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Flashcards in The dizzy patient Deck (11):
1

What is menieres disease?
-what are the symptoms?
-what has to be documented for this diagnosis?
-what has to be excluded?

¥ History of recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours)
¥ Occurrence of or worsening of tinnitus on the affected side
¥ Occurrence of aural fullness on the affected side (stuffy feeling)
¥ Documented SNHL on at least one occasion – snhl during episode and gradual snhl development after more episodes
¥ Other causes excluded – have to exclude vestibular schwannoma = MRI

2

What are the treatment options for menieres disease?

¥ Supportive treatment during episodes
¥ Tinnitus therapy
¥ Hearing Aids
¥ Prevention
o Salt restriction / Betahistine / caffeine / alcohol / stress

♣ Grommet insertion
Probs. placebo

♣ Intratympanic Gentamicin / Steroids
Gentamicin acts a poison to the ear and in some patients injecting this into the middle ear works – hearing can be affected but is normally quite bad anyway

♣ Surgery

3

What is BPPV?

Vertigo on:
¥ looking up
¥ turning in bed - often worse to one side
¥ first lying down in bed at night
¥ on first getting out of bed in the morning
¥ bending forward
¥ rising from bending
¥ moving head quickly – often only in one direction

4

Describe the vertigo:
-how long does it last?
-are there assoc. symptoms?q

The vertigo lasts a few seconds (brief episodes) and there are no other associated symptoms (tinnitus/hearing loss/aural fullness)
The phenomenon becomes less severe on repeated movements due to fatigue.

5

What is the aetiology of BPPV?

Otolithiasis:
¥ the little crystals (otoliths) have broken off and travel to the posterior semicircular canal with gravity and so when the head moves the otolith moves activating the nerve here = dizziness

6

What is the diagnosis of BPPV?

Hallpike’s test:
¥ patient is sat on couch and their head is turned to the affected side. The patients head is supported by the examiner and the patient lies down so that the head is just below the horizontal. Nstagmus after a latent interval of about 30s is noted as is any subjective sensation of vertigo. Remember that the test fatigues on repetition.

1. Sit on couch so that head will be off end when lies back
2. Turn head 45º to one side
3. Warn patient not to close eyes if dizzy
4. Lie back as quickly as comfortable
5. Hold in position and observe

7

What is the treatment for BPPV?

epley manouvre

8

What is vertebrobasilar insufficiency?

For a diagnosis of VBI need other symptoms of impaired circulation in posterior brain associated with the vertigo
¥ e.g. visual disturbance
¥ weakness
¥ numbness
this is a condition characterized by poor blood flow to the posterior portion of brain

9

What is vestibular neuronitis?
-how long is the vertigo?
-is there tinnitus/hearing loss?
-what is the probable aetiology?

This means inflammation of the vestibular nerve
¥ Prolonged vertigo (days)
¥ No associated tinnitus or hearing loss
¥ Probable viral aetiology
¥ May be viral prodromal symptoms (e.g. cough/cold)

10

What is labrynthitis? how long is the vertigo? is there tinnitus or hearing loss?

This means inflammation of the labrynth and tinnitus/hearing loss MAY BE PRESENT
¥ Prolonged vertigo (days)
¥ May be associated tinnitus or hearing loss
¥ Probable viral aetiology
¥ May be viral prodromal symptoms

11

What is the management for both vestibular neuronitis and labrynthitis?

¥ Supportive management with vestibular sedatives
¥ Generally self-limiting
¥ If prolonged or atypical may require further investigation
¥ May be helped by rehabilitation exercises if prolonged