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Inner ear Flashcards

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1
Q

Perilymph is?

A

Like CSF surrounding membranous labryinth

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2
Q

Endolymph is?

A

W/in membranous labyrinth

High K+ (auditory signals)

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3
Q

Vertigo is a S/S of?

A

Vestibular dysfx

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4
Q

Vertigo is

A

Illusion - sensation of motion (spin, tumble, fall) when there is no motion or an exaggerated sense of motion in response to movement

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5
Q

Key to Dx vertigos are?

A

The episode and +- HL

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6
Q

Vestibular dysfx types? and Notes of each?

A

Based upon location of dysfx of vestibular pathway
Central - Gradual w/ no auditory S/S
Peripheral - Sudden w/ tinnitus/HL+
—–

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7
Q

Is vertigo a Dx?

A

No - its a S/S of vetibular Dz

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8
Q

What type of vertigo do Otolaryngologists focus on?

A

Peripheral causes of vertigo (balancing organs of inner ear/semicircular canals

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9
Q

What type of vertigo do Neurologist focus on?

A

Central causes

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10
Q

Which is more serious peripheral or central causes of vertigo?

A

Central

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11
Q

3 most common causes of peripheral vertigo?

A

BPPV
Vestibular neuritis
Meniere disease

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12
Q

2 MC causes of central vertigo?

A

Vestibular migraine

Vascular etiologies

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13
Q

Peripheral vertigo pathophys?

A

Issues w/ labyrinth or vestibular nerve

causing severe S/S esp. due to sudden onset

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14
Q

Central vertigo pathophys?

A

Vertigo caused by the balance centers (brainstem and cerebellum)
S/S mild/discrete +- neuro deficits

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15
Q

General S/S of Central vertigo?

A

slurred speech,
diplopia,
pathologic nystagmus

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16
Q

Comprehensive list of peripheral vertigo causes?

A 
Ménière disease
Vestibular neuritis/labyrinthitis
Benign positional vertigo
ETOH intoxication
Inner ear barotrauma
Semicircular canal dehiscence
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17
Q

Comprehensive list of central vertigo causes?

A 
Seizure
Multiple sclerosis
Wernicke encephalopathy
A/V malformation
Brainstem/cerebellum tumor
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18
Q

Clinical approach to vertigo is to?

A

Identify peripheral vs Central
Duartion of vertigo and quality
Ass/w triggers? Rx?
Ass/w S/S (HA, HL, weak, numb, photophobia, tinnitus

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19
Q

When eval for Nystagmus identify what qualities of it?

A

horizontal vs. vertical, +/- fatigability

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20
Q

Brainstem ass/w S/S?

A 
Diplopia
Facial numbness
Weakness 
Hemiplegia
Dysphasia
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21
Q

Does the abscence of brainstem involvement R/O it?

A

No - (Pos findings does rule in)

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22
Q

Persistent vertigo or CNS dz should be eval w/?

A

Audiogram
Brain MRI
Electronystagmography (ENG) or videonystagmography (VNG)

