Dizziness

Question 1

list the main ENT causes of dizziness

Answer 1

benign paroxysmal positional vertigo 
meniere's disease
vestibular neuritis 
labyrinthitis 
migrainous vertigo

Question 2

list the main optic causes of dizziness

Answer 2

cataracts

retinopathy

Question 3

in basic terms, how does the vestibulocochlear reflex prevent dizziness?

Answer 3

keeps eyes fixed despite head movements

turning head to the right inhibits left sided firing and excites right sided firing

Question 4

what is the main clinical sign of impaired vestibulocochlear reflex?

Answer 4

nystagmus

Question 5

what is nystagmus?

Answer 5

uncontrolled continuous to and fro movement of eyes

Question 6

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

Answer 6

otoscopy 
neurological
blood pressure
balance system
audiometry

Question 7

what happens in benign positional paroxysmal vertigo (BPPV)?

Answer 7

dizziness on looking up or turning a certain way

Question 8

how long does dizziness usually last in BPPV?

Answer 8

a few seconds (max one minute)

Question 9

what is the supposed pathophysiology behind BPPV?

Answer 9

otolith material from utricle breaks off and traps in posterior semicircular canal

Question 10

list movements that typically illicit BPPV

Answer 10

turning in bed
looking up/down
rising from bending
sudden head movement in one direction

Question 11

true or false: BPPV is associated with tinnitus, aural fullness and hearing loss

Answer 11

false

Question 12

what is the main examination test done for BPPV?

Answer 12

hallpike test

Question 13

describe the hallpike test

Answer 13

lie on couch with head hanging off the edge

turn head 45 degrees

don’t close eyes if dizzy

will usually see nystagmus, but only the first time

Question 14

which two manoeuvres can be used to treat BPPV?

Answer 14

epley

brandt daroff exercise

Question 15

what happens in vestibular neuritis?

Answer 15

prolonged vertigo (for days)

Question 16

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

Answer 16

labrynthitis

Question 17

list the criteria that must be met for diagnosing meniere’s disease?

Answer 17

two episodes of recurrent/spontaneous/rotational vertigo

worsening tinnitus

aural fullness

SNHL on one occasion or more

Question 18

outline management for meniere’s disease

Answer 18

support 
tinnitus therapy 
hearing aids 
salt, caffeine and alcohol restriction 
grommet insertion 
surgery