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ENT > Dizziness > Flashcards

Dizziness Flashcards

1
Q

define dizziness and vertigo

A

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

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2
Q

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

A

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

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3
Q

which vestibular condition only lasts for seconds

A

BPPV

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4
Q

which vestibular condition lasts for minutes-hours

A

Menieres

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5
Q

which vestibular condition lasts for days

A

vestibular neuritis

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6
Q

list the common symptoms associated with vertigo

A 
hearing loss
tinnitus
migraines 
aural pressure/fullness 
sound induced symptoms
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7
Q

which conditions presents with dizziness when rolling over in bed

A

BPPV

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8
Q

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

A

vestibular neuritis

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9
Q

which condition has light sensitivity during dizzy spells

A

vestibular migraine

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10
Q

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

A

Menieres

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11
Q

what is the function of the vestibular-oculo reflex

A

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

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12
Q

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

A

semi-circular canals

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

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13
Q

what is BPPV

A

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

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14
Q

what causes BPPV

A

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

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15
Q

what investigations are done for BPPV

A

dix-hallpike manoeuvre

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16
Q

describe dix-hallpike manoeuvre

A

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

17
Q

what is the management for BPPV

A

active monitoring - should resolve in 6 weeks

repositioning manoeuvres to dislodge crystals in ear

18
Q

describe the epley manoeuvre

A

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

19
Q

describe the Brandt-Daroff exercises

A

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

20
Q

what is the difference between labyrinthitis and vestibular neuritis

A

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

21
Q

what is the presentation of vestibular neuritis

A

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

22
Q

what are the investigations for vestibular neuritis

A

bloods to identify bacterial cause

MRI of internal acoustic meatus

23
Q

what is the management for vestibular neuritis

A

active monitoring as self-limiting

vestibular sedatives eg prochlorperazine

24
Q

what is the presentation of Menieres disease

A

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

25
Q

what causes Menieres disease

A

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

26
Q

what substances should be avoided to prevent menieres

A

salt, caffeine, alcohol and stress

27
Q

what is the management of Menieres

A

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

28
Q

phonophobia is the most common symptom with what condition

A

vestibular migraine

29
Q

which condition has a clear trigger

A

BPPV

30
Q

which conditions presents with hearing loss and tinnitus

A

Menieres and labyrinthitis

ENT (8 decks)

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