ENT - Vestibular Neuronitis Flashcards
What are the three parts of the inner ear?
- Semicircular canals
- Vestibule (middle section)
- Cochlea
What do the semicircular canals detect?
Rotation of the head
What do the otolith organs (utricle and saccule) detect?
Gravity and linear acceleration
What results from the inflammation of the vestibular nerve?
Distorted signals from the vestibular system to the brain, causing vertigo
What is a common history associated with vestibular neuronitis?
Acute onset of vertigo and recent viral upper respiratory tract infection
What are common symptoms of vestibular neuronitis?
- Severe nausea and vomiting
- Balance problems
What is crucial to differentiate when a patient presents with vertigo?
Peripheral vs central
Neurological signs - central cause rather than vestibular neuronitis - may need urgent management
Particularly if posterior circulation infarction
How can you remember labyrinthitis vs neuronitis?
Labyrinthitis - L oss of hearing
Neuronitis - No hearing loss
What conditions should be considered if tinnitus and hearing loss are present?
- Labyrinthitis
- Ménière’s disease
What is the head impulse test used for?
Diagnosing peripheral causes of vertigo
What does a patient with a normally functioning vestibular system do during the head impulse test?
Keeps their eyes fixed on the examiner’s nose
What happens in a patient with an abnormally functioning vestibular system during the head impulse test?
Eyes will saccade before fixing back on the examiner
What should be checked before performing the head impulse test?
Ensure the patient has no neck pain or pathology
What are short-term options for managing symptoms of peripheral vertigo?
- Prochlorperazine
- Antihistamines (e.g., cyclizine, cinnarizine, promethazine)
How is bacterial labyrinthitis treated?
Antibiotics, treat underlying infection e.g. otitis media or meningitis
Patients rarely have lasting symptoms, but more common after bacterial labyrinthitis and particularly meningitis
What is a key complication of meningitis?
HEARING LOSS
All patients offered audiology assessment as soon as they are recovered
How long can symptomatic treatment for vestibular neuronitis be used according to NICE?
Up to 3 days, extended use can slow recovery
When should a patient be referred for further investigation or vestibular rehabilitation therapy?
If symptoms do not improve after 1 week or resolve after 6 weeks
May need further investigation or vestibular rehabilitation therapy
What is the typical prognosis for symptoms of vestibular neuronitis?
Symptoms are most severe for the first few days and gradually resolve over 2-6 weeks
What condition may develop after vestibular neuronitis?
Benign paroxysmal positional vertigo (BPPV)
