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Otolaryngology > Dizziness > Flashcards

Dizziness Flashcards

1
Q

What are 5 complaints associated with dizziness?

A
  1. Disequilibrium
  2. syncope
  3. lightheaded
  4. ataxia
  5. vertigo
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2
Q

Disease processes that cause true vertigo (illusion of motion) are mainly assoc with what?

A

Balance organs of the inner ear (peripheral vestibular disorders)

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3
Q

Central or peripheral vertigo?

BPPV, cholesteatoma, Ramsay Hunt Syndrome, Meniere’s disease, otosclerosis?

A

Peripheral

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4
Q

Central or peripheral vertigo?

Cerebellopontine angle tumor, TIA, migraine, multiple sclerosis,

A

Central

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5
Q

Differentiate central vs peripheral vertigo.

A

Etiology for central relates to CNS; PNS for peripheral. central impairs gait and posture more bc involves balance and posture pathway.

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6
Q

If pt doesnt have true vertigo, what should you evaluate for?

A

Syncope or episodic hypotension

Neoplasm, demyelinating disease or vascular abnormality

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7
Q

What are 4 parts of the electronystagmography test to evaluate vestibular (balance) part of the inner ear?

A
  1. Calibration test
  2. Tracking test
  3. positional test
  4. caloric test
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8
Q

Which part of the ENG test measures responses to warm and cold water introduced to the ear canal.

A

Caloric test

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9
Q

What is the gold standard to test unilateral peripheral vestibular disorders?

A

ENG (electronystagmography)

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10
Q

Which part of the ENG test measures response due to head mvt?

A

Positional test

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11
Q

Which part of the ENG test evaluates ability for eyes to track a moving target?

A

Tracking test

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12
Q

Which part of the ENG test measures rapid eye movements?

A

Calibration test

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13
Q

What is the gold standard to diagnose bilateral vestibular weakness

A

Rotatory chair testing - pt spun slowly in a chair and test dizziness w/optokinetic testing and fixation test

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14
Q

What test is most useful in quantifying balance improvement after tx for a particular problem and can help ID functional dizzy pt. But shouldnt be used alone to dx vestibular disorders

A

Moving platform posturography

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15
Q

What is a useful test to evaluate Meniere’s dz but doesnt really test the vestibular system?

A

electrocochleography - variant of brainstem audio-evoked response. Best performed during Meniere’s attack

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16
Q

most common causes of vertigo seen by otolaryngologists

A

Benign paroxysmal positional vertigo (BPPV)

17
Q

BPPV is caused by sediment, such as ___ (calcium carbonate crystals) that have become free floating within the ___ ear.

A
  1. otoconia

2. inner

18
Q

What is the balance canal fluid in the inner ear that stimulates the vestibular division of the 8th CN?

A

Endolymph

19
Q

What type of vertigo lasts 24-48hrs and gets less intense over this time with hearing unchanged?

A

Vestibular neuronitis - nausea common

20
Q

What type of vertigo lasts 30min-4hrs?

A

Meniere’s disease

21
Q

What type of vertigo lasts less than 1 min?

A

BPPV

22
Q

BPPV is commonly seen after what events?

A

Significant head trauma or episode of vestibular neuronitis

23
Q

Tx for BPPV?

A
  1. Canolith reposition maneuver (Epley or Semont) - 80% effective
  2. Meds INEFFECTIVE
  3. Bradnt-Daroff exercises at home
  4. Severe cases: Transtympanic gentamycin injections, posterior semicircular canal plugging, vestibular nerve sectioning, sacculotomy, and labyrinthectomy
24
Q

What is another name for vestibular neuronitis? Cause?

A

Labyrinthisis
inflammation, secondary to a viral infection, of the vestibular portion of the 8th CN or of the inner ear balance organs (vestibular labyrinth). Freq assoc w/URI

25
Q

How do you tx vestibular neuronitis?

A

Symptomatically

  1. vestibular supressant meds
  2. antiemetics
  3. tapering oral steroids
  4. Vestibular rehab if persist for mo to yrs
26
Q

What is this condition?
Patients develop intense, episodic vertigo, usually lasting 30 min - 4 hrs, and assoc w/fluctuating hearing loss, roaring tinnitus, and the sensation of aural fullness. Even after the episode is over, some hearing loss often remains

A

Meniere’s dz

27
Q

Possible cause of Meniere’s dz?

A

Symptoms are believed to be secondary to a distention of the endolymphatic space within the balance organs of the inner ear.

28
Q

What are tx strategies to dec endolymphatic fluid pressure w/in the vestibular portion of the inner ear for Meniere’s dz (6)?

A
  1. salt restriction
  2. thiazide diuretics
  3. vestibular ablation by instillation of ototoxic meds (gentamicin)
  4. endolymphatic sac decompression into mastoid cavity
  5. vestibular nerve section
  6. labryinthectomy - destroys hearing

Otolaryngology (15 decks)

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