Ent Balance Flashcards
Vertigo is.
Illusion of movement
Often but not always rotatory
How does dizziness/vertigo makes patients feel
Sick
Nystagmus
Can’t stand up
Dizzy
Nystagmus is
Periodic rhythmic ocular oscillation
Types Of nystagmus
Pendular- (both directions)
Jerk (fast phase and slow phase)
Nystagmus can be physiological or
Central or vestibular
Key features of vestibular nystagmus
Horizontal
Maximal in direction of gaze
Suppresses with fixation
Only goes in one direction
3 main diagnosis of peripheral vestibular problems
Vestibular
Benign paroxysmal positional vertigo
Ménière’s disease
3 main diagnosis of CNS problems
Migraine Brain stem infarcts Cerebellar infarct Tumours MS
Vestibular neuritis is
Intense episode of vertigo
Vestibular neuritis lasts how long
Single episode can last for days
Vestibular neuritis is often preceded
ByURTI
Vestibular neuritis features
Vertigo,nausea and vomiting unable to get out of bed
Present to A&E
Slow compensation
Vestibular neuritis other names
Vestibular neuronit is , labryrinthitis
Vestibular neuritis diagnosis
History, examination for nystagmus, positive thrust test
The head thrust test physiology
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
Management of vestibular neuritis
Hydration
Stop sedatives as soon as possible
Rehabilitation
Vestibular neuritis is not likely if
Other cranial nerve signs
Head thrust test is normal
Nystagmus has atypical features
Associated hearing loss
Bppv is
Benign paroxysmal positional vertigo
Bppv features
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
Bppv treatment
Particle repositioning manoeuvres
Peleus
Modified semont
Aptyical positional nystagmus can indicate
CNS cause
Ménière’s disease first episode?
May look like vestibular neuritis
Attacks of : Incapacitating vertigo Unilateral tinnitus Unilateral hearing loss Preceded by aural fullness pressure
Ménière’s disease attack features
Multiples episodes, often occurring in clusters
Episode 30. Ins - hours
Vomiting/diarrhoea
Exhausted for day
Natural history of menieres
Initially fluctuating low freqhearing loss
Hearing normal between attacks
Gradual loss Of hearing
Disease burns out eventually
Some patients develop drop attacks
Menieres pathology and diagnosis
Diagnosis history=
Audiometry
MRI in future
Pathology-
Endolymphatic hydrops
Treatment for menieres
To prevent attacks -low salt diet
- thiazide Diuretics
- betahistine
Abort attacks-
Prochlorperazine
Other vestibular suppressants
Ménière’s disease treatment
Intratympanic gentamicin Intratympanic steroids Endolymphatic sac surgery Vestibular neurectomy Labyrinthectomy
Vestibular migraine features
Hearing normal
Duration v variable mins- days
Provoked by migraine triggers
Vestibular suppressants and rehab also needed
