The Dizzy Patient

Question 1

Define Vertigo

Answer 1

A sensation of movement, usually spinning

Question 2

What are the 5 vestibular end organs

Answer 2

3 semi-circular canals:
Lateral, posterior and superior
2 otolith organs: utricle and saccule

Question 3

What is the function of the utricle

Answer 3

It senses motion in the horizontal plane

Question 4

What is the function of the saccule

Answer 4

It senses motion in the sagittal plane

Question 5

What is the function of the semi-circular canals

Answer 5

They sense motion in an angular plane (head rotations)

Question 6

What cochlear problems can result in an upset in the balance system

Answer 6

BPPV
Meniere’s
Vestibular neuronitis

Question 7

What optic problems can result in an upset in the balance system

Answer 7

Cataracts

Diabetes Mellitus

Question 8

What MSK problems can result in an upset in the balance system

Answer 8

Diabetes mellitus
Arthritis
Neurology

Question 9

What cardiac problems can result in an upset in the balance system

Answer 9

Arrhythmias

postural hypotension

Question 10

What neurological problems can result in an upset in the balance system

Answer 10

Stress
Migraine
SOL
MS

Question 11

How can SCC be tested

Answer 11

Caloric tests

Question 12

What is the supposed diagnosis if the vestibulo-ocular reflex is not working

Answer 12

Nystagmus

Question 13

Where is the problem if the eye is pointing towards the left side of the nose nose

Answer 13

Right ear

Question 14

What are some of the causes of Dizziness

Answer 14

Cardiovascular 
Haematogological and metabolic 
Drug side - effects / interactions 
Migraines
otological 
trauma

Question 15

What are some triggers of dizziness

Answer 15

Head movement

Sitting down or standing up

Question 16

What are some possible associated symptoms with dizziness

Answer 16

Palpitations
fits
incontinence

Question 17

What are some common alleviating factors

Answer 17

Eyes open or closed

Question 18

What are some medications that can cause dizziness

Answer 18

Alcohol

Benzodiazipines

Question 19

What examination should be carried out for dizziness

Answer 19

Otoscopy - usually normal and regular 
Neurological - nystagmus at rest --> SOL
BP - lying and standing 
Balance system - stand up and close eyes and be prepared for falling 
Audiometry

Question 20

What are the 3 common causes of dizziness

Answer 20

Postural dizziness
Side effect of medication
Psychogenic and interaction with imbalance

Question 21

What are some underlying causes of postural dizziness

Answer 21

Hb, Na or BP lying and standing

Question 22

What medication can cause dizziness

Answer 22

Medication for anxiety or depression

Question 23

What are specific causes of dizziness

Answer 23

Miner's disease
BPPV 
Vestibular neuronitis
Labyrinthitis 
Migrainous vertigo

Question 24

What is Meniere’s Disease

Answer 24

a disease of unknown cause affecting the membranous labyrinth of the ear, causing progressive deafness and attacks of tinnitus and vertigo

Question 25

Benign paroxysmal positional vertigo (BPPV)

Answer 25

is a disorder arising in the inner ear.

Question 26

What is the most common cause of vertigo

Answer 26

BPPV

Question 27

What are some causes of BPPV

Answer 27

Head trauma, ear surgery, idiopathic

Question 28

What is the pathophysiology of BPPV

Answer 28

Otolith material from utricle displaced into semicircular canals

Question 29

What is BPPV sometimes confused for

Answer 29

Vertebrobasilar insufficiency (VBI)

Question 30

How can we make a diagnosis of VBI

Answer 30

Other symptoms of impaired circulation in posterior brain associated with the vertigo e.g. visual disturbance Weakness Numbness

Question 31

What are some of the common phrases a patient with BPPV would come out with

Answer 31

``` Dizziness on: looking up turning in bed first lying down in bed at night first getting out of bed in the morning bending forward rising from bending moving head quickly ```

Question 32

Is BPPV long lasting or brief episodes

Answer 32

Brief episodes

Question 33

What can be done to help BPPV

Answer 33

Hallpike's test Epley Manoeuvre Semont Manoeuvre Brandt- Daroff Exercises

Question 34

What is the purpose of the Epley Manoeuvre

Answer 34

To physically change the position of the calcium carbonate crystals within the SCC

Question 35

What is Vestibular neuronitis

Answer 35

Prolonged vertigo (days) with no associated tinnitus or hearing loss

Question 36

What is the underlying cause of vestibular neuritis

Answer 36

Inflammation of the vestibular nerve

Question 37

What is Labyrinthitis

Answer 37

Prolonged vertigo (days) that may be associated with tinnitus or hearing loss

Question 38

What is the main cause of labyrinths

Answer 38

Viral

Question 39

What is the treatment for both vestibular neuronitis / labyrinthitis

Answer 39

Supportive management with vestibular sedatives

Question 40

What are the main symptoms of Meniere's disease

Answer 40

History of recurrent, spontaneous, rotational vertigo with t least 2 episodes >20 mins often lasting hours Occurrence of or worsening of tinnitus on the affected side occurrence of aural fulness on the affected side

Question 41

What is the treatment for Meniere's disease

Answer 41

``` supportive treatment during episodes tinnitus therapy hearing aids prevention: salt restriction, Betahistine, caffeine, alcohol, stress ```

Question 42

What is the management for Meniere's disease

Answer 42

Grommet insertion Intratympanic Gentamicin / steroids Surgery

Question 43

What is the issue with using gentamicin

Answer 43

It can destroy the hair cells and result in hearing loss

Question 44

What is the most common symptom of migraine

Answer 44

phonophobia (fear of loud sounds)

Question 45

What condition causes Aural Fullness

Answer 45

Meniere's disease

Question 46

What condition causes a clear positional trigger

Answer 46

BPPV

Question 47

What conditions cause associtted HL or tinnitus

Answer 47

Meniere's disease and labyrinthitis