Dizziness

Question 1

List the main ENT causes of dizziness

Answer 1

Benign paroxysmal positional vertigo
Meniere's disease
Vestibular neuritis
Labrynthitis
Migrainous vertigo

Question 2

List the main optic causes of dizziness

Answer 2

Cataracts

Retinopathy

Question 3

In basic terms, how does the vestibulo-cochlear reflex prevent dizziness?

Answer 3

Keeps eyes fixed despite head movements

Turning head to right inhibits left-sided firing + excites right-sided firing

Question 4

What is the main clinical sign of impaired vestibulo-cochlear reflex? State its definition

Answer 4

Nystagmus

Uncontrolled continuous to-and-fro movement of eyes

Question 5

List the main examinations that may be carried out when investigating dizziness

Answer 5

Otoscopy
Neurological
Blood pressure
Balance system
Audiommetry

Question 6

What happens in benign positional paroxysmal vertigo (BPPV)?

Answer 6

Dizziness on looking up/turning a certain way

Question 7

How long does dizziness usually last in BPPV?

Answer 7

A few seconds (max 1 min)

Question 8

What is the supposed pathophysiology behind BPPV?

Answer 8

Otolith material from utricle breaks off + traps in posterior semicircular canal

Question 9

List movements that typically illicit BPPV

Answer 9

Turning in bed
Looking up
Lying down
Rising from bending (gardening)
Sudden head movement in 1 direction

Question 10

BPPV is associated wit tinnitus, aural fullness and hearing loss. True/False?

Answer 10

False

Not usually

Question 11

What is the main examination test done for BPPV?

Answer 11

Hallpike test

Question 12

Describe the Hallpike test

Answer 12

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

Question 13

Which 2 manoeuvres can be used to treat BPPV?

Answer 13

Epley

Brandt-Daroff exercise

Question 14

What happens in vestibular neuritis?

Answer 14

Prolonged vertigo (days)

Question 15

Which is more likely to be associated with hearing loss and tinnitus - vestibular neuritis or labrynthitis?

Answer 15

Labyrinthitis

Question 16

List the criteria that must be met for diagnosing Meniere’s disease

Answer 16

2 episodes of recurrent/spontaneous/rotational vertigo
Worsening tinnitus
Aural fullness
SNHL on 1 occasion or more

Question 17

Meniere’s disease involves progressive deafness, tinnitus and vertigo. Outline management

Answer 17

Support
Tinnitus therapy
Hearing aids
Salt/caffeine/alcohol restriction
Grommet insertion, surgery

Question 18

BPPV has (select all appropriate):
Aural fullness
Hearing loss/tinnitus
Short duration
Long duration
Positional trigger

Answer 18

Short duration

Positional trigger

Question 19

Vestibular neuritis has (select all appropriate):
Aural fullness
Hearing loss/tinnitus
Short duration
Long duration
Positional trigger

Answer 19

Long duration

Question 20

Meniere's disease has (select all appropriate):
Aural fullness
Hearing loss/tinnitus
Short duration
Long duration
Positional trigger

Answer 20

Aural fullness
Hearing loss/tinnitus
Short duration

Question 21

Labyrinthitis has (select all appropriate):
Aural fullness
Hearing loss/tinnitus
Short duration
Long duration
Positional trigger

Answer 21

Long duration

Hearing loss/tinnitus