ENT/Opthal Flashcards
What is vertigo?
The sensation that the environment is spinning around relative to oneself or vice versa
WHat is tinnitus?
Hearing noises that are not caused by sounds from outside e.g. ringing, buzzing, whooshing, humming, hissing
What is BPPV?
Peripheral vestibular disorder characterised by sudden short lived vertigo
1) idiopathic 50-70%
2) secondary to trauma, labryinthitis, vestibular neuronitis, Menieres, migraines
50-70YO
Migraine and head trauma common in younger
Rfs for BPPV?
Hx, recent head trauma, viral infection URTI, viral labryinthitis, or vestibular neuronitis, migraines, inner ear surgery and MENIERES
Pathophysiology of BPPV?
Freefloating endolymph canalith particles (displaced otoconia) in the psoterior (most common) semicircular cancals
BPPV presentation?
nausea, imbalance and lightheadedness
Nystagmus 1) slow phase
2) fast phase correction
BPPV canals and nystagmus?
Posterior (common) = fatigued and torsional + weak upbeat position R side eye rotates anticlockwise in fast phase and L clockwise
Anterior = rare and torsional + vertical down beat
Lateral = less common, no fatigues and horizontal nystagmus
BPPV diagnosis and Mx?
Diz-hallpike manouevre
Supine test procedure
Repositioning manouvres or surgery in severe intractable
What is Menieres?
Episodic auditory and vestibular disease with sudden onset vertigo, hearing loss, tinnitus and sensation of fullness in the affected ear
1) idiopathic
2) secondary to inner ear pathology
epi = 40YO, 50% have FHx
Pathophysiology of menieres?
Raised endolymphatic pressure -> reissners mebrane herniation -> mixing of K+ rich endloymph and K+ low perilymph -> abnormal vestibular nerve firing = symptoms
Presentation of menieres?
Hearing loss , roaring tinnitus, sensation of fullness
+ VERTIGO
Drop attacks = sudden loss of balance, no LOC
IX for Menieres?
Ix = +ve rombergs, poor tandem walking, Fukuda/unterberger test (cannot hold position and turns to affected side), audiometry
+ exlcusion MRI
Mx for Menieres?
Lifestyle = salt restriction, reduce caffeine and ETOH, smoking cessation and stress management
Diuretics to reduce endolymph volume e.g hydroclorothiazide
Sx = Vertigo = anti-emetics, e.g. antihistamine, denzo, anticholernergics, corticosteroids
Tinnitus = white noise generation, counselling. 2nd line = antidepressants
Hearing loss = cortiocsteroids + hearing devices
What causes opacification of lens?
Normal ageing, trauma, metabolic disoders, infection e.g. rubella, corticosteroids, congenital conditions
RFS: UV radiation and smoking cause progression
What metabolic conditions cause cataracts?
Wilsons, galactosaemia, myotonic dystrophy and Marfasn