Vertigo + ENT

Question 1

What is Menières disease?

Answer 1

disorder of the inner ear caused by impaired endolymph resorption

recurrent episodes of acute, unilateral symptoms that last from minutes to hours inlcuding

• vertigo
• tinnitus
• asymmetric, fluctuating sensorineural hearing loss

Can be acompanied by
* nystagmus
* fulness and
* N&V

Question 2

What is a classical presentation of a vestibular schwannoma?

Answer 2

• unilateral sensorineural hearing loss
• tinnitus and
• imbalance rather than true vertigo

(no episodic symptoms)

Late signs can involve the
* Facial nerve or
* Trigeminal nerve

Question 3

What is a typical presentatio of Vestibular neuritis?

Answer 3

• single episode of severe vertigo lasting days, exacerbated by head movement
• nystagmus towards affected side
• often after viral infection
• associated with nausea and vomiting does
• usually no auditory symptoms tinnitus or hearing loss.

Question 4

What would be the characteristics and diganostic criteria for a vestibular migraine?

Answer 4

• Most common cause of spontaneous episodic vertigo
• Diagnosed migraine plus ≥ 5 episodes of vestibular symptoms (e.g., vertigo) lasting ≤ 72 hours
• Treatment may be complemented with antivertigo agents (e.g., dimenhydrinate DOSAGE ).

Question 5

What is the general management approach to sinusiti?

Answer 5

• analgesia
• intranasal decongestants/ nasal saline (limited evidence)
• consider intranasal corticosteroids if the symptoms have been present for more than 10 days
• oral antibiotics are not normally required but may be given for severe presentations.
  The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’

Question 6

What is the mode of inheritence and epidemiology of otosclerosis?

Answer 6

Otosclerosis

• usually autosomal dominant
• in young-middle aged females (young adults)

Question 7

What are the signs and symptoms of otosclerosis

Answer 7

• Slowly progressive conductive hearing loss with the 2nd ear affected in ∼ 70% of patients as the disease progresses
• tinnitus
• mild vertigo (1/4 of patients)

Question 8

What is Labyrinthitis?

Answer 8

Inflammation of the inner ear, due to toxins or bacteria spread to the inner ear (labyrinth) through the round or oval window

Presentation
* Severe vertigo, nausea, and vomiting
* Hearing loss - can differentiate from vestibular neuritis
* tinnitus
* Nystagmus direction toward healthy ear: due to decreased vestibular activity (due to damage
* Fever, ear rash, facial paralysis in case of herpes zoster oticus