[ENT] Vertigo

Question 1

what is the 1st line ix for vertigo?

Answer 1

thorough hx and examination

specifically for Meniere’s: audiometry

Question 2

what is vertigo?

Answer 2

a spinning / moving sensation

as opposed to “light headedness” or “unsteadiness”

Question 3

neurological exam shows unidirectional nystagmus but no neuro signs. what kind of vertigo is this?

Answer 3

peripheral

Question 4

neurological exam shows nystagmus and neuro signs. what kind of vertigo is this?

Answer 4

central

Question 5

peripheral vs central: posture

Answer 5

peripheral: can walk, but may be reluctant
central: inability to stand/walk

Question 6

peripheral vs central: hearing loss/tinnitus

Answer 6

peripheral: common
central: uncommon

Question 7

peripheral vs central: other neurological signs

Answer 7

peripheral: no
central: yes (commonly CN dysfunction or DANISH signs)

Question 8

peripheral vs central: nystagmus

Answer 8

peripheral: horizontal and fatiguable
central: multi-directional and fatiguable

Question 9

peripheral vs central: Dix Hallpike test

Answer 9

peripheral: horizontal nystagmus induced by exam
central: vertical or multidirectional nystagmus

Question 10

what are some non-vertigo causes?

Answer 10

1. postural hypotension
2. cardiac failure
3. arrhythmias
4. hypoglycaemia

Question 11

what are some peripheral causes of vertigo?

Answer 11

1. BPPV
2. Meniere’s disease
3. Labyrinthitis / vestibular neuronitis
4. trauma (vestibular damage)

Question 12

what are some central causes of vertigo?

Answer 12

1. stroke / TIA
2. vestibular migraine
3. acoustic neuroma
4. trauma (cerebellar haemorrhage)

Question 13

what are the hallmark sx for Meniere’s disease?

Answer 13

Meniere’s triad:

1. intermittent vertigo
2. unilateral hearing loss
3. tinnitus

Question 14

what other sx do you get with Meniere’s disease?

Answer 14

• sensitivity to loud noises (hyperacusis)

- ‘drop attacks’ due to vertigo

Question 15

what is the diagnostic criteria for a definitive dx of Meniere’s disease?

Answer 15

1. ≥2 episodes of vertigo lasting 20 mins-12 hours
2. fluctuating aural sx
3. sensorineural hearing loss on audiometry before/after vertigo attacks
4. not better accounted for by other vestibular dx

Question 16

what are the risk factors for Meniere’s disease?

Answer 16

• FHx
• age 40-60
• more common in women

Question 17

what is the mx for acute attacks of Meniere’s disease?

Answer 17

oral/buccal prochlorperazine

Question 18

what can be trialled for attack improvement in Meniere’s disease?

Answer 18

betahistine

Question 19

what can be done for severe and refractory cases of Meniere’s disease?

Answer 19

surgical options (e.g. labyrinthectomy)

Question 20

what is the course of Meniere’s disease and what does it terminate as?

Answer 20

progressive, 5-15 year course

terminating as moderate hearing loss, tinnitus and mild imbalance

Question 21

diabetic with persistent otalgia despite abx rx. dx?

Answer 21

malignant otitis externa

Question 22

progressive hearing loss and aural fullness with a persistent, foul smell. dx?

Answer 22

cholesteatoma

Question 23

vertigo, tinnitus, aural fullness, facial weakness +/- neurofibromatosis 2. dx?

Answer 23

acoustic neuroma

Question 24

what is true vertigo?

Answer 24

rotational dizziness

in contrast to disequilibrium (poor balance) or presyncope/lightheadedness

Question 25

• reproducible
• fatiguable
• horizontal nystagmus
• no other neurological signs

dx?

Answer 25

peripheral vertigo

Question 26

• not always reproducible
• does not fatigue
• multidirectional nystagmus
• neurological signs (e.g. CN palsies, DANISH signs)

dx?

Answer 26

central vertigo