Dizziness

Question 1

What is benign positional paroxysmal vertigo?

Answer 1

BPPV - the commonest cause of vertigo on looking up

Question 2

What are the causes of BPPV?

Answer 2

Idiopathic
Head trauma
Ear surgery

Question 3

What is the pathophysiology of BPPV?

Answer 3

Otolith material from the utricle is displaced into semicircular canals (most commonly posterior SCC)

Question 4

When do you get vertigo in BPPV?

Answer 4

Vertigo on:
looking up 
turning in bed - worse on 1 side 
bending forward 
rising from bending 
moving head quickly

Question 5

What is the test to diagnose BPPV?

Answer 5

Hall pike’s test
sit on a sofa so that head is off the end when laying back
head to 45 degrees
lie back quickly and don’t close eyes
hold and observe - (should see nystagmus)

Question 6

What is nystagmus?

Answer 6

Constant uncontrolled movement of the eyes

Question 7

What manœuvres help end the symptoms of vertigo in BPPV?

Answer 7

Epley

Brandt Daroff

Question 8

What is vestibular neuritis?

Answer 8

Infection of the vestibular nerve in the inner ear - nerve becomes inflamed
Usually viral infection

Question 9

What is labyrinthitis?

Answer 9

Inflammation of the inner ear

Question 10

What type of vertigo do you get in vestibular neuritis/ labyrinthitis?

Answer 10

Prolonged - lasts for days

Question 11

What is the management of vestibular neuritis/ labyrinthitis?

Answer 11

Usually self limiting
Supportive with vestibular sedatives
Rehab exercises?

Question 12

What is the vertigo like in Menieres disease?

Answer 12

Recurrent
Spontaneous
Rotational
Episodes last from 20 mins to hours

Question 13

What is the presentation of Menieres disease?

Answer 13

Vertigo
Occurrence of or worsening of tinnitus on affected side
SNHL - fluctuating
aural fullness on affected side

Question 14

What is the management of Menieres disease?

Answer 14

Supportive during episodes 
Tinnitus therapy 
Hearing aids 
Intratympantic gentamicin/ steroids 
Grommet insertion/ Meniette 
surgery