Dizziness Flashcards
List the main ENT causes of dizziness
Benign paroxysmal positional vertigo Meniere's disease Vestibular neuritis Labrynthitis Migrainous vertigo
List the main optic causes of dizziness
Cataracts
Retinopathy in DM
In basic terms, how does the vestibulo-cochlear reflex prevent dizziness?
Keeps eyes fixed despite head movements
Turning head to right inhibits left-sided firing + excites right-sided firing
What is the main clinical sign of impaired vestibulo-cochlear reflex? State its definition
Nystagmus
Uncontrolled continuous to-and-fro movement of eyes
List the main examinations that may be carried out when investigating dizziness
Otoscopy Neurological Blood pressure Balance system Audiometry
What happens in benign positional paroxysmal vertigo (BPPV)?
Dizziness on looking up/turning a certain way
How long does dizziness usually last in BPPV?
A few seconds (max 1 min)
What is the supposed pathophysiology behind BPPV?
Otolith material from utricle breaks off + traps in posterior semicircular canal
List movements that typically illicit BPPV
Turning in bed Looking up Lying down Rising from bending (gardening) Sudden head movement in 1 direction
BPPV is associated with tinnitus, aural fullness and hearing loss. True/False?
False
Not usually
What is the main examination test done for BPPV?
Hallpike test
Describe the Hallpike test
Lie on couch with head hanging off edge;
Turn head 45’;
Don’t close eyes if dizzy;
Will usually see nystagmus, but only 1st time
Which 2 manoeuvres can be used to treat BPPV?
Epley
Brandt-Daroff exercise (do at home)
What happens in vestibular neuritis?
Prolonged vertigo (days)
Which is more likely to be associated with hearing loss and tinnitus - vestibular neuritis or labrynthitis?
Labyrinthitis
List the criteria that must be met for diagnosing Meniere’s disease
2 episodes of recurrent/spontaneous/rotational vertigo (>20 minutes, usually hours)
Worsening tinnitus
Aural fullness
SNHL on 1 occasion or more
Meniere’s disease involves progressive deafness, tinnitus and vertigo. Outline management
Support with vestibular sedatives during episodes Tinnitus therapy Hearing aids Salt/caffeine/alcohol restriction Grommet insertion, surgery Intratympanic gentamicin/ steroids
BPPV has (select all appropriate): Aural fullness Hearing loss/tinnitus Short duration Long duration Positional trigger
Short duration (minutes) Positional trigger
Vestibular neuritis has (select all appropriate): Aural fullness Hearing loss/tinnitus Short duration Long duration Positional trigger
Long duration (days - weeks)
Meniere's disease has (select all appropriate): Aural fullness Hearing loss/tinnitus Short duration Long duration Positional trigger
Aural fullness
Hearing loss/tinnitus
Short duration (hours)
Labyrinthitis has (select all appropriate): Aural fullness Hearing loss/tinnitus Short duration Long duration Positional trigger
Long duration (days - weeks) Hearing loss/tinnitus
Labyrinthitis and vestibular neuritis are usually precipitated by…
Viral infection
Can be viral prodromal symptoms
Outline management for labyrinthitis and vestibular neuronitis
Support with vestibular sedatives during episodes
Self-limiting
What is the supposed pathophysiology behind Menieres’s disease?
Perilymphatic space gets compressed and allows mixing of perilymph with other fluids
List features of vestibular migraine
Phonophobia
Fluctuating/ acute hearing loss
Motion sickness
State the main cardiac cause of dizziness
Postural hypotension
