Medical and Surgical Management Flashcards
1
Q
medical management of acute disorders (goal)
A
- reduce discomfort
- suppress emesis
- sedation
2
Q
medical management of chronic disorders (goal)
A
- suppression of vestibular symptoms
- treatment of specific conditions
- –like meniere’s or migraine
- treatment of reactive depression
3
Q
types of drugs given during acute vestibular crisis
A
- vestibular suppressants: takes the edge off
- –antihistaminic (antivert, bonine, drammamine)
- –anticholinergic (phenergan, scopalamine)
- –benzodiazepines (valium, antivan, klonopin, xanax)
- —-if you see there on a pts case history, ask them why they are taking it, it could be anxiety
- antimetics: makes the vomiting and nausea calm down
- –phenergan, inapsine, zofran, rubinul, compazine
- –oral corticosteroids
- –decadron, deltasone
4
Q
sould vestibular suppressants be givent for long term?
A
no because it prevents the brain from compensating for the peripheral loss
5
Q
benzodiazepines
A
are extremely effective at suppressing severe vertigo
- –alprazolam (xanax) is great for panic attack related vertigo
- –clonazepam (klonopin) is used for migraine related vertigo
- —-can be for seizure disorder, so see why before having them discontinue for VNG
- –diazepam (valium) has a longer life
- –lorazepam (ativan) for attacks under 4 hours and can be administered sublingually which is good for if the pt keeps vomiting
6
Q
antihistamines
A
- most common medications used for “maintenance” of symptoms
- used at the first signs of meniere’s attack
- antihistamines are a milder vestibular suppressant
- –meclizine (antivert)
- –dimenhydrinate (dramamine)
- –diphenjydramine (benedryl)
- –promethazine (phenergan)
7
Q
anticholinergics
A
- a substance that blocks the neurotransmitter aceylcholine in the central and peripheral nervous system
- the most common form we see is the scopolamine patch
- can also slow compensation and can have mental status altering side effects so watch for this
8
Q
migraines
A
- 2nd most common cause of recurrent vertigo after BPPV
- meds frequently used:
- –benzo’s, calcium channel blockers, beta-blockers, tricyclic antidepressants, and selective serotonin reuptake inhibitors
- sleep modification or sleep hygiene
- dietary exclusions
- –caffeine, alcohol, chocolate, cheese, processed meats, red wines, aspartame
9
Q
medical management of menieres
A
- dietary management’
- –reduced sodium (1500mg)
- —-pts often report return of symptoms after a party, wedding, traveling because they exceed the sodium restrictions
- –dietary exclusions: same as migraine: caffeine, alcohol, chocolate, cheese
- medications
- –diuretics
- —-dyazide, diamox
- ——-diuretics control vertigo in 58% of pts and stabilized hearing in 60 %
- other
- –transtympanic steroid injections
- —-becoming more popular but still limited data on effectiveness for menieres
10
Q
meniett device
A
- cleared in 1999 by the FDA for use in the USA for menieres
- tympanoplasty tube is placed in the affected ear
- the meniette is used by the pt to apply repetitive low-pressure pulses to the ear
- the theory is that the pressure changes increase the flow of endolymph through the utriculoendolympatic valve, reducing the buildup of the endolymph
11
Q
surgical management of menieres
A
- transtympanic delivery of aminoglycoside
- –gentamicin perfusion is common
- —-“gent” injections common in ENT
- –under local anesthesia
- –4-6 injections (1/week) until change in vertigo is seen
- –contra ear is unaffected
- –vertigo dissipated over 7-30 days post treatment
- reparative
- -middle ear surgery
- –perilymph fistula
- –sac decompression/endolymphatic shunt
- ablative
- –labyrinthectomy
- –vestibular nerve section
- –canal plugging
- –chemical destruction
12
Q
perilymph fistula repair
A
- exploratory surgery can be done for a fistula if it is presenting like one but it cant be seen with imaging but it is controversial because you could potentially mess something else up
- success
- –64% improve when fistula found
- –44% improve when no fistula found
- vestibular improvement if common
- auditory symptoms such as hearing loss o tinnitus generally are not improved
13
Q
endolymphatic sac decompression/endolymphatic shunt
A
- for endolymphatic hydrops
- moderately beneficial over 2 yrs
- shunts close up by 4 years
- neither very effective at 5 yrs
14
Q
rationale for ablative procedures
A
- fluctuating or progressive peripheral dysfunction doesnt allow compensation to occur
- surgery procedures stable peripheral lesion
- permits central compensation
15
Q
labyrinthectomy
A
- surgical destruction of the inner ear
- trans-canal or trans-mastoid
- eliminated vertigo in 90-93% of cases
- hearing is sacrificed
