3a - Inner Ear (vertigo) Flashcards
Fluids in the inner ear
Perilymph
Endolymph
Perilymph is?
Chemically similar to CSF
Surrounds membranous labyrinth
Endolymph is?
Found w/in membranous labyrinth
High level of K
Role in generating auditory signals
What is vertigo?
Symptom of vestibular dysfunction
- Sensation of motion w no motion or an exaggerated sense of motion
With vertigo you must differentiate between? How to differentiate them
Peripheral:
- sudden onset
- w tinnitus/hearing loss
Central:
- gradual onset
- no auditory symptoms
Is Vertigo a disease?
No - its a symptom of vestibular disease not a diagnosis
types of dizziness
Vertigo
Presyncope/syncope
Disequilibrium
Non-specific lightheadedness
Causes of peripheral vs central vertigo?
Peripheral (80% of cases)
- BPPV
- vestibular neuritis
- meniere disease
Central (big deal)
- vestibular migraine
- vascular etiologies
Otolaryngologist focus primarily on?
Peripheral causes
Central is prob neuro
Clinical approach to diagnosing vertiog?
Hx
- duration
- quality
- triggers
- associated sx
- med hx
HEENT exam
- ears
- eye motion (w head turning)
- CN exam
- Romberg
Meds that often cause vertigo?
Aminoglycosides Anti-HTN drugs Vasodilators Phenothiazines Tranquilizers Antidepressants Anticonvulsants Hypnotics Analgesics Alcohol Caffeine Tobacco
To differentiate central from peripheral evaluate?
Brainstem symptoms
- diplopia
- facial numbness
- weakness
- hemiplegia
- dysphasia
Lack of these does not r/o central
Tests to run for suspected central vertigo?
Audiogram ENG - electronystagmography VNG - videonystagmography Brain MRI Caloric stimulation - (COWS - cold opposite Warm Same)
Peripheral vertigo nystagmus?
- Fatiguable
- Horizontal w rotary component
- Latency
- Suppressed by visual fixation
Peripheral causes of vertigo?
- Meniere disease
- Vestibular neuritis/labryinthitis
- Benign positional vertigo
- Traumatic vertigo
- Perilymphatic fistula
- Migrainous vertigo
- Semicircular canal dehiscence
Inner ear digarm?
Slide 20
Endolymphatic hydrops is aka?
Meniere syndrome
Endolymphatic hydrops cause?
Idiopathic - consider chronic condition
Also could be:
- syphilis
- head trauma
Classic diagnosis of endolymphatic hydrops (meniere syndrome)
Episodic vertigo - 20min-hrs
SNHL - fluctuating and lower freq
Tinnitus - low tone, blowing
Sensation of unilateral aural fullness
Eval for endolymphatic hydrops?
Audiometry: SHL
Caloric testing: loss/impairment on involved side
Tx for endolymphatic hydrops?
Symptomatic
- Acute: meclazine/valium
- Primary: low salt and diuretics
Refractory:
- intratympanic cortoicosteroids
- endolymphatic sac decompression
- vestibular ablation (gentamicin, nerve section or surgical)
With endolymphatic hydrops pts should avoid?
High salt MSG Caffeine Nicotine ETOH
Vestibular neuronitis is aka?
Labrynthitis (when unilateral HL is present)
Vestibular neuritis
Acute peripheral vestibulopathy
Symptoms of vestibular neuronitis?
Acute onset, persistent and severe N/V Hearing is preserved Unilateral SHL Tinnitus (+/-)
Pt will awaken w room-spinning vertigo that will continue but gradually get better over days/weeks
What causes labrynthitis?
Idiopathic
- may be inflammation of the labyrinth
- poss following URI
PE for labrynthitis?
Spontaneous horizontal nystagmus, suppressed w visual fixation
Positive head thrust test
Tx for vestibular neuronitis?
Symptomatic
- antihistamines/benzos
Vestibular therapy (rehab) - should begin after acute symptoms subside
BPPV - benign paroxysmal positioning vertigo
Otoconia (calcium carbonate crystals) or other sediment become free floating and enter one of the semicircular canals
Key word for BPPV?
Sudden onset vertgo lasting less than one minute
- Triggered by change in head position
- quick movements
- goes away as sediment settles
They have a precise movement that cause it
What test is key to diagnosing BPPV
Dix-hallpike maneuver (DHM)
How is dix-hallpike maneuver conducted?
33-35
- moving head around and laying them down
- nystagums and vertigo appear w a latency of few seconds and last <30 sec
Tx for BPPV?
Meds dont work
Epley particualr repositioning maneuver
- moves debris toward common crus and out of the auricular cavity
(Pic on 36)
Lsit of meds for vertigo?
Slide 38
Traumatic causes of vertigo?
Labyrinth concussion Basilar skull fx
Chronic posttraumatic vertigo from cupulolithiasis
MC cause of verticgo s/p head injury?
Labyrinth concussion
- diminish over days/month
What is a perilymphatic fistula?
Rare
- leaking of perilymphatic fluid into middle ear
Vertico is worse w/ straining and SHL
Causes of perilymphatic fistula?
Physical injury
Extreme barotrauma
Vigorous valsalva maneuvers
Post surgical (stapedectomy)
Key word for perilymphatic fistula?
Worse with straining
Tx for perilymphatic fistula?
Bed rest
Avoid straining
Failure of tx
- surgery/graft
What is migranous vertigo?
Mixed peripheral/central etiology
- episodic vertigo w HA
- migraine symptoms
- hx of motion intolerance
Tx of migrainous vertigo?
Dietary and lifestyle changes
migraine meds
Semicircular canal dehiscence?
Deficiency in bony covering of the superior semicircular canal
Causes vertigo from lout nosies
Conductive hearing loss is present
Central vertigo etiologies?
Brainstem vascular disease A/V malformation Tumor MS Vertebrobasilar migraine
Send them to neuro
Differentation of vertigo chart?
Slide 46
Lesions of CN VIII and central audiovestibular pathways can cause?
Neural HL and vertigo
Deterioration of speech discrimination
Auditory adaptation
Eval for CN VIII lesion?
Brainstem auditory evoked response (BAER)
MRI
Disorders associated w CN VIII lesion?
Vestibular schwannoma (acoustic neuroma)
Vascular compromise
MS
What is acoustic neuroma?
Aka vestibular schwannoma
- MC intracranial tumor
- nerve sheath tumor of 8th CN
- unilateral
Keyword for acoustic neuroma?
Unilateral sensory hearing loss
Preferred imaging for acoustic neuroma?
MRI w gandolinium
Tx for acoustic neuroma?
Its a space occupying lesion
Asymptomatic - observation, annual MRI
Symptomatic - excision, radiation, annual MRI
MS can present?
Symptoms identical to meniere’s disease
MS is a?
Inflammatory and degnerative d/o involving CNS
Vertigo is sometimes the presenting symptom
MS is commonly associated with (s/s)
Hyper/hypoacusis
Facial numbness
Diplopia
Vertebrobasilar insufficiency is?
Elderly pts w arteriosclerosis
- reduced blood flow in vertebrobasilar system
Triggered by change in posture/extension of neck
Tx for vertebrobasilar insufficiency?
Vasodilators
Aspirin
Vestibular rehab (mainstay of tx)
What would bears be with bees?
Ears
