Vertigo and Tonsils Flashcards by Cathy Wang

What are otoliths

Calcium carbonate crystals located in the saccule and utricle of the inner ear

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Function of saccule and utricle

Detect linear movements of the head hence contribute to balance and equilibrium

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What is benign positional paroxysmal vertigo

Vertigo caused by the detachment of the otoliths hence loose otoliths move around in semicircular canals

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Risk factors of BPPV

Elderly

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Causes of BPPV

Head trauma
Cholelithiasis - deposits of calcium
idiopathic

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How does BPPV cause vertigo

Once the otolith is in the canal, movement of the head will result in movement of the otoliths hence causing an abnormal movement of endolymph -> abnormal stimulation of hair cells

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Triggers of vertigo in BPPV

Looking up
Turning in bed
First lying down in bed
Getting out of bed
Bending forward
Moving head quickly in one direction

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How long does BPPV last

30sec - 1 min
Episodes will disappear but reappear again within a few weeks / months

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Does BPPV have any ear symptoms

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Investigations for BPPV

Dix-Hallpike manouevre

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What would suggest a positive Dix-hallpike manoeuvre

Causing vertigo
Torsional nystagmus

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What is nystagmus

Eyes make repetitive, uncontrolled rotatory movements

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Management of BPPV

Epley manoeuvre
Selmont manoeuvre
Brandt-Daroff exercises

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Describe the epley manoeuvre

Patient sitting up with their heads 45 degress turned to the affected side
Keep the head turned and lay the patient down
Turn head 90 degrees to the opposite side
Turn head another 90 degrees by rolling body towards unaffected side
Sit patient up while keeping head turned

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What is vestibular neuritis

Inflammation of the vestibular nerve

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Symptoms of vestibular neuritis

First attack is severe - lasts hours
Prolonged vertigo - days or weeks
horizontal nystagmus

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Symptoms of labrynthitis

Prolonged vertigo - days or weeks
Tinnitus / hearing loss
Horizontal nystagmus

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vestibular neuritis is commonly preceded by

viral illness

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How to differentiate between vestibular neuritis and labrynthitis

Vestibular neuritis does not cause tinnitus / hearing loss whereas labrynthitis does

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Management of vestibular neuritis / labrynthitis

Self-limiting, resolves in a month
May be helped by rehabilitation exercises if prolonged

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What is vestibular migraine

Episode of vertigo in someone who has a history of migraines

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Symptoms of vestibular migraine

Light sensitive during dizzy spells
Phonophobia
Fluctuating hearing loss
Motion sensitivity

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Management of vestibular migraine

Lifestyle modifications, avoid triggers
Propanolol
CCB
Amitriptyline

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Pathophysiology of Ménière’s disease

Dilatation of endolymph spaces -> excess endolymph in the membranous labryinth

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Symptoms of Ménière's disease

Severe paroxysmal vertigo Sensorineural hearing loss Tinnitus Sensation of ear being full

What type of vertigo does Ménière's disease cause

Rotational vertigo

Pattern of attacks of Ménière's disease

Recurrent Spontaneous Lasts for hours

What is the pattern on audiometry for Ménière's disease

Sensorineural hearing loss Affecting low frequency

management of Ménière's disease

Supportive Tinnitus therapy Hearing aids Lifestyle modifications Prochlorperazine - for acute attacks

What are the lifestyle modifications suggested for patients with Ménière's disease

Reduce salt Avoid chocolate Avoid caffeine Avoid stress

What is a possible prophylactic therapy for Ménière's disease

Betahistine

Which type of vertigo has a positional trigger

BPPV

Which types of vertigo causes tinnitus

Labrynthitis Meniere's

Most common type of vertigo

BPPV

Most common cause of obstructive sleep apnea in children

Adenotonsillar hypertrophy

How does adenotonsillar hypertrophy cause obstructive sleep apnoea

Disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in narrowed upper airway

At what age do tonsils and adenoids grow the most

between 2-8 years old

Symptoms of adenoid hypertrophy

Hyponasal voice Snoring Sleep disturbances Acute otitis media Otitis media with effusion

How does adenoid hypertrophy cause otitis media / otitis media with effusion

Blocks the Eustachian tube opening causing Eustachian tube dysfunction

Symptoms of tonsil hypertrophy

Muffled voice Snoring Sleep disturbances Visibly enlarged tonsils

Management of adenotonsillar hypertrophy

Adenoidectomy / tonsillectomy if indicated

When is adenoidectomy indicated

Recurrent AOM / OME Upper airway obstruction (snoring, obstructive sleep apnoea) Dysphagia Speech difficulty

Where is the most common site of head and neck cancer

Larynx

Types of head and neck cancers

Squamous cell carcinoma Nasopharyngeal carcinoma Laryngeal carcinoma Oropharyngeal carcinoma Oral cavity carcinoma

Most common type of head and neck cancer

Squamous cell carcinoma

Squamous cell carcinoma of the head and neck is associated with

Smoking Alcohol HPV type 16

How may HPV type 16 cause squamous cell carcinoma

Produce proteins E6 and E7 which disrupts p53 -> cellular immorality

Risk factors of head and neck cancers

Male >55 Smoking Alcohol HPV, EBV Radiation exposure Immunosuppression Occupational exposure (acid mists, asbestos, wood dust) Family history

Which type of head and neck cancer is associated with EBV

Nasopharyngeal carcinoma

Who does HPV related oropharyngeal carcinoma typically affect

NON-SMOKER Higher socio-economic class Multiple sexual partners

What is the route of spread for head and neck cancers

Lymphatic spread

Which lymph nodes does supraglottic tumours drain into

Drains into the superior deep cervical nodes

Which lymph nodes does subglottic tumours drain into

Drains into paratracheal nodes

What is special about glottic tumours

Most stay on the vocal cords instead of spreading

Symptoms of head and neck cancer

Dysphonia Dysphagia Unilateral otalgia Neck lump Stridor Hoarseness Lymphadenopathy

Symptoms of nasopharyngeal carcinoma

Unilateral symptoms Symptoms of eustachian tube obstruction Nasal obstruction Blood-stained nasal discharge Persistent epistaxis May develop a glue ear

Investigations for head and neck cancer

Urgent referral if symptoms occurred for more than 3 weeks US + Fine needle aspiration Panendoscopy + biopsy Staging

What is used to stage head and neck cancer

CT neck, chest MRI PET

Management for early laryngeal cancer T1-T2

Transoral laser surgery Radiotherapy

Management for late laryngeal cancer T3-T4

Partial / total laryngectomy Chemo and radiotherapy

Management for early oropharyngeal cancer T1-T2

Transoral laser surgery Radiotherapy

Management for late oropharyngeal cancer T3-T4

Chemo and radiotherapy

Management for nasopharyngeal cancer

Chemo and radiotherapy

Vertigo and Tonsils Flashcards

(63 cards)