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clin med I exam II > ENT 3- vertigo > Flashcards

ENT 3- vertigo Flashcards

(64 cards)

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1
Q

otolith organs are responsible for…

A

linear motion

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2
Q

semicircular canals are responsible for…

A

angular motion

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3
Q

info from _____ is relayed via _____ portion of CN___ to _____, _____, _____

A

info from vestibular labyrinth relayed via vestibular portion of CN VII to cerebellum, ocular nuclei, spinal cord

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4
Q

utricle

A

horizontal plane

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5
Q

saccule

A

vertical plane

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6
Q

what is vertigo

A

illusory movement; swaying/tilting

symptom not diagnosis

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7
Q

what causes vertigo

A

damage or dysfunction in otolith organs, semicircular canals, CN 8, central brainstem/vestibular origin
causes asymmetrical signal to be sent

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8
Q

what is peripheral vertigo

A 
sudden onset
associated w tinnitus usually
hearing loss
\+/- horizontal nystagmus
most common = BPPV
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9
Q

types of peripheral vertigo

A 
BPPV
vestibular neuritis (AKA labyrinthitis) 
meniere's disease
herpes zoster oticus (ramsey hunt)
acoustic neuroma (can be both but usually peripheral)
otitis media
aminoglycoside toxicity
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10
Q

what is central vertigo

A

gradual onset

no associated auditory sx

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11
Q

types of central vertigo

A 
migraines
cerebral tumor on CNVIII
chiari malformation
brain ischemia- cerebellar infarct +hemorrhage 
TIA
MS
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12
Q

other causes of vertigo

A 
antidepressants
anxiolytics
aminoglycosides
furosemide
amiodarone
ASA
NSAIDs
EtOH + cocaine
traumatic brain injury
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13
Q

dix-hallpike positioning test

A

clockwise, rotary nystagmus which is fatiguable w repetition when undergoing Dix-Hallpike positional testing
latency of 5-15sec btw supine positioning + onset nystagmus
induces vertigo/spinning in nystagmus

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14
Q

Dix hallpike findings in peripheral vertigo

A 
latent before nystagmus for 2-20sec
duration of nystagmus = <1min
fatiguing w repetition
direction of nystagmus- only one type, may change direction w gaze
severe vertigo
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15
Q

dix hallpike findings in central vertigo

A 
no latent period before nystagmus
nystagmus lasts >1min
non-fatiguing
direction of nystagmus may change direction w given head position
less severe, sometimes no vertigo
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16
Q

what further tests (after dix hallpike) can be conducted

A

electronystagmography (records eye movements)

rule out other causes

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17
Q

tx for vertigo

A

symptomatic
often self-resolving w.i months

antihistamines
anti-emetics
benzos
scopolamine (PATCH)

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18
Q

when should a vertigo pt be referred to neuro

A

vestibular rehab- gaze stimulation exercises
repositioning maneuvers- epley maneuver
brant-daroff exercise

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19
Q

when should surgery be considered for vertigo pt?

A

only after 6mo

very rare

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20
Q

BPPV

A

benign paroxysmal positional vertigo

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21
Q

what is the most common cause of vertigo

A

BPPV (50%)

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22
Q

clinical presentation of BPPV

A

sudden onset of vertigo pecipitated by sudden head movements
N/V
short duration
No hearing loss, ear pain or tinnitus

