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ENT > Vertigo disorders > Flashcards

Vertigo disorders Flashcards

1
Q

BPPV : Definition

A
  • Recurrent episodes of vertigo triggered by head movement
  • Peripheral vertigo : Pathology in the inner ear
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2
Q

BPPV : Pathophysiology

A

1 . Inner ear : displacement of crystal in the semi-circular canal
- Displacement cause : Viral infection, head trauma, idiopathic

2 . Disruption of endolymph : crystal distrupt the normal flow , confusing the vestibular system

3 . Head movement : Create flow of endolymph, triggering episodes of vertigo

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3
Q

BPPV : Clinical presentation

A
  1. Vertigo triggered by head movement
  2. Episode : 20 - 60 seconds
  3. Prognosis : last severe weeks then resolve intermittently
  4. No hearing loss or tinnitus
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4
Q

BPPV : Diagnosis

A
  1. Dix-Hallpike manoeuvre
    * Manoeuvre head movement to disrupt endolymph flow
  2. Positive result for BPPV
    * Vertigo : triggered
    * Rotational Nystagmus : beats towards the effected ear

Direction of nystagmus is influenced by flow of endolymph

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5
Q

BPPV : Management

A
  1. Epley manoeuvre : treats vertigo
    * Moves crystals in semi circular canal in a position that does not disrupt endolymph flow
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6
Q

Vestibular neuronitis : Definition

A
  • Inflammation of the vestibular nerve
  • Usually caused by a viral infection
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7
Q

Vestibular neuronitis : Pathophysiology

A
  1. Innervation of inner ear; to the brain
    * Vestibular nerve transmits signals from the semicircular canals and vestibule
    * Information for ‘Balance’
  • Cochlear nerve transmits signals from cochlea to the brain
  • Information for ‘Hearing’

2 . Inflammation of the vestibular nerve due to virus
* Affects transmission of signals of ‘Balance’ } Vertigo
* Cochlear nerve unaffected : no tinnitus or hearing loss

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8
Q

Vestibular neuronitis : Clinical features

A

1 . Hx of URTI
2 . Acute onset of vertigo
* Severe and constant vertigo initially - then mainly triggered by head movement

3 . Issues with balance
4 . Nausea and vomitting

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9
Q

Vestibular neuronitis : Management

A
  1. R/O Central cause of vertigo ?Posterior circulation infarction
  2. Sx relief : Prochloperazine
  3. Vestibular rehabilitation therapy (VRT)
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10
Q

Labyrinthitis : Definition

A

Caused by viral upper respiratory tract infection

1) Inflammation of the bony labyrinth of the inner ear
2) Bony labyrinth : Semicircular canal, vestibule and cochlea

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11
Q

Labyrinthitis : Clinical presentation

A
  1. Unlike vestibular neuronitis, labyrinthitis includes both cochlear and vestibular nerve
  • Can also be associated with:
    1. Vertigo : not triggered/exacerbated by movement
    2. Hearing loss
    3. Tinnitus
    4. Association sx : N+V, URTI : coryzal sx
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12
Q

Labyrinthitis : Clinical Signs

A
  1. Horizontal nystagmus : Towards unaffected side due to compensation when one side of the vestibular system is affected
  2. Sensorineural hearing loss
  3. Gait disturbance : fill towards affected size
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13
Q

Labyrinthitis : Management

A
  • Episodes self-limiting
  • Sx relief : Prochloperazine
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14
Q

Labyrinthitis : Complication

A

Bacterial infection of Labyrinthitis : 2nd to otitis media or meningitis

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15
Q

Meniere’s disease : Definition

A

Ménière’s disease is a long-term inner ear disorder that causes recurrent attacks of vertigo, and symptoms of hearing loss, tinnitus and a feeling of fullness in the ear.

