Ears 4 Flashcards
Quickly lower pt to supine position, head extended over edge and placed 30 degrees lower than rest of body, head turned L or R.
- What test is this?
- What is a + test for central and peripheral causes?
Dix-Hallpike maneuver to determine if vertigo is from a central or peripheral cause.
- Peripheral cause: latency, fatigable nystagmus
- Central cause: no latency, non-fatigable nystagmus
What is the most common type of BPPV? What type of nystagmus will be seen?
Posterior, will see horizontal nystagmus
What are the 3 conditions which cause Vertigo?
- BPPV
- Labyrinthitis
- Meniere Disease
Caused by sediment in semicircular canals (otoliths)
BPPV (benign paroxysmal positional vertigo)
- Type of vertigo provoked by changs in head position
- 10-15 second latency period
- Acute vertigo for 10 - 60 seconds
- Imbalanced for several hours
- Brief episodes, recurrent
- Appear in clusters for several days
BPPV
- Particle repositioning maneuver
- What is it used to tx?
- Describe how it’s done
Epley Maneuver to tx BPPV
- Pt seated upright, legs extended, head rotated 45 towards + Dix Hallpike test side
- Quickly / passively force pt down into supine position w/ head in 30 extension
- Observe eyes for primary nystagmus, remain here for 1 - 2 mins
- Rotate 90, remain for 1 - 2 mins
- Role pt onto shoulder, rotate 90 (looking down at 45 angle) Observe for secondary nystagmus. Remain 1 - 2 mins
- Slowly bring pt back to seated, maintaining 45 rotation. Stay seated for 30 seconds
- Inflammation disorder of vestibular portion of CN VIII
- Occurs after URI
Labyrinthitis
- Acute onset of continuous vertigo
- Hearing loss/tinnitus are common
- N/V
- Gait impaired
Labyrinthitis
In which condition should you be careful to not miss a cerebellar hemorrhage or stroke?
Labyrinthitis
- Abx given if pt is febrile or sxs of bacterial infection
- Give vestibular suppressants (2 days maximum)
- Anticholinergics
- Antihistamines
- Benzodiazepines
- Anti-emetics (Zofran)
- Corticosteroids
Tx for Labyrinthitis
- Reassure pt that condition is benign and self limited
- Recovery is gradual (several weeks)
- Refer to PT for vestibular rehabilitation
Tx for Labyrinthitis
Vertigo syndrome due to peripheral lesion (sorta)
- Distention of endolymphatic compartment of inner ear
- Sxs wax/wane as pressure rises and falls
- Can permanently damage inner ear structures
Meniere disease
Endolymphatic hydrops
Meniere Disease
- Episodic vertigo w/ discrete spells lasting 20 mins to several hours
- Fluctuating sensorineural hearing loss of low frequency sounds
- Low tone tinnitus “blowing/roaring”
- Unilateral ear pressure
Meniere Disease
- Refer to ENT/Audiology
- Caloric testing is positive if pt does not have nystagmus w/ cold water in ear
Dx for Meniere Disease
