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ENT week 2 > Dizziness > Flashcards

Dizziness Flashcards

1
Q

Define dizziness

A

Non-specific term, which may cover vertigo, pre-syncope, disequilibrium, etc.

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2
Q

Define vertigo

A

A sensation of room spinning around you, implies vestibular pathology

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3
Q

Reminder

What are the 4 main systems which are involved in balance or have an effect on it ?

A
  • Ears
  • Eyes
  • MSK
  • Cardiac
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4
Q

What are the 3 main causes of dizziness which affect the ear ?

A
  • BPPV
  • Vestibular neuronitis / labyrinthitis
  • Ménière’s Disease
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5
Q

Describe what the vestibulo-ocular reflex is

A
  • A rotation of the head is detected, which triggers an inhibitory signal to the extraocular muscles on one side and an excitatory signal to the muscles on the other side.
  • The result is a compensatory movement of the eyes in relation to the movement of the head
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6
Q

What is nystagmus ?

A

Rapid involuntary movements of the eyes.

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7
Q

What does the presence of nystagmus indicate ?

A

Indicates a vestibular or cerebellar pathology

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8
Q

What is the vestibular system ?

A
  • The vestibular system, is the sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance.
  • It consists of two structures; the bony labyrinth of the inner eae & the structures of the membranous labyrinth contained within them.
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9
Q

Describe what benign positional paroxysmal vertigo is

A

Attacks of sudden rotational vertigo provoked by head turning

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10
Q

What is the pathogenesis of BPPV?

A

Otolith material (calcium carbonate crystals from cells within the endolymph) from utricle displaced into semicircular canals

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11
Q

What are some of the causes of BPPV?

A

Head trauma, ear surgery, idiopathic

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12
Q

On what movements is BPPV often experienced ?

A
  • Looking up
  • Turning in bed - often worse to one side
  • On First lying down in bed at night
  • On first getting out of bed in the morning
  • Bending forward
  • Rising from bending
  • Moving head quickly – often only in one direction
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13
Q

What are the important symptoms which are all negative in BPPV?

A

No associated tinnitus, hearing loss or aural fullness

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14
Q

How long does BPPV last?

A

Minutes

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15
Q

What test is done to diagnose BPPV?

A

Halipike test

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16
Q

What in general is used to commonly treat nausea, vomiting & vertigo?

A

Prochlorperazine or anti-histamine e.g. cyclizine, cinnarizine or promethazine

17
Q

What is the treatment of BPPV?

A
  • Usually self-limiting
  • But Epley manoeuvres can be done to try and treat it
18
Q

What is vestibular neuronitis and what does it often develop after ?

A
  • Infection of the vestibular nerve, which causes it to be inflamed and disturbed balance
  • It is a cause of vertigo that often develops following a viral infection.
19
Q

What are the main symptoms of vestibualr neuronitis ?

A
  • Recurrent vertigo attacks lasting hours or days-weeks
  • +/- N&V, horizontal nystagmus
  • No tinnitus
  • No hearing loss
  • No aural fullness
  • No positional trigger
20
Q

What is the treatment of vestibular neuronitis?

A
  • Mild cases tx = PO prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine)
  • Severe cases tx = buccal or IM prochlorperazine
21
Q

What is labyrinthitis ?

A
  • An inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs.
  • Usually caused by viral infection
22
Q

What are the key symptoms of labyrinthitis ?

A

Patients typically present with an acute onset of:

  • Vertigo: not triggered by movement but exacerbated by movement
  • N&V, horizontal nystagmus
  • Hearing loss (sensorineural): may be unilateral or bilateral
  • Tinnitus
  • Preceding or concurrent symptoms of URTI
  • No aural fullness
23
Q

Both labyrinthitis and vestibular neuronitis can present very similar what is the key difference between the two ?

A

Labyrinthitis is associated with hearing loss and tinnitus, vestibular neuronitis is not (because it only involves the vestibular nerve)

24
Q

How long does the symptoms of vestibular neuronitis and labyrinthitis last ?

A

Days- weeks

25
Q

What is menieres disease?

A

It is dilatation of the endolymphatic spaces of the membranous labyrinith

26
Q

What are the symptoms of menieres disease ?

A
  • Vertigo
  • Tinnitus
  • Sensorineural hearing loss
  • Aural fullness
  • Occurs for hours
27
Q

What is the treatment of menieres disease ?

A
  • Mild attacks tx = PO prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine)
  • Severe attacks tx = buccal or IM prochlorperazine
  • Prevention tx = betahistine and vestibular rehabilitation exercises may be of benefit
28
Q

Note that patients with migraines can often develop symptoms of vertigo secondary to the migraine

A

ENT week 2 (10 decks)

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