ENT

Question 1

Define benign paroxysmal positional vertigo

Answer 1

Peripheral vestibular disorder that manifests as sudden, short-lived episodes of vertigo elicited by specific head movements.

The most common cause of vertigo causing an illusion of movement

Question 2

Explain the aetiology / risk factors of benign paroxysmal positional vertigo

Answer 2

Otoliths become detached from the macula of the ear into the semi-circular canals; most cases are idiopathic. Other causes include:
• Head injury
• Post-viral illness
• Complication of stapes surgery
Risk Factors: older age, female, Meniere’s Disease, anxiety disorders, head trauma, vestibular neuronitis

Question 3

Summarise the epidemiology of benign paroxysmal positional vertigo

Answer 3

1-3% prevalence

Question 4

Recognise the presenting symptoms of benign paroxysmal positional vertigo

Answer 4

Episodes of vertigo following head movement (rolling over in bed, lying down, sitting up) (provoking positions)
Symptoms are worse on head tilt to one side, and attack are sudden, and last 20-30 seconds.
Usually a latent period between movement and vertigo onset, with nausea.
No tinnitus or loss of hearing
presence of risk factors

Question 5

Recognise the signs of benign paroxysmal positional vertigo on physical examination

Answer 5

Dix-Hallpike Test: nystagmus is a positive sign

Question 6

Identify appropriate investigations for benign paroxysmal positional vertigo and interpret the results

Answer 6

Dix-Hallpike manoeuvre:
Supine lateral head turns
audiogram
CT/MRI: to exclude other differentials (e.g. lesions)

Question 7

Define Meniere’s disease

Answer 7

Disorder of the inner ear caused by a change in fluid volume in the labyrinth
Diagnostic: vertigo, tinnitus, hearing loss

Question 8

Explain the aetiology / risk factors of Meniere’s disease

Answer 8

There is a progressive distension of the membranous labyrinth, the exact cause in unknown.
Risk Factors: allergy, autoimmunity, genetic susceptibility, vascular factors, viral infection

Question 9

Summarise the epidemiology of Meniere’s disease

Answer 9

157:100,000; peak incidence at 40-60 years

Question 10

Recognise the presenting symptoms of Meniere’s disease

Answer 10

Core Symptoms: vertigo, tinnitus, fluctuating hearing loss with a sensation of aural pressure
Pattern:
• Acute attack lasting minutes-hours (often 2-3 hours)
• Acute episodes occurring in clusters (6-11 per year)
• Remission lasting several months
• Initially unilateral, developing to bilateral
Other Symptoms: ‘drop-attacks,’ imbalance,

Question 11

Recognise the signs of Meniere’s disease on physical examination

Answer 11

No diagnostic signs; examine for:
• Anaemia, blood pressure, arrhythmias, carotid bruits
• Cranial nerves, gait, and co-ordination
• Ears for wax, hearing tests
• Dix-Hallpike manoeuvre

Question 12

Identify appropriate investigations for Meniere’s disease and interpret the results

Answer 12

Bloods: exclude systemic illness – FBC, TFTs, ESR, CRP

MRI – advised for unilateral cases (exclude other causes of vertigo e.g. acoustic neuroma)