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ENT > The Dizzy Patient > Flashcards

The Dizzy Patient Flashcards

1
Q

what is the most common cause of GP presentation in 75+ year olds?

A

dizziness

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2
Q

dizziness can be related to what 8 things?

A 
cardio
haematological and metabolic
anxiety
neurological
drugs
migrane
ontological
trauma
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3
Q

dizziness vs vertigo?

A

non-specific - can cover vertigo, pre-syncope, disequilibrium
vertigo = sensation of movement, usually spinning

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4
Q

what can affect cardio system to cause dizziness?

A

arrhythmias

postural hypotension

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5
Q

what can affect vestibular system to cause dizziness?

A

BPPV
Menieres
vestibular neuronitis

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6
Q

what can affect proprioceptive system to cause dizziness?

A

diabetes
arthritis
neurology

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7
Q

what can affect visual system to cause dizziness?

A

cataracts

diabetes

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8
Q

how can central pathways be affected to cause dizziness?

A

stress
migraine
MS
space occupying lesion

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9
Q

features of cardiac dizziness?

A

lightheaded, syncope, palpitations

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10
Q

features of neurological dizziness?

A 
blackouts
visual disturbance
paraesthesia
weakness
speech and swallow problems
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11
Q

features of vertigo dizziness?

A

spinning, falling, being pushed sensation

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12
Q

how can duration of episodes aid diagnosis?

A 
seconda = BPPV
hours = menieres
days = vestibular neuritis
variable = migraine associated vertigo
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13
Q

what symptoms may be associated with dizziness?

A 
hearing loss
tinnitus
aural pressure
migraines or sensory sensitivity
sound or pressure induced symptoms
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14
Q

top questions for quick diagnosis?

A

do you get dizzy rolling over in bed? = BPPV
was your first attack severe, lasting hours with nausea and vomiting = vestibular neuritis
do you ever get light sensitive during the dizzy spells? = vestibular migrane
does one ear ever feel full or do you get hearing loss before or during the dizzy spell? = menieres

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15
Q

components of examination of dizziness?

A 
otoscopy
neurological
BP (lying and standing)
balance system
audiometry
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16
Q

what are the vestibular end organs?

A

ampullae of lateral posterior and superior semi-circular canals
maculae of utricle and saccule

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17
Q

how can direction of nystagmus indicate which ear is affected?

A

usually away from lesion

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18
Q

bilateral nystagmus?

A

central lesion

19
Q

excitement of left and right sides of vestibule when head is static/moving
how is this different in normal and right vestibular neuritis?

A

normal
- equal left and right excitement when static
- more left excitement when turning left
- more right side excitement when turning right
right vestibular neuritis
- no excitement in the right when static so left seems more by comparison and brain therefore thinks head is moving?

20
Q

vertical nystagmus?

A

e.g stroke

central lesion

21
Q

head impulse test?

A

quick movements of head while focusing on a spot
tests V.O.R
eyes will slip if V.O.R is abnormal

22
Q

name 3 common causes of ???

A

postural dizziness
side effects of medication
psychogenic and interaction with imbalance

23
Q

what causes BPPV

A

crystals (otoliths) break off membrane of the utricle and float around the ear
can enter the semi-circular canal which can trick the semi-circular canal into thinking youre spinning

24
Q

what can initially cause BPPV?

A

head trauma
ear surgery
idiopathic

25
Q

what can BPPV be confused with and how can they be differentiated?

A 
vertebrobasilar insufficiency (VBI)
VBI diagnosis requires other symptoms of impaired circulation in posterior brain associated with the vertigo
- visual disturbance
- numbness
- weakness
26
Q

when does vertigo occur in BPPV?

A 
looking up
turning in bed
first lying down in bed at night
first getting out of bed in the morning
bending forwards
rising from bending
moving head quickly (often only in one direction)
27
Q

how is BPPV diagnosed?

A

Dix hallpike test
turn head 45 degrees to the left or right and
lay down flat with eyes open
hold for 10 seconds
will produce symptoms of characteristic nystagmus in this 10 seconds
- vertical/torsional nystagmus

28
Q

how is BPPV managed?

A

Epley manoeuvre (most common)
semont manoeuvre
brandt-daroff exercises

29
Q

how does the Epley manoeuvre work?

A

moves the displaced crystals back into the utricle and out of the semi-circular canal

30
Q

how successful is Epley manoeuvre?

A

70-75% success with 1 manoeuvre

90% are symptoms free with 2 manouvres

31
Q

prolonged vertigo and no hearing loss?

A

probably vestibular neuritis

32
Q

features of vestibular neuritis?

A

prolonged vertigo (days)
no associated tinnitus or hearing loss
may be viral prodromal symptoms

33
Q

common cause of vestibular neuritis?

A

usually viral

34
Q

features of labrynthitis?

A

prolonged vertigo (days)
may be associated with tinnitus or hearing loss
probably viral
may have viral prodromal symptoms

35
Q

how is vestibular neuritis/labrynthitis managed?

A

supportive with vestibular sedatives (diazepam etc)
generally self limiting
rule of 3s
- in bed for 3 days
- 3 weeks off work
- off balance for 3 months
further investigation needed if prolonged or atypical

36
Q

how common in menieres?

A

very rare
endolymphatic hydlops?/hydrops?
- pressure builds and can rupture and endolymph and perilymph can mix causing severe attacks of vertigo and tinnitus etc

37
Q

how does menieres disease present?

A

history of recurrent spontaneous rotational vertigo with at least 2 episodes lasting >20 mins (often last hours)
occurrence of or worsening of tinnitus on affected side
occurrence of aural fullness on affected side
documented sensorineural hearing loss on at least one occasion
other causes excluded

38
Q

what type of hearing loss in menieres?

A

low frequency, sensorineural hearing loss

39
Q

sensorineural vs conductive hearing loss?

A 
sensorineural = cause lies in inner ear, cochlea or vestibulocochlear nerve
conductive = due to a blockage, usually temporary
40
Q

how is menieres disease managed?

A 
supportive during attacks
tinnitus therapy
hearing aids
prevention (low salt/betahistine/caffeine/alcohol/stress)
grommet insertion/meniette
intratympanic steroids/gentamicin
surgery
41
Q

why does gentamicin work in menieres?

A

gentamicin is vestibulotoxic (damages vestibular apparatus)

42
Q

what surgery can be used for menieres?

A

vestibular nerve section (separate vestibular and cochlear nerves and then cut the vestibular nerve)

43
Q

what symptoms can accompany migrane?

A

photophobia
phonophobia
25% have spontaneous vertigo and ataxia (doesn’t have to come with headache, can occur in the absence of a headache)
motion sensitivity with bouts of motion sickness

44
Q

how does vestibular schwannoma present?

A

progressive imbalance and hearing loss with tinnitus

ENT (21 decks)

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