ENT - Vertigo = BPPV, Meniere's Disease, Vestibular Neuronitis Flashcards
Benign paroxysmal positional vertigo (BPPV) - what is it?
It is one of the most common causes of vertigo
Characterised by dizziness and vertigo triggered by changes in head position
BPPV - pathophysiology?
Calcium carbonate crystals called otoconia become displaced in semicircular canals
Occurs most often in posterior semicircular canal
Crystals disrupt flow of endolymph through canals, confusing vestibular system
BPPV - what are the causes for the displacement of the crystals?
Viral infection
Head trauma
Ageing
No clear cause
BPPV - clinical features?
Vertigo triggered by head position change
Nausea
Each episode lasts 10-20 seconds
BPPV - how long does an attack episode last for?
10-20 seconds
Asymptomatic between attacks
BPPV - How do you diagnose?
Dix-Hallpike manoeuvre
BPPV - what do you see in a positive Dix-Hallpike?
Patient experiences vertigo
Rotatory nystagmus
BPPV - how do you perform the manoeuvre?
To perform the manoeuvre:
- The patient sits upright on a flat examination couch with their head turned 45 degrees to one side (turned to the right to test the right ear and left to test the left ear)
- Support the patient’s head to stay in the 45 degree position while rapidly lowering the patient backwards until their head is hanging off the end of the couch, extended 20-30 degrees
- Hold the patient’s head still, turned 45 degrees to one side and extended 20-30 degrees below the level of the couch
- Watch the eyes closely for 30-60 seconds, looking for nystagmus
- Repeat the test with the head turned 45 degrees in the other direction
BPPV - what clinical features does it characteristically NOT cause?
Does NOT cause:
Hearing loss
Tinnitus
BPPV - how do you treat?
Usually resolves spontaneously after few weeks to months
Symptomatic relief gained by:
EPLEY MANOEUVRE
Brandt-Daroff exercises
BPPV has a good prognosis - but 50% of patients have a recurrence 3–5 years after their diagnosis
BPPV - how do you do the epley manoeuvre?
Moves the crystals in the semicircular canal into a position that does not disrupt endolymph flow.
To perform the manoeuvre:
- Follow the steps of the Dix-Hallpike manoeuvre, having the patient go from an upright position with their head rotated 45 degrees (to the affected side) down to a lying position with their head extended off the end of the bed, still rotated 45 degrees
- Rotate the patient’s head 90 degrees past the central position
- Have the patient roll onto their side so their head rotates a further 90 degrees in the same direction
- Have the patient sit up sideways with the legs off the side of the couch
- Position the head in the central position with the neck flexed 45 degrees, with the chin towards the chest
- At each stage, support the patient’s head in place for 30 seconds and wait for any nystagmus or dizziness to settle
BPPV - what are Brandt-Daroff Exercises
Brandt-Daroff exercises can be performed by the patient at home to improve the symptoms of BPPV. These involve sitting on the end of a bed and lying sideways, from one side to the other, while rotating the head slightly to face the ceiling. The exercises are repeated several times a day until symptoms improve
Meniere’s Disease - what is it?
Long term inner ear disorder that causes a characteristic triad of symptoms:
- Hearing loss (sensorineural)
- Tinnitus
- Vertigo
Meniere’s Disease - pathophysiology?
Caused by excessive buildup of endolymph in labyrinth of inner ear causing higher pressure than normal and disrupting sensory signals
Excessive pressure called endolymphatic hydrops
Meniere’s Disease - what are some other clinical features?
Sensation of aural fullness
Nystagmus
Positive romberg test
Typically unilateral, but bilateral symptoms develop after number of years
Vestibular neuronitis (VN) - what is it?
Vestibular neuronitis describes inflammation of the vestibular nerve that causes vertigo, and often develops following a viral infection
VN - clinical features?
Sudden onset
Recurrent vertigo attacks, that last hours or days
N+V
Ataxia
Horizontal nystagmus
Table for three conditions
