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ENT > The dizzy patient > Flashcards

The dizzy patient Flashcards

1
Q

What can cause dizziness?

A 
CV system
Haematological and metabolic
Anxiety
Neurological conditions
Drug side-effects/ interactions
Migraine
Otological
Trauma
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2
Q

What is dizziness?

A

A non-specific term which covers vertigo, presyncope, disequilibrium etc

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3
Q

What is vertigo?

A

A sensation of movement, usually spinning or falling

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4
Q

What vestibular problems can cause dizziness?

A

BPPV
Meniere’s
Vestibular neuronitis

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5
Q

What visual problems can cause dizziness?

A

Cataracts

DM

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6
Q

What proprioceptive problems can cause dizziness?

A

DM
Arthritis
Neurology

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7
Q

What cardiovascular problems can cause dizziness?

A

Arrhythmias

Postural hypotension

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8
Q

What central pathways can cause dizziness?

A

Stress
Migraine
SOL - space occupying lesion
MS

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9
Q

What would point to a cardiac cause of dizziness in the history?

A

Lightheadedness
Syncope
Palpitations

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10
Q

What would point to a neurological cause of dizziness in the history?

A 
Blackouts
Visual disturbance
Paraesthesia
Weakness
Speech and swallow problems
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11
Q

Why is the duration of vertigo cruital in history taking for a diagnosis?

A

Seconds - benign positional paroxysmal vertigo
Minutes/hours - meniere’s
Days - vestibular neuritis
Variable - migraine associated vertigo

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12
Q

What are common signs of meniere’s disease?

A

Vertigo for mins/hours
Hearing loss
Tinnitus
Aural pressure - inner ear problem causing SNHL

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13
Q

What would point to a migraine cause of vertigo?

A

Smell or vision triggers
Closing eyes makes it better
Photophobia

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14
Q

What are good questions to ask in a dizzy history?

A

Do you get dizzy rolling over in bed? BPPV
Was your first attack severe, lasting hours with assoc N+V? Vestibular neuritis
Are you light-sensitive during the spells? Vestibular migraine
Do you feel one ear full or do you get hearing loss before or during the spell? Meniere’s

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15
Q

What should be included in an examination of a dizzy patient?

A 
Otoscopy
Neurological
BP lying and standing
Balance system
Audiometry
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16
Q

What would stem an urgent referral to an ENT surgeon upon examination of the ears of a dizzy patient?

A

Acute otitis media

Cholesteatoma

17
Q

What does the fast phase of a nystagmus tell you?

A

The affected ear - the fast phase is away from the affected ear

18
Q

What is bi-directional nystagmus pathognomonic of?

A

Central MS plaque

19
Q

What does a vertical nystagmus tell you?

A

Central lesion - commonly a stroke

20
Q

What can cause BPPV and what is the pathophysiology of it?

A

Causes: head trauma, ear surgery, idiopathic
Pathophysiology: otolith material from utricle displaced into the posterior semicircular canal

21
Q

What other condition can benign positional paroxysmal vertigo be confused with?

A

Vertebrobasilar insufficiency
For a diagnosis of VBI, need other symptoms of impaired circulation in the posterior brain such as visual disturbance, weakness and numbness

22
Q

What commonly triggers vertigo in BPPV?

A

Looking up
Turning in bed
Upon first lying down at night and on first getting out of bed in the morning
Bending forwards
Rising from bending
Moving head quickly - often only in one direction

23
Q

How can BPPV be diagnosed?

A

Sit up with eyes open
Lie down rather quickly
Look for a short delay and then symptoms of vertigo and vertical nystagmus with twisting
Feel dizzy and sick

24
Q

How can BPPV be treated?

A

Epley manoeuvre
Semont manoeuvre
Brandt-daroff exercises

25
Q

What is vestibular neuronitis?

A

Prolonged vertigo for days
No assoc tinnitus or hearing loss
Viral aetiology

26
Q

What is labyrinthitis?

A

Prolonged vertigo for days
Associated tinnitus or SNHL
Viral aetiology

27
Q

How is vestibular neuronitis/ labyrinthitis treated?

A

Supportive with vestibular sedatives
Self-limiting
If prolonged requires further investigation
Can be helped with rehab exercies

28
Q

What is the rule of 3 associated with vestibular neuronitis?

A

In bed for 3 days
Off work for 3 weeks
Off balance for 3 months

29
Q

What should be suspected with chronic vestibular neuronitis?

A

Vestibular schwanomma

30
Q

What is the pathophysiology behind meniere’s disease?

A

Endolymphatic hydrops - high pressure causing a rupture

This results mixing of endolymph and perilymph

31
Q

What is the criteria for diagnosing meniere’s disease?

A

Recurrent, spontaneous rotational vertigo with at least 2 episodes lasting more than 20 mins
Occurence of or worsening of tinnitus on affected side
Occurence of aural fullness on affected side
Documented SNHL on at least one occasion

32
Q

What are of hearing will be affected in meniere’s disease?

A

Low frequency reduced in bone and air conduction in one side

Bone conduction and air conduction on unaffected side normal

33
Q

How is meniere’s disease treated?

A 
Supportive treatment during episodes
Tinnitus therapy
Hearing aids
Salt restriction 
Caffeine and alcohol limitations 
Grommet insertion
Intratympanic steroids or gentamicin
Surgery - vestibular nerve section
34
Q

What is the most common auditory symptom in migraines?

A

Phonophobia - dislike of loud noises during attack

Fluctuating hearing loss occur in a small proportion of patients

35
Q

What vertigo conditions are associated with hearing loss or tinnitus?

A

Meniere’s disease

Labryinthitis

36
Q

What vertigo condition is associated with aural fullness?

A

Meniere’s disease

37
Q

What vertigo condition is associated with a clear positional trigger?

A

BPPV

38
Q

What is a vestibular schwannoma?

A

Benign tumour of the VIIIth nerve sheath at the cerebellopontine angle
Progressive imbalance and hearing loss
Space occupying disease of IMA so can have facial nerve dysfunction

ENT (20 decks)

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