Vertigo Pathologies

Question 1

BENINGN PAROXYSMAL POSITIONAL VERTIGO

1. Symptoms of BPPV?
2. Diagnosis of BPPV?
3. Management of BPPV?

Answer 1

1. Vertigo lasting 30s - 1minute triggered by head position
2. Dix hallpike manoeuvre
3. Epley manoeuvre

Question 2

CHOLESTEATOMA

1. Risk factors for cholesteatoma?
2. Symptoms and signs?
3. Investigations for cholesteatoma?
4. Management of cholesteatoma?

Answer 2

1. Otitis media, 5-15 years old
2. Symptoms:
   Foul smelling ear discharge
   Unilateral hearing loss
   Ear pain
   Headache
   Vertigo
3. Investigations:
   white area in attic behind tympanic membrane
4. Management of cholesteatoma?
   Surgery and follow up after to monitor for recurrence

Question 3

MENIERE’S DISEASE

1. Symptoms of Meniere’s disease?
2. Management of it?

Answer 3

1. Clusters of vertigo lasting 20 minutes - hours and months-long remission periods. NOT triggered by positional change
   Sensorineural hearing loss
   Tinnitus
2. Prophylaxis with betahistine
   Prochloperazine during acute attacks
   Diuretics
   Low salt diet

Question 4

VESTIBULAR NEURONITIS

1. What is vestibular neuronitis?
2. What are the two causes of vestibular neuronitis? Which one is most common?
3. Symptoms of vestibular neuronitis?
4. Diagnosis of peripheral vestibular neuronitis?
5. Management of vestibular neuronitis
6. What condition may follow after vestibular neuronitis?

Answer 4

1. Inflammation of vestibular nerve which is a sensory nerve transmitting signals from SCN/vestibule to the brain
2. Peripheral cause, e.g. viral URTI (most common)
   Central cause, e.g. Posterior circulation infarct
3. Vertigo constant and severe during first few days, after worsened by head movement
   N+V
   Balance problems
   NO hearing loss/tinnitus
   Horizontal nystagmus
4. Head impulse test.
5. If severe vomiting -> admit due to dehydration risk
   1st line: Peripheral VN -> prochlorperazine or cyclizine/cinnarizine/promethazine for up to 3 days only
   2nd line: vestibular rehabilitation therapy
6. BPPV

Question 5

LABRYNTHITIS
1. What is labrynthitis?
2. What is the main cause? Other causes?
3. Symptoms?’
4. Diagnosis?

Answer 5

1. Inflammation of the SCN, cochlea and vestibule
2. Viral URTI - main
   Bacterial - otitis media, meningitis
3. Single spontaeous vertigo episode
   Tinnitus
   Hearing loss
4. Head impulse test to diagnose for peripheral causes of labrynthitis
5. Peripheral VN -> prochlorperazine or cyclizine/cinnarizine/promethazine for up to 3 days only.
   If bacterial cause of labrynthitis -> abx

Question 6

ACOUSTIC NEUROMA

1. What is an acoustic neuroma
2. Whereabouts does the acoustic neuroma grow?
3. Are they usually unilateral or bilateral?
4. What are bilateral acoustic neuromas strongly associated with?
5. Signs and symptoms?
6. Management?
7. Risks of surgery?

Answer 6

1. Benign tumour forming from Schwann cells.
2. Around CN VIII, at cerebellopontine angle
3. Unilateral
4. Neurofibromatosis Type II
5. Unilateral hearing loss, tinnitus, imbalance, dizziness sensation of fullness, facial nerve palsy
6. Monitoring if asymptomatic
   Surgery
   Radiotherapy
7. Vestibulocochlear or facial nerve injury