Meniere's Disease, BPPV, Acoustic Neuroma, Vestibular Neuritis, Viral Labyrinthitis ☺️

Question 1

Meniere’s Disease vs BPPV

• epidemiology and etiology
• pathophysiology
• symptoms and signs

Answer 1

Meniere’s - excess endolymph

• middle age, found in both sexes
• episodes last mins-hours
• symptoms generally unilateral but may become bilateral with time
• recurrent attacks of vertigo, tinnitus, sensorineural hearing loss, ear pressure
• nystagmus, +ve Romberg test

BPPV - otoliths move into semicircular ducts, cause vertigo when displaced

• most common cause of vertigo
• 55s
• episodes last seconds
• nausea, +ve Dix Hallpike manoueuvre

Question 2

Meniere’s Disease vs BPPV

• diagnosis
• management (practical, attacks, prevention)
• prognosis

Answer 2

ENT assessment confirms diagnosis for both

Meniere’s

• inform DVLA, stop driving until symptoms controlled
• Acute - prochlorperazine (typical antipsychotic with antiemetic properties)
• Prevention - betahistine (anti-vertigo) and vestibular rehab
• Self-limiting- 5-10years but with hearing loss and psychological distress

BPPV

• Epley, vestibular rehab
• Betahistine given but not always effective
• Self-limiting but can recur

Question 3

Acoustic neuroma

• epidemiology, etiology
• pathophysiology
• symptoms and signs

Answer 3

No obvious cause but linked to neurofibromatosis T2

Benign tumour that may compress CN5, 7, 8

Triad of vertigo, hearing loss, tinnitus (CN8), no corneal reflex (CN5)
-CN7 - facial palsy

Question 4

Acoustic neuroma

• diagnosis
• management

Answer 4

If suspected => URGENT REFERAL TO ENT

Gold standard - MRI of CPA
-audiometry

Management
-observe/surgery/radiotherapy

Question 5

Viral labyrinthitis vs vestibular neuritis

• epidemiology and etiology
• pathophysiology
• symptoms and signs

Answer 5

Viral labyrinthitis - inflammed membranous labyrinth

• 40-70, recent URTI
• vertigo exacerbated by mv but not a trigger => N+V
• sensorineural hearing loss, tinnitus
• nystagmus

Vestibular neuritis -inflammation of vestibular nerve

• recent URTI
• vertigo attack lasts hours-days => N+V
• no hearing loss
• nystagmus

Question 6

Viral labyrinthitis vs vestibular neuritis

• diagnosis
• management (practical, attacks, prevention)
• prognosis

Answer 6

Clinical diagnosis

Self limiting
-prochlorperazine or betahistine can help