dizziness

Question 1

dizziness history

Answer 1

• vertigo?
• constant or episodic?
• duration?
• what brings it on?
• any other symptoms such as,

nausea, vomiting
hearing loss
tinnitus
ear pain or pressure

Question 2

vestibular neuronitis + examination

Answer 2

• rapid onset rotatory vertigo
• nausea and vomiting pronounced
• very debilitating
• if associated with hearing loss = labyrhinthitis
• symptoms progressively settle over weeks

examination: can perform the Dix-halpike test - torsional nystagmus

Question 3

vestibular neuronitis treatment

Answer 3

Vestibular sedatives (short term only!) 
- Prochlorperazine, Cinnarazine

Exercise encourages compensation drugs prevent it.

Question 4

BPPV Benign Paroxysmal Positional Vertigo: aetiology + symptoms + treatment

Answer 4

• Due to cellular debris in the semicircular canals.
• Head movement sets these particles in motion which gives a spinning sensation until the particles settle (stimulates stereocilia inappropriately)
• Classically when looking up or turning in bed.
• No other symptoms
• Can follow URTI, head injury or vestibular neuronitis.

Treatment: Epley Manoeuver.

Question 5

common causes of vertigo

Answer 5

• BPPV
• vestibular neuritis
• labrynthitis

Question 6

stereocilia

Answer 6

actin-based protrusions on auditory and vestibular sensory cells that are required for hearing and balance. They convert physical force from sound, head movement or gravity into an electrical signal, a process that is called mechanoelectrical transduction

Question 7

Meniere’s disease

Answer 7

• Classic triad of vertigo, hearing loss and tinnitus.
• Often preceded by aural fullness
• Patients well between attacks but gradually loose the hearing in the affected ear.
• Named after Prosper Meniere.
• Idiopathic causes

Question 8

labrynthitis

Answer 8

Rare infection of the inner ear causing vertigo and permanent sensorineural hearing loss and tinnitus

on examination - horizontal nystagmus, sensorineural hearing loss and impaired vestibule-ocular reflex

self revolving infection

Question 9

treatment of Meniere’s disease

Answer 9

• Only cure is surgical removal of the affected vestibular apparatus.
• Limit salt intake.
• Betahistine 16mg tds.
• Vestibular sedatives for acute attacks.
• Gentamicin injections into inner ear.