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ENT Medicine > The Dizzy Patient > Flashcards

The Dizzy Patient Flashcards

1
Q

What is the most common reason for presenting to the GP in patients over 74?

A

Dizziness

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2
Q

What are some underlying aetiologies that cause dizziness?

A

CV system, haematological and metabolic, drug side effect, neurological conditions, migraine, otological, trauma

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3
Q

What does dizziness describe?

A

Non-specific term which may cover a number of conditions

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4
Q

What is vertigo?

A

Sensation of movement, usually spinning

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5
Q

What are some pathologies affecting the vestibular and cardiovascular systems that may cause dizziness?

A 
Vestibular = BPPV, Meniere's, vestibular neuritis
CV = arrhythmias, postural hypotension
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6
Q

What are some conditions that affect the proprioceptive and visual pathways to cause dizziness?

A 
Visual = diabetes, cataracts
Proprioceptive = diabetes, arthritis, neurology
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7
Q

What conditions may cause dizziness by affecting the vestibulospinal tract and vestibulo-ocular reflex?

A

Stress, migraine, SOL, MS

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8
Q

What must you differentiate between in the history?

A

Whether the underlying pathology is cardiovascular, neurological or vestibular

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9
Q

What associated symptoms would indicate that dizziness is being cause be a cardiovascular problem?

A

Lightheadedness, syncope, palpitations

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10
Q

What associated symptoms would suggest that a neurological problem is causing dizziness?

A

Blackouts, visual disturbances, paraesthesia, weakness, speech and swallow problem

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11
Q

What symptom occurring alongside dizziness would suggest that the underlying cause is a vestibular issue?

A

Vertigo = sensation of motion (falling, spinning, being pushed)

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12
Q

What are some important things to ascertain in the history of a patient with dizziness?

A

Triggers, time course, associated symptoms, precipitators, alleviating factors, medication

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13
Q

What is the key to diagnosing vertigo?

A

Duration of attacks = seconds is BPPV, hours is Meniere’s, days is vestibular neuritis variable would be migraine-associated vertigo

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14
Q

What are some common associated symptoms of dizziness?

A

Hearing loss, tinnitus, pressure, migraines or sensory sensitivity, sound/pressure induced symptoms

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15
Q

What are some top questions that narrow down the list of differentials?

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 get light sensitive during episodes? = vestibular neuritis
Does one ear feel full, or do you get hearing loss before/during the dizzy spell? = Meniere’s

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16
Q

What would be examined in a dizzy patient?

A

Otoscopy, neurological exam, blood pressure (including lying/standing), balance system, audiometry

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17
Q

What are the vestibular end organs?

A

Ampullae of lateral/posterior/superior semi-circular canals, maculae of utricle and saccule

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18
Q

What are common causes of nystagmus?

A

Postural dizziness, side effect of medication, psychogenic and interaction with imbalance

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19
Q

What is the most common cause of vertigo when looking up?

A

Benign positional paroxysmal vertigo (BPPV)

20
Q

What are some causes of BPPV?

A

Idiopathic, head trauma, ear surgery

21
Q

What is the underlying pathology of BPPV?

A

Otolith material from utricle is displaced into semi-circular canals (most commonly posterior canal)

22
Q

What is BPPV often confused with?

A

Vertebrobasilar insufficiency

23
Q

What is needed to diagnose vertebrobasilar insufficiency?

A

Other symptoms of impaired circulation in posterior brain associated with the vertigo = weakness, visual disturbances, numbness

24
Q

What movements trigger vertigo in a patient with BPPV?

A

Looking up , turning in bed (worse on one side), when first lying down/getting out of bed, bending forward, rising from bending, moving head quickly (often in one direction)

25
Q

What test is done to diagnose BPPV?

A

Dix Hallpike test = sit up (ensure enough room to lie back), eyes open, short latency, symptomatic/nystagmus, vertical/torsional geotrophic

26
Q

What would be a positive result in the Dix Hallpike test?

A

Patient is dizzy and may even be sick

27
Q

What interventions can be done to treat BPPV?

A

Epley manoeuvre, Semont manoeuvre, Branolt-Daroff exercises

28
Q

How successful is the Epley manoeuvre in treating BPPV?

A

70-75% treated successfully with single manoeuvre, 90% symptom free after two manoeuvres

29
Q

What are the most easily and successfully treated dizzy patients?

A

Those with BPPV

30
Q

How long does the vertigo associated with vestibular neuritis and labyrinthitis last?

A

Days

31
Q

What is the likely aetiology of vestibular neuritis and labyrinthitis?

A

Viral = may be viral prodromal symptoms

32
Q

What is the difference between labyrinthitis and vestibular neuritis?

A

Labyrinthitis has associated tinnitus/ hearing loss with dizziness, vestibular neuritis just has dizziness

33
Q

How are labyrinthitis and vestibular neuritis treated?

A

Supportive management with vestibular sedatives = usually self limiting

34
Q

When should labyrinthitis and vestibular neuritis get further investigations?

A

If prolonged or atypical

35
Q

What may be helpful in treating prolonged labyrinthitis and vestibular neuritis?

A

Rehabilitation exercises

36
Q

What is the “rule of 3” for labyrinthitis and vestibular neuritis?

A

3 days in bed, 3 weeks off work, 3 months off balance

37
Q

What kind of diagnosis is that of Meniere’s disease?

A

Diagnosis of exclusion = has unknown cause so other reasons for dizziness must be ruled out first

38
Q

What is the typical history for Meniere’s disease?

A

Recurrent, spontaneous, rotational vertigo with at least two episodes of >20 mins duration (often lasting hours)

39
Q

What are some features associated with Meniere’s disease?

A

Occurrence/worsening of tinnitus on affected side
Occurrence of aural fullness on affected side
Documented sensorineural hearing loss at least once

40
Q

How is Meniere’s disease managed?

A

Supportive treatment during episodes
Tinnitus therapy, hearing aids
Grommet insertion/Meniette, surgery
Intratympanic steroids/gentamicin

41
Q

How can episodes of dizziness be prevented in Meniere’s disease?

A

Salt restriction, betahistine, limit alcohol/caffeine/stress

42
Q

How common are migraines?

A

15-20% of patients

43
Q

What do 25% of migraine sufferers also suffer from?

A

Attacks of vertigo and ataxia

44
Q

What is the most common auditory symptom associated with migraines?

A

Phonophobia

45
Q

How may hearing be affected in migraine sufferers?

A

Small percentage report fluctuating hearing loss and acute permanent hearing loss

46
Q

How common is motion sensitivity with bouts of motion sickness in migraine sufferers?

A

About 2/3

47
Q

How common is vertigo in association with migraines?

A

Occur in 1/4 of patients

ENT Medicine (22 decks)

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