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23
Q

Electronystagmography is

A

electrodes to record eye movements in response to visual or vestibular stimuli

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24
Q

Videonystagmography is

A

uses video cameras to record eye movements in response to stimuli

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25
Caloric stimulation is?
vestibulo-ocular reflex, vestibular or non vestibular (normal response- COWS- Cold Opposite Warm Same)
26
ENG or VNG are used to?
discriminate between central and peripheral etiologies.
27
Peripheral vertigo S/S and PE?
Sudden onset, episodic Can be severe, pt is unable to stand or walk Frequent N/V, excessive perspiration -Tinnitus and HL may be associated -Nystagmus (Fatigable + Horizontal with rotatory component) -Latency -Suppressed by visual fixation
28
Ménière Syndrome AKA?
Endolymphatic Hydrops
29
Ménière Syndrome is?
Chronic condition 2/2 distention of endolymphatic space w/in balance organs
30
Two known causes of Ménière Syndrome?
syphilis and head trauma
31
Ménière Syndrome classic Dx?
Episodic vertigo, lasting 20 min to several hours SNHL – fluctuating and usually lower frequencies Tinnitus – low tone & blowing Sensation of unilateral aural fullness
32
Ménière Syndrome eval consists of?
Audiometry: SHL | Caloric Testing: loss or impairment on the involved side
33
Ménière Syndrome initial TXT
Symptomatic - acute - (po) Meclizine or Valium - primary - low salt diet/diuretics(acetazolamide)
34
Ménière Syndrome refractory TXT
- Intratympanic CCS - endolymphatic sac decompression - vestibular ablation
35
Vestibular ablation performed by?
Transtympanic gentamicin Vestibular nerve section Surgical labyrinthectomy
36
Ménière Syndrome TXT goals
Reduce freq/severity | Reduce/eliminate HL/tinnitus
37
Ménière Syndrome Rehabilitation?
Vestibular rehab w/ exercises to maximize balance. | Able to maintain ADLs
38
Ménière Syndrome Behavior mods for PVT
< 2-3g salt/MSG No lrg meals Reduce caffeine/nicotine/Etoh (fluid/lyte shifts)
39
Vestibular neuronitis AKA
Labyrinthitis if HL present
40
S/S of Vestibular neuronitis?
``` Acute Persistent/severe vertigo (days/wks) N/V Tinnitus +- Wakes w/ room spinning (less intense w/in wk) ```
41
Is HL preserved in Vestibular neuronitis
Yes
42
Labyrinthitis is?
Vestibular neuronitis but w/ unilateral SHL in involved ear
43
Vestibular neuronitis Patho
Idiopathic - inflam of vestibular n. Or labyrinth Freq ass/w viral URI
44
Vestibular neuronitis Dx
Clinical
45
Vestibular neuronitis PE
Spon horizontal nystagmus (suppress w/ visual fixation) | POS head thrust test
46
Vestibular neuronitis TXT
``` Symptomatic- (N/V, vertigo) Rx- AH or Benzos (Meclizine/diazepam) D/c Rx ASAP Vestibular Rehab ```
47
Benign paroxysmal positioning vertigo (BPPV) is?
Calcium carbonate crystals or other sediment free floats > enters semicircular canals
48
BPPV - key association
Sudden onset vertigo lasting <1m triggered w/ head position | pt notes precise motion
49
BPPV - patho of head movements
Cause sediment to move endolymph stim vestibular nerve.
50
Is BPPV ass/w HL?
No
51
BPPV PE? Is it Dx?
Yes - Nystagmus w/ Dix-hallpike maneuver (DHM)
52
BPPV nystagmus w/ DHM attributes?
Nystagmus and vertigo appear w/ latency of few seconds lasting <30s
53
DHM process
Sit to supine (head off bed) w/ L/R head turn. Upon returning to sit. Process will Fatigue
54
BPPV Txt
Epley repositioning - moves debris to common crus > exits into auricular cavity Rx - episodes are freq or prior to Epleys
55
BPPV Dx/Txt per DHM
Post SC canals - torsional > Epley to txt. Lateral/horizontal SC - txt Lempert (BBQ) Superior/anterior SC - vertical > txt deep hanging head.
56
Is meclizine safe for preg?
Yes
57
Rx for BPPV?
Doc - AH Benzos Antiemetic
58
Traumatic vertigo is usually caused by?
Labyrinthine concussion Basilar skull fx BPPV - chronic post traumatic vertigo
59
MC cause of vertigo post head injury
Labyrinthine concussion
60
Basilar skull fx vertigo - notes
Severe vertigo lasts days-wks w/ deafness in involved ear.
61
Cupulolithiasis AKA
BPPV
62
Txt of traumatic vertigo
Support Vestibular suppressant Rx (meclizine/diazepam) Vestibular therapy
63
Inner ear barotrauma AKA?
Perilymphatic fistula
64
Perilymphatic fistula is?
leakage of Perilymphatic fluid into middle ear via oval/round window
65
Perilymphatic fistula vertigo attributes?
Worse w/ straining and SHL
66
Perilymphatic fistula TXT? Fails?
Bed rest Head elevation Avoid straining Fails > Middle ear exploration and window graft
67
Migrainous Vertigo has what type of etiology?
Mixed central/peripheral
68
Migrainous Vertigo attributes?
Episodic vertigo w/ HA Visual/Motion sensitivty Photo/phono-phobia worsens w/ lack of sleep, anxiety, stress
69
Migrainous Vertigo pts may have a hx of?
Motion intolerance (easily carsick as a child) - Familial
70
Triggers of Migrainous Vertigo?
Caffeine, chocolate, Etoh
71
Migrainous Vertigo TXT?
Dietary/lifestyle changes (sleep/stress avoidance) | Antimigraine prph
72
Migrainous Vertigo is similar to what other disease? But w/ what difference?
Meniere disease w/o HL or tinnitus
73
Semicircular canal dehiscence is?
Deficiency in bony covering of superior semicircular canal which causes vertigo when triggers by loud noise or straining.
74
Semicircular canal dehiscence is tirggered by?
Loud noise or straining
75
Semicircular canal dehiscence accompanied by CHL?
Yes
76
Vertigo - central causes attributes?
Gradual Progressively more severe/debilitating CNS deficits Nystagmus
77
Is auditory fx spared w/ central vertigo causes?
Yes
78
Central vertigo nystagmus attributes?
Nonfatigable Vertical W/out latency Unsuppressed w/ visual fixation (and often worsened)
79
Where to refer central vertifo causes?
Neurology
80
Lesions of CN VIII and central audiovestibular pathways can cause?
Neural HL and vertigo Speech deterioration/dsicrimination Auditory adapation
81
Eval of central auditory/vestibular sys?
- Brainstem Auditory Evoked Responses (BAER): distinguishing cochlear from neural losses - MRI of the internal auditory canal, cerebellopontine angle, and brain
82
Central auditory/vestibular sys D/Os
Vestibular Schwannoma (Acoustic Neuroma) Vascular Compromise Multiple Sclerosis
83
Acoustic Neuroma AKA?
Vestibular Schwannoma
84
Acoustic Neuroma is?
Benign Nerve sheath tumor of the CN 8 arising in internal auditory canal; and gradually grows to involve the cerebellopontine angle (CPA)
85
Acoustic Neuroma are found how usually?
Unilaterally (MC) Incidentally - one of the MC intracranial tumors
86
Bilateral Acoustic Neuroma is AKA?
neurofibromatosis type 2
87
Progressive or sudden unilateral SNHL is what until R/O?
Acoustic neuroma
88
Acoustic neuroma Dx SOC?
MRI w/ gandolinium contrast
89
Acoustic neuroma vertigo presents as?
Vague/continuous disequilibirum +- tinnitus
90
TXT of Acoustic neuroma that is asymptomatic?
Observation + annual MRI for slow growers
91
TXT of Acoustic neuroma that is symptomatic?
excision, radiation + annual MRI
92
Vertebrobasilar Insufficiency MC pop?
elderly with arteriosclerosis
93
Vertebrobasilar Insufficiency is?
Reduced bloodflow in the vertebrobasilar system
94
Vertebrobasilar Insufficiency is triggered by?
Changes to Posture/extension of the neck
95
Vertebrobasilar Insufficiency produces?
transient vertigo but later episodes almost always include other brainstem symptoms
96
Vertebrobasilar Insufficiency TXT?
Empiric w/ vasodilators and ASA | Early Rehabilitation

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