Dizziness

Question 1

define dizziness and vertigo

Answer 1

dizziness - non-specific term covering vertigo, pre-syncope etc
vertigo - sensation of movement whilst stationary, usually spinning

Question 2

what are the differences in symptoms with cardiovascular, neurological and vestibular dizziness

Answer 2

cardio - palpitations, pre-syncope, light headedness
neuro - paraesthesia, blackout, visual disturbance
vestibular - vertigo, falling or spinning

Question 3

which vestibular condition only lasts for seconds

Answer 3

BPPV

Question 4

which vestibular condition lasts for minutes-hours

Answer 4

Menieres

Question 5

which vestibular condition lasts for days

Answer 5

vestibular neuritis

Question 6

list the common symptoms associated with vertigo

Answer 6

hearing loss
tinnitus
migraines 
aural pressure/fullness 
sound induced symptoms

Question 7

which conditions presents with dizziness when rolling over in bed

Answer 7

BPPV

Question 8

which conditions has severe first attack lasting hours with nausea and vomiting

Answer 8

vestibular neuritis

Question 9

which condition has light sensitivity during dizzy spells

Answer 9

vestibular migraine

Question 10

which condition does the ear have fullness and tinnitus around time of dizziness

Answer 10

Menieres

Question 11

what is the function of the vestibular-oculo reflex

Answer 11

stabilise the eyes in space during head movements, eyes move at the same time as the head but in the opposite direction

Question 12

which organ of the inner ear is responsible for the vestibular-oculo reflex

Answer 12

semi-circular canals

transduce velocity of head movements accurately converting neural impulse which drives the eyes at required speed

Question 13

what is BPPV

Answer 13

benign positional paroxysmal vertigo
sudden onset of room spinning only lasting seconds
self-limiting and can resolve within 6 weeks
fixation of point in the room can alleviate symptoms

Question 14

what causes BPPV

Answer 14

debris from the membrane of utricle causes mismatch in vestibular and ocular stimuli to the brain causing vertigo
can arise due to trauma, stapes surgery or idiopathic

Question 15

what investigations are done for BPPV

Answer 15

dix-hallpike manoeuvre

Question 16

describe dix-hallpike manoeuvre

Answer 16

patient lies down on bed with head lying off bed supported by clinician - turn patients head to 45 degrees one side and keep eyes open - observe for 30 seconds for nystagmus - repeat on other side

positive test = nystagmus present

Question 17

what is the management for BPPV

Answer 17

active monitoring - should resolve in 6 weeks

repositioning manoeuvres to dislodge crystals in ear

Question 18

describe the epley manoeuvre

Answer 18

lie on bed with head hanging over supported by clinician, tilt head to one side, then tilt head to other side, then sit back up

Question 19

describe the Brandt-Daroff exercises

Answer 19

sit on bed, lie down on right side of body, back to sitting, lie down on left side of body
10 reps 3 times a day

Question 20

what is the difference between labyrinthitis and vestibular neuritis

Answer 20

labyrinthitis affects vestibular and cochlear nerve whereas vestibular neuritis only affects vestibular nerve
this means labyrinthitis presents with vertigo + hearing loss whereas vestibular neuritis only presents with vertigo

Question 21

what is the presentation of vestibular neuritis

Answer 21

prolonged vertigo lasting days + nausea and vomiting
usually following viral URTI
usually presents when first wake up
nystagmus away from affected side

Question 22

what are the investigations for vestibular neuritis

Answer 22

bloods to identify bacterial cause

MRI of internal acoustic meatus

Question 23

what is the management for vestibular neuritis

Answer 23

active monitoring as self-limiting

vestibular sedatives eg prochlorperazine

Question 24

what is the presentation of Menieres disease

Answer 24

recurrent spontaneous vertigo with 2 episodes lasting more than 20 mins
new tinnitus
aural fullness
sensorineural hearing loss which begins with low frequency loss first

Question 25

what causes Menieres disease

Answer 25

expansion of scala media within membraneous labyrinth (endolymphatic hydrops)
endolymph mixes with perilymph – exciting vestibular system causing vertigo

Question 26

what substances should be avoided to prevent menieres

Answer 26

salt, caffeine, alcohol and stress

Question 27

what is the management of Menieres

Answer 27

supportive episodes treatment
tinnitus therapy
hearing aids
intratympanic steroid injection or intratympanic gentamicin to destroy part of inner ear

Question 28

phonophobia is the most common symptom with what condition

Answer 28

vestibular migraine

Question 29

which condition has a clear trigger

Answer 29

BPPV

Question 30

which conditions presents with hearing loss and tinnitus

Answer 30

Menieres and labyrinthitis