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16
Q

Meniere’s disease : Pathophysiology

A
  • Excessive build up of endolymph in the labyrinth of the inner ear
  • Causes a higher pressure than normal and disrupting the sensory signals.
  • Affects both vestubar and chochlea due to high pressure created - may cause ishchaemia over time
  • Endolymphatic hydrop : increased pressure of the endolymph
17
Q

Meniere’s disease : Clinical presentation

A
  • Unilateral

Triad of symptoms
1 . Vertigo : 20 min - several hour episodes, occur in clusters intermittent resolving
-Not association with head movement
2 . Sensorineural hearing loss
3 . Tinnitus
Associated with : ‘Fullness’ in ear, imbalance leading to falls

18
Q

Meniere’s disease : Diagnosis

A
  1. Clinical diagnosis
  2. Audiology r/v of hearing loss
19
Q

Meniere’s disease : Management

A

REFER TO ENT

Sx relief : Prochloperazine
Propphylactic : Betahistine - histamne analogue which increases blood flow to vestibulocochlear system

20
Q

Acoustic Neuroma : Definition

A

Benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear.

21
Q

Acoustic Neuroma : Pathophysiology

A
  1. Tumors originate from schwann cells lining the vestibulocochlear nerve
  2. Unilateral tumors : Occur at the cerebellopontine angle
22
Q

Acoustic Neuroma : Incidence

A

40 - 60 year olds

23
Q

Acoustic Neuroma : Clinical presentation

A

Gradual onset of symptoms
1. Unilateral sensorineural hearing loss } first sx
2. Unilateral tinnitus
3. Dizzyness/Imbalance (cerebellar sx)
4. Sensation of ‘Fullness’ in ear

24
Q

Acoustic Neuroma : Complications

A
  • Facial nerve palsy : Large tutors can compress facial nerve
25
Q

Acoustic Neuroma : Genetic association

A

neurofibromatosis type II : causes bilateral acoustic neuromas

26
Q

Acoustic Neuroma : Diagnosis

A
  1. CT scan : identifies tumor
  2. Audiometry : identifies sensorineural hearing loss
27
Q

Acoustic Neuroma : Management

A
  • Conservative management with monitoring if there are no symptoms
  • Surgery to remove the tumour (partial or total removal)
  • Radiotherapy to reduce the growth
28
Q

Vertigo : definition

A
  • Movement between the patient and their environment
  • Vertigo is often associated with nausea, vomiting, sweating and feeling generally unwell.
29
Q

Vertigo : Physiology

A

Vestibular apparatus : Inner ear

1 . Semicircular canals : contain endolymph fluid which shifts during head movement

2 . Vestibular nerve : recieves sensory input from movement of endolymph and transmits it to;

3 . Vestibular nucleus : Brain stem and cerebellum which then transmits it to

  • Oculomotor,trochlear,abducens nuclei } coordinate eye movement
  • Spinal chord/cerebellum } coordinate movement throughout the body

Vestibular signals help the CNS coordinate eye movements + body movements

30
Q

Vertigo : Pathophysiology

A

The sensory inputs that are responsible for maintaining balance and posture are:
1. Vision
2. Proprioception
3. Signals from the vestibular system

Vertigo is caused by a mismatch between these sensory inputs

Cause :

⦁ Peripheral problem : usually affecting the vestibular system

⦁ Central problem : usually involving the brainstem or the cerebellum

31
Q

Vertigo : Causes of peripheral vertigo

A
  1. Benign paroxysmal positional vertigo
  2. Ménière’s disease
  3. Vestibular neuronitis
  4. Labyrinthitis
  5. Acoustic neuroma
  6. Otosclerosis
32
Q

Vertigo : Causes of Central vertigo

A

Pathology that affects the cerebellum or the brainstem disrupt the signals from the vestibular system and cause vertigo.

The most common pathology that results in a central cause of vertigo are:

  1. Posterior circulation infarction
    * Sudden onset
    * Assoc with : ataxia, diplopia, cranial nerve defects or limb symptoms.
  2. Tumours in the cerebellum/brainstem
    *Gradual onset
    * Assoc with : sx of cerebellar or brainstem dysfunction.
  3. Multiple sclerosis
    * relapsing and remitting symptoms,
    * Assoc with : optic neuritis or transverse myelitis.
  4. Vestibular migraine
    * Lasting minutes to hours,
    * Assoc with : visual aura, head ache and may be a trigger
33
Q
A

ENT (9 decks)

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