibular neuritis = PERSISTANT VERTIGO
What is Meniere’s disease?
Disorder of the endolymph volume (labyrinthine fluid) with progressive distention of the labyrinthe
What are the symptoms of Meniere’s disease?
How long do symptoms last?
Triad of:
- Vertigo (with sickness)
- Tinnitus
- Hearing loss (sensorineural)
-Preceded by AURAL FULLNESS
-+/- nystagmus
Symptoms are episodic, lasting minutes to hours
How can you treat Meniere’s disease? (acute/prophylaxis)
Acute:
Prochlorperazine (buccal for severe sickness)
Prophylaxis:
- Betahistine 16mg/8hr po
- Limit salt intake
Surgical procedures:
Labyrinthectomy (but causes total ipsilateral deafness)
-medical (Instillation of gentamicin via grommets)
What is vestibular neuronitis/labyrinthitis?
Inflamation of inner ear (either labrynth or vestibular nerve)
How does vestibular neuronitis/labyrinthitis present?
-Sudden and severe PERSISTANT vertigo (days) • does not progressively get worse • worsened by head movements -Nausea + vomiting -Nystagmus AWAY from affected side
Neuronitis - VERTIGO with no hearing loss or tinnitus
Labyrinthitis -VERTIGO WITH hearing loss + tinnitus
(NB cochlear + SCC = labyrinth)
What are common causes of vestibular neuronitis/labyrinthitis?
-Often following URTI /herpes simplex reactivation
How do you manage vestibular neuronitis/labyrinthitis?
Reassure, could take prochlorperazine/antihistamine for vertigo
vestibular rehab if lasting 1+ week
How does acute otitis media present?
- Otalgia - might be pulling at ear
- Malaise
- Crying, poor feeding, restlessness
- Fever
- Vomiting
- Coryza/rhinorrhoea
Perforation of TM often relieves pain - a child who is screaming and distressed may settle remarkably quickly then ear starts to discharge green pus
What is the management of acute OM?
Analgesia
Acute OM resolves in 60% in 24hr with no abx
When should abx be considered in acute OM?
Immediate abx:
- Systemically unwell
- Immunocompromised
- No improvement in symptoms in >4 days
Immediate or 2 day ‘delayed’ abx:
<3 months old
Perforation / discharge
<2yrs with bilateral OM (most commonly caused by Haemophilus influenza)
