Ent Balance

Question 1

Vertigo is.

Answer 1

Illusion of movement

Often but not always rotatory

Question 2

How does dizziness/vertigo makes patients feel

Answer 2

Sick
Nystagmus
Can’t stand up
Dizzy

Question 3

Nystagmus is

Answer 3

Periodic rhythmic ocular oscillation

Question 4

Types Of nystagmus

Answer 4

Pendular- (both directions)

Jerk (fast phase and slow phase)

Question 5

Nystagmus can be physiological or

Answer 5

Central or vestibular

Question 6

Key features of vestibular nystagmus

Answer 6

Horizontal

Maximal in direction of gaze

Suppresses with fixation

Only goes in one direction

Question 7

3 main diagnosis of peripheral vestibular problems

Answer 7

Vestibular
Benign paroxysmal positional vertigo
Ménière’s disease

Question 8

3 main diagnosis of CNS problems

Answer 8

Migraine 
Brain stem infarcts 
Cerebellar infarct 
Tumours 
MS

Question 9

Vestibular neuritis is

Answer 9

Intense episode of vertigo

Question 10

Vestibular neuritis lasts how long

Answer 10

Single episode can last for days

Question 11

Vestibular neuritis is often preceded

Answer 11

ByURTI

Question 12

Vestibular neuritis features

Answer 12

Vertigo,nausea and vomiting unable to get out of bed

Present to A&E

Slow compensation

Question 13

Vestibular neuritis other names

Answer 13

Vestibular neuronit is , labryrinthitis

Question 14

Vestibular neuritis diagnosis

Answer 14

History, examination for nystagmus, positive thrust test

Question 15

The head thrust test physiology

Answer 15

Vestibulao-ocular reflex keeps gaze on a target during head movement and is extremely fat

It is disrupted in a peripheral lesion

Slower pathways are used to make up for deficit

Question 16

Management of vestibular neuritis

Answer 16

Hydration
Stop sedatives as soon as possible

Rehabilitation

Question 17

Vestibular neuritis is not likely if

Answer 17

Other cranial nerve signs

Head thrust test is normal

Nystagmus has atypical features
Associated hearing loss

Question 18

Bppv is

Answer 18

Benign paroxysmal positional vertigo

Question 19

Bppv features

Answer 19

Short episodes : seconds to minutes

Roll over then a couple of seconds later room begins to spin

Cluster of episodes will resolve with time

More common in elderly people

Question 20

Bppv treatment

Answer 20

Particle repositioning manoeuvres
Peleus
Modified semont

Question 21

Aptyical positional nystagmus can indicate

Answer 21

CNS cause

Question 22

Ménière’s disease first episode?

Answer 22

May look like vestibular neuritis

Attacks of :
Incapacitating vertigo
Unilateral tinnitus
Unilateral hearing loss
Preceded by aural fullness pressure

Question 23

Ménière’s disease attack features

Answer 23

Multiples episodes, often occurring in clusters

Episode 30. Ins - hours
Vomiting/diarrhoea
Exhausted for day

Question 24

Natural history of menieres

Answer 24

Initially fluctuating low freqhearing loss
Hearing normal between attacks

Gradual loss Of hearing

Disease burns out eventually
Some patients develop drop attacks

Question 25

Menieres pathology and diagnosis

Answer 25

Diagnosis history=
Audiometry
MRI in future

Pathology-

Endolymphatic hydrops

Question 26

Treatment for menieres

Answer 26

To prevent attacks -low salt diet

• thiazide Diuretics
• betahistine

Abort attacks-

Prochlorperazine
Other vestibular suppressants

Question 27

Ménière’s disease treatment

Answer 27

Intratympanic gentamicin
Intratympanic steroids
Endolymphatic sac surgery 
Vestibular neurectomy 
Labyrinthectomy

Question 28

Vestibular migraine features

Answer 28

Hearing normal
Duration v variable mins- days
Provoked by migraine triggers
Vestibular suppressants and rehab also needed