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23
Q

nystagmus in BPPV

A

classic clockwise rotary
fatiguable in dix-hallpike
latency of 5-15secc

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24
Q

who is most likely to get BPPV

A

> 60yrs, women

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25
vestibular neuritis (labyrinthitis) cause
viral or postviral inflam affecting vestibular portion of CN VIII
26
what are the two different types of vestibular neuritis
pure (no hearing loss) | labyrinthitis (vertigo w unilateral hearing loss)
27
clinical presentation of vestibular neuritis
``` rapid onset severe, persistent vertigo N/V gait instability horizontal nystagmus suppressed by visual fixation head thrust unilateral hearing loss (labyrinthitis) ```
28
imaging for vestibular neuritis
if concerned for lesion or stroke in cerebellum MRI/MRA CT if MRI/MRA isn't available
29
tx for vestibular neuritis
benign + self-limited (few days-1wk) may have nonspecific dizziness/imbalance for months corticosteroids may help antihistamines anti-emetics vestibular rehab after acute sx subside w aggressive proprioception + balance exercises
30
meiere's dz cause
peripheral | excess endolymphatic fluid pressure causing episodic inner ear dysfunction
31
what is in the labyrinth/inner ear
cochlea, semicircular canals, otolithic organs
32
clinical presentation of menieres dz
vertigo + unilateral sensorineural hearing loss + tinnitus fullness, pressure in ears N/V disabling imbalace horizontal-torsional nystagmus during acute attack
33
unpredictable episode of meniere's
may last hours, recurring, followed by fatigue
34
spontaneous episode of menieres
sx last 20min-24hrs | 6-11 attacks a year
35
vestibular testing for menieres
ENG abnormal on affected side rotatory chair test computerized dynamic posturography
36
audiometry for menieres
if low freq hearing loss- helps confirm | not looking for conductive hearing loss!
37
lab tests for menieres
``` test for comorbid ELEVATED NA RPR (rapid plasma reagin) for syphilis MRI to rule out lesions controverial tests for endolymphatic hydrops (glycerine, urea or sorbitol stress test, electrocochleography) ```
38
goals of tx for menieres
treat symptoms, improve QOL | prevent progression
39
tx for acute sx of menieres
``` antihistamines antiemetics benzos anticholinergics (scopolamine) lifestyle adjustment salt restriction limit caffeine + nicotine + alcohol avoid excessive noise diuretics vestibular rehab ```
40
nondestructive procedures for menieres
surgical (endolyphatic sac + sacculotomy) intratympanic glucocorticoids pressure pulse generator
41
destructive procedures for menieres
intratympanic gentamicin injection surgical labyrinthectomy vestibular nerve resection
42
what populations are at highest risk of menieres? other risk factors?
female > male 20s-40s allergies, stress, viral
43
what does the eustachian tube connect
middle ear to nasopharynx
44
what is the purpose of eustachian tubes
provide ventilation + drainage for middle ear cleft
45
when is eustachian tube open
usually closed | open during swallowing/yawning
46
how is negative pressure created in the ear
when eustachian tube is comprimed, air is trapped in middle + gets absorbed -> TM retraction
47
clinical presentation of eustachian tube dysfunction
``` fullness in ear mild/moderate hearing decrease maybe popping sound when yawning/swallowing (only if partial blockage) ear pain retracted TM + decreased TM mobility ```
48
dilatory eustachian tube dysfunction exam findings
effusion, scarring, thickening of TM retractions, cholesteatomas, perforations, tympanosclerotic plaques weber test- lateralization to affected ear (conductive hearing loss)
49
patulous eustachian tube dysfunction exam findings
``` AUTOPHONY (hear own voice) sx fluctuate worsened by exercise + prolonged speaking ear fullness varies in severity breathing induces movements of TM sensorineural hearing loss ```
50
blockage of eustachian tube by ____ causes dysfunction
``` allergic response URI sinusitis chronic otitis media genetics ```
51
what happens when there is impaired protective function of ET
reflux of nasopharyngeal pathogens into ET
52
what happens when there is impaired clearance of ET
loss of mucociliary function contributing to inability to clear pathogens
53
what is pressure dysregulation of the ET
fails to open to allow ventilation leading to ET dysfunction
54
what happens due to dilatory dysfunction of ET
tube doesn't dilate | leads to otitis media
55
what happens in patulous dysfunction of ET
valve incompetency --> chronic patency (stuck open)
56
tx of dilatory ET dysfunction
``` tx underlying etiology antihistamines decongestants nasal steroids valsalva ```
57
tx of patulous ET dysfunction
tx if severe sx >6wks | ventilation tubes in severe cases
58
tx of ET dysfunction
refer to ENT nasal endoscopy audiology studies CT or MRI w contrast if >3mo of unilateral sx or middle ear effusion -> increased risk of malignancy surgery if mass found or continued otitis media w effusion if 2/2 ET dysfunction --> tubes balloon dilation
59
what is tinnitus
``` perception of sound w.o external source can be unilateral or bilateral around the head or distant noise continuous or intermittent buzzing, ringing, or hissing ```
60
what should be accounted for in hx of pt w tinnitus
description (episodic/constant, pulsatile/nonpulsatile, rhythmicity, pitch, quality of sound) previous ear dz, noise exposure, hearing status, head injury, TMJ syndrome sx review meds, supplements other conditions (HTN, atherosclerosis, neurologic illness, surgery)
61
what is involved in the physical exam of pt w tinnitus
complete HEENT exam cranial nerve exam eval TM auscultate neck, periauricular area, temple, orbit + mastoid effects of position + vascular compression on involved side
62
diagnosis of tinnitus
audiometry to R/O associated hearing loss | MRI if unilateral esp w hearing loss to R/O retrocochlear lesion (vestibular schwannoma)
63
tx of tinnitus
``` avoid noise, ototoxic drugs correct comorbidities tx underlying depression + insomnia cochlear implants in severe sensorineural hearing loss tinnitus retraining therapy bio-feedback cognitive therapy (adjunct) ```
64
epidemiology of tinnitus
increases w age | more likely in smokers

clin med I exam II (10 decks)

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