4 - ENT - Vertigo - Peripheral vertigo Flashcards
how to peripheral diff to central vertigo
peripheral affects the labyrinth or vestibular nerve
clinical features of peripheral vertigo
vertigo, horizontal nystagmus away from lesion, unless irritative
hearing loss, tinnnitus, and N+V are more common
6 possible causes for peripheral vertigo
menieres benign paroxysmal positional vertigo BPPV acute vestibular failure vestibular neuronitis drug induced vertigo migraine associated
5 features of menieres
recurrent attacks of vertigo - 10mins-24h duration
tinnitus and fluctuating sensorineural loss
fullness of ears
N+V
may give permanent deafness
what must be ruled out if ?menieres
acoustic neuroma, otosyphillis
what is the cause of menieres
what Ix should be done
cause - unknown, possible excess fluid in endolymphatic fluid compartment
audiometry, electocochleography, CT/MRI
mgmt of menieres (medical)
spontaneous resolution common - 70%
bed rest, sedatives
anti-emetics - beta histine may be helpful
intratympanic gentamicin
mgmt of menieres surgical
endolymphatic sac decompression
vestibular nerve section
labyrinthectomy - gives deafness
BPPV - what? other Sx?
attacks of sudden rotational vertigo lasting >30sec provoked by head turning
no other oto/neuro Sx
Causes of BPPV
idiopathic
middle ear disease
trauma
post viral
Hallpike test - how? what does it do? what does it show?
turn head to affected side - provokes vertigo and horizontal nystagmus - fatigues after <1min
if no fatigue consider central cause
mgmt of BPPV + prognosis
positioning exercises for vestibular rehab
usually resolves over 12-18 months
Acute vestibular failure - causes
post viral
bact labyrinthitis (AOM/cholesteatoma)
cholesteatoma
vascular, trauma, autoimmune, idiopathic
acute vestibular failure - what happens? resolution?
sudden onset of SN deafness, vertigo, N+V, nystagmus
recovery usually within 2-3 weeks, although hearing loss may persist
mgmt of acute vestibular failure
plasma expanders, carbogen gas to improve blood supply to labyrinth
steroids
