Balance problems

Question 1

What is the definition of vertigo?

Answer 1

The feeling that the patient or the room they’re in is spinning

Question 2

What are the causes of vertigo?

Answer 2

BPPV
Meniere’s disease
Labyrinthitis

Stroke
Brain tumour
Brain injury
MS
Migraine

Question 3

What is BPPV?

Pathophysiology

Answer 3

Benign paroxysmal positional vertigo

In the inner ear

Otolith goes from saccule or uricle into semi-circular canals

The otolith continues to move after head stops moving, giving the brain the sensation that the person is still moving when they’re not

Question 4

Causes of BPPV?

Answer 4

Idiopathic
Trauma
Post-viral
Chronic otitis

Question 5

Risk factors for BPPV?

Answer 5

Age 40-60
Female
Meniere’s
Migraines

Question 6

Clinical features of BPPV?

Answer 6

Episodic sudden transient vertigo

Provoked by head movement

Question 7

Investigations of BPPV?

Answer 7

Dix Hallpike test

Rapid depression of tilted head provokes vertical nystagmus

Question 8

What is an otolith?

Answer 8

Calcium carbonate debris which breaks off from a membrane in saccules or uricles

It enters the semi-circular canals and causes BPPV

Question 9

Management of BPPV?

Answer 9

Self-resolves

Epley’s manoeuvre: moving the head in different positions which makes otoliths leave semi-circular canals

Question 10

What’s the difference between labyrinthitis and vestibular neuritis?

Answer 10

They are basically the same

Labyrinthitis: inflammation of labyrinth causing damage to vestibular and auditory organs

Vestibular neuritis: is when there is neuropathy of vestibular nerve only

Question 11

Where is the labyrinth?

Answer 11

In the inner ear, it consists of the sensory organs for balance and hearing (utricle, saccule, SC canals, cochlea)

Question 12

Clinical features of labyrinthitis and vestibular neuritis?

Answer 12

Often follows URTI

Sudden onset vertigo
Otalgia
Nausea
Facial weakness

LAB

• hearing loss
• tinnitus

VEST
- nystagmus away from the affected side

Question 13

Management of labyrinthitis and vestibular neuritis?

Answer 13

Vestibular suppresants (Bucastem)

Cyclizine

Question 14

Which bug usually causes labyrinthitis and vestibular neuritis?

Answer 14

Viruses from URTI

Sometimes herpes simplex

Question 15

What is Meniere’s disease?

Pathophysiology

Answer 15

Distension of the labyrinth (which contains cochlea, SC canals, saccule, uricle)

Due to a change in volume of fluid (endolymph) in the labyrinth

This injures the vestibular system (causing vertigo) and the cochlea (causing hearing loss)

Question 16

Cause of Meniere’s disease?

Risk factors?

Answer 16

Unknown!

Autoimmunity
Allergy
Genetics
Viral infections
Migraine

Question 17

Clinical features of Meniere’s disease?

Answer 17

Fluctuating course, relapsing remitting

Vertigo attacks (lasting 2-4hours)
Tinnitus
Fullness in ear
Fluctuating hearing loss

Nystagmus

Symptoms go on to become bilateral

Question 18

What type of hearing loss is it in Meniere’s disease?

Answer 18

Sensorineural

Question 19

What is the diagnostic criteria for Meniere’s disease?

Answer 19

1. Vertigo: two spontaneous attacks lasting at last 20 mins during one Meniere’s relapse
2. Tinnitus +/- aural fullness
3. Sensorineural hearing loss confirmed by audiometry

Question 20

Investigations of Meniere’s disease?

Answer 20

Bloods to exclude systemic illness

Audiometry to establish type of hearing loss

Electrocochleography: recording electrical impulses generated by cochlea

MRI brain

Question 21

Management of Meniere’s disease?

Answer 21

Acute attack:

• prochlorperazine
• cyclizine

Prophylaxis:

• low salt diet
• avoid caffeine + chocolate
• betahistine

Hearing support
Mobility support