ENT - Vestibular neuronitis and labyrinthitis Flashcards
What is vestibular neuronitis?
Inflammation of vestibular nerve, usually due to viral infection
It distorts signals from the vestibular system to the brain
Results in episodes of vertigo
(brain thinks the head is moving when it is not)
Presentation of vestibular neuronitis
Acute onset vertigo
Nausea and vomiting
Balance problems
May be a history of recent viral URTI
Management of vestibular neuronitis
Short term management (up to 3d):
- Prochlorperazine
- Antihistamines (e.g., Cyclizine, promethazine)
- Just during the acute phase of VN
Referral if symptoms do not improve after 1 week or resolve after 6w (may require further investigation or vestibular rehabilitation therapy (VRT))
Prognosis of vestibular neuronitis
Symptoms are most severe for the first few days, after which they gradually resolve over the following 2-6 weeks.
BPPV may develop after VN
How to differentiate between VN and acute labyrinthitis
Labyrinthitis – Loss of hearing
Vestibular Neuronitis – No loss of hearing
Examination to distinguish between central and peripheral vertigo?
The head impulse test
What is the head impulse test?
Involves the patient sitting upright and fixing their gaze on the examiner’s nose.
The examiner holds the patient’s head and rapidly jerks it 10-20 degrees in one direction while the patient continues looking at the examiner’s nose.
The head is slowly moved back to the centre before repeating in the opposite direction.
Ensure they have no neck pain or pathology before performing the test.
RESULTS:
- Normal in central vertigo, no current Sx, or normal
- In peripheral vertigo eyes will saccade as they eventually fix back on examiner
What is labyrinthitis?
Inflammation of the bony labyrinth of the inner ear, including the semicircular canals, vestibule (middle section) and cochlea
Inflammation usually due to viral URTI
- Rarely secondary to bacterial OM or meningitis
Presentation of labyrinthitis?
Acute onset vertigo
Also can have:
Hearing loss
Tinnitus
Diagnosis of labyrinthitis
Clinical diagnosis based on Hx/Exam
But important to exclude central cause of vertigo
- head impulse test to diagnose peripheral causes of vertigo
Management of labyrinthitis?
Same as VN
Supportive care and short-term use (up to 3 days) of medication to suppress the symptoms:
- Prochlorperazine
- Antihistamines (e.g., Cyclizine, promethazine)
Abx used in bacterial labyrinthitis