ENT Flashcards
Associated Signs & Symptoms of Vertigo (8)
Nausea and vomiting – vomiting can be severe and can cause electrolyte imbalance
*Postural and gait instability – gait and posture impairment: vertigo of central origin > vertigo of
peripheral origin
- Pallor and sweating
- Tinnitus, deafness, headache, photophobia
- Nystagmus (eyes move rapidly and uncontrollaby) – oscillation of the eyes
Pathophysiology of Vertigo
- CNS receives signals from both…
- Vestibular labyrinth – relays…
CNS receives signals from both the right and left labyrinths and compares these signals with one
another
- Head is still – tonic discharges in both vestibular afferents = balanced
- During motion – right and left labyrinths are alternately excited and inhibited -> left-right difference in
eighth nerve activity, which is recognized as motion - Acute unilateral peripheral vestibular disorder – also interpreted by the CNS as motion or vertigo due to left-right differences
*Vestibular labyrinth – relays information via the vestibular portion of CN VIII to the brainstem
vestibular nuclei and from there to the cerebellum, ocular motor nuclei, and spinal cord
- Vestibuloocular connections – responsible for coordinated eye movements during head motion
- Vestibulospinal pathways – maintain upright posture
- Cerebellar connections – modulate activities by the vestiboocular and vestibulospinal connections
Vestibuloocular connections –
responsible for coordinated eye movements during head motion
Vestibulospinal pathways –
maintain upright posture
Cerebellar connections
modulate activities by the vestibuloocular and vestibulospinal connections
Presence of vertigo – likely suggests an abnormality….
*Presence of vertigo – likely suggests an abnormality of the semicircular canals or the central nervous system structures that process
signals from the semicircular canals
Semicircular canals and the otolith organs –
end organs of the vestibular system
Semicircular canals
sense angular motion
Otolith organs
sense linear motion
Management of Vertigo
Disease-specific treatment
* Management of the condition that causes the vertigo
Symptom-specific treatment
* Use of medications that target the symptoms
* Anti-histamines
* Anti-emetics
* Benzodiazepines
Vestibular rehabilitation
- Exercise-based program, designed by a specialty-trained vestibular physical therapist, to improve
balance and reduce problems related to dizziness - Encourages patients to perform challenging balance exercises with several potential benefits
General Nursing Considerations Vertigo (5)
Assist the patient to make sure he/she is in a comfortable position
- Closely monitor vital signs and level of consciousness of patient
- Provide fall precaution
- Keep the patient calm and the room darkened to ensure the patient’s comfort, if possible
- Administer medications to reduce the patient’s signs and symptoms
Otitis Media
*Inflammation of the middle ear which can present as Acute Otitis Media (AOM) or Otitis Media
with Effusion (OME)
- Acute Otitis Media – abrupt onset; related to middle ear inflammation and effusion
*Otitis Media with Effusion – (+) fluid in the middle ear without signs and symptoms of acute
infection; can be due to poor Eustachian tube function
Chronic Otitis Media
inflammation of the middle ear lasting more than 12 weeks; irreversible damage has occurred
- Perforation of the tympanic membrane
- Calcification of the ossicles
- (+) cholesteatomas
- (+) purulent drainage from the ear
- Can be a consequence of AOM
- Pain is an uncommon finding; hearing loss
Clinical Manifestations of AOM (5)
Otalgia
- Fever
- Hearing loss
- Younger children may have non-specific signs and symptoms
- Otitis Media with Effusion – usually an asymptomatic condition
Management of Acute Otitis Media
Symptom control and management of underlying pathologic process
- Pain management
- Myringotomy/ Tympanocentesis
- Observation – uncomplicated AOM
- Antibiotics
Meniere Disease Pathophysiology
Pathogenesis
Meniere disease is an excessive accumulation of endolymph in the membranous labyrinth
The volume of endolymph increases with distention
of the scala media until the membrane ruptures.
Consequently, the neural end organs of the cochlea
degenerate.
Etiology
Many conditions including allergies, viral and bacterial infections (such as syphilis), head trauma, metabolic
derangements, and chronic stress have been suggested as causative
agents
Symptoms Meniere Disease
Tinnitus
- Fluctuating hearing loss,
- Severe vertigo + progressive sensorineural hearing loss.
- Vertigo may improve as hearing impairment worsens.
The most common cause of peripheral episodic vertigo is:
Benign paroxysmal positional vertigo.
A 24-year-old male with vertigo and tinnitus has Meniere’s disease. He has fallen many times and injured his body. He refused operative intervention, but agrees to a trial of medication. Which one of the following substances is most likely to be prescribed?
Lasix
A 66 years old patient complains of left ear hearing loss, fullness, tinnitus, headache and drainage for one year. These symptoms are concurrent most of the time. The ear exam reveals left eardrum perforation. The weber test lateralizes to the left ear, and the Rinne test is negative in the left ear and positive in the right ear. The diagnosis is peripheral vestibular system disease. All of the following symptoms support the diagnosis except:
tinnitus
hearing loss
ear fullness
headache
headache
