Dizziness

Question 1

Which systems are involved in dizziness?

Answer 1

ENT

Opthalmology

MSK

Neurology

Cardiovascular

Question 2

Which conditions can arise as a dysfunction of the vestibular system?

Answer 2

BPPV

Ménière’s

Vestibular Neuronitis

Question 3

Which cardiovascular conditions can cause dizziness?

Answer 3

Arrhythmias

Postural hypotension

Question 4

What questions should be covered in a history of dizziness?

Answer 4

Description of dizziness

Triggers?

Time Course?

Associated symptoms?

Alleviating factors?

Medication?

Question 5

What are some specific causes of vertigo?

Answer 5

Ménière’s disease

BPPV

Vestibular neuronitis

Labyrinthitis

Migrainous vertigo

Question 6

What are the symptoms of Ménière’s disease?

Answer 6

Vertigo, >20mins - several hours

Tinnitus on affected side

Paroxysmal hearing loss

Question 7

What are the management options for Ménière’s disease?

Answer 7

Supportive treatment during episodes

Tinnitus therapy

Hearing Aids

Prevention e.g. salt restriction, Benahistine, stress, caffeine

Grommets

Intratympanic Gentamicin / Steroids

Surgery

Question 8

What is benign positional paroxysmal vertigo (BPPV)?

Answer 8

Vertigo lasting several minutes on:

Looking up

Turning in bed - often worse to one side

First lying down in bed at night

Getting out of bed in the morning

Bending forward

Rising from bending

Moving head quickly – often only in one direction

Question 9

What symptoms are associated and not associated with BPPV?

Answer 9

There is a clear positional trigger

NO: vertigo, aural fullness, or hearing loss

Question 10

What is Ménière’s disease?

Answer 10

A disorder of the inner ear affecting hearing and balance characterised by vertigo, low-pitched tinnitus and hearing loss

Question 11

What is the most common cause of vertigo on looking up?

Answer 11

Benign positional paroxysmal vertigo

Question 12

What is the Dix-Hallpike test used to assess?

Answer 12

Nystagmus on lying back with head turned 45 degrees, a sign of BPPV

Question 13

What is nystagmus?

Answer 13

Involuntary, continuous, uncontrolled to and fro movement of the eyes

Question 14

How is the Dix-Hallpike test performed?

Answer 14

Sit patient on bed so head will extend just beyond end of the bed when lying down

Turn head 45 degrees

Lie patient down quickly with head still turned

Watch for nystagmus - hold in position and observe, usually delay of approx. 30 seconds

Question 15

What is the Brant-Daroff exercise?

Answer 15

Used to relieve symptoms of BPPV

Question 16

What is vestibular neuronitis?

Answer 16

A condition that causes vertigo lasting several days, and is a type of unilateral vestibular dysfunction

Question 17

What is vestibular neuronitis associated with?

Answer 17

Nausea/vomiting

Viral aetiology e.g. previous upper respiratory tract infection

NO: hearing loss or tinnitus associated

Question 18

What is labyrinthitis?

Answer 18

An infection of the inner ear causing inflammation and swelling that disrupts balance and causes prologned vertigo and may also cause hearing loss or tinnitus

Question 19

What is the management of vestibular neuronitis/labyrinthitis?

Answer 19

Usually self-limiting - supportive management with vestibular sedatives

May need referral if prolonged or atypical

Question 20

Which vertigo-causing disease is associated with a clear positional trigger?

Answer 20

BPPV

Question 21

Which vertigo-causing disease is associated with aural fullness?

Answer 21

Meniere’s disease

Question 22

Which vertigo-causing diseases are NOT associated with hearing loss or tinnitus?

Answer 22

BPPV

Vestibular neruonitis