Tinnitus and vertigo Flashcards
What is tinnitus?
The perception of sound typically in the absence of sound
What are the different characters of tinnitus and what do they suggest?
Ringing, hissing or buzzing suggests an inner ear or central cause
popping or clicking suggests problems in the external or middle ear
Pulsatile can suggest increased awareness of the ears bloodflow
What are the two main types of tinnitus?
Objective - heard by examiner - rare - vascular disorders, high output carotid states
Subjective - associated commonly with SNHL - ototoxic drugs can cause bilateral hearing loss with subjective tinnitus
What is the pathophysiology of tinnitus?
It is poorly dnerstood, possible mechanisms include spontaneous otoacoustic emissions or increased activity in the acoustic nerve
What tests should be done for tinnitus?
Audiometry and tympanogram
MRI for unilateral tinnitus to exclude acoustic neuroma
What is the treatment for tinnitus?
Take time to explain tinnitus, it usually starts to resolve itself over time by habituation
Treatment is aimed at reducing symptoms:
-hearing aids to improve perception of background noise
-psychological support - sound therapy
-Cognitive behavioural therapy
What is an acoustic neuroma?
A benign vestibular schwanoma that causes problems through compression
What are the symptoms of an acoustic neuroma?
Ipsilateral tinnitus with or without SNHL
Large tumours can give ipsilateral cerebellar signs
Can also compress nearby CNs (V, VI, VII)
What tests should be done for a suspected acoustic neuroma?
MRI
What is the treatment for acoustic neuroma?
Difficult surgery
Not usually required in elderly, radiosurgery is increasingly popular
What is true vertigo?
The sensation that the world around you is moving or spinning
How can you determine in a history if ‘Dizziness’ is vestibular?
Ask whether things seemed to spin around the patient. Which way did they spin? The patient does not usually hesitate to answer this if it is true vertigo
What do the different lengths of time of vertigo suggest in terms of diagnosis?
seconds to minutes = BPPV
30min to 30 hr = Meniere’s or migraine
30hr to a week = acute vestibular failure
What does the examination for vertigo involve?
Assess cranial nerves and ears
Test cerrebellar function and reflexes
Assess nystagmus, gait, Romberg’s test
Provocation tests (head thrust, Hallpike test
What are the clinical features and pathogenesis of BPPV?
This is vertigo brought on by head turning and lasts more than 30 seconds. It is caused by displacement of otoconia that irritate the semicircular canals
How is BPPV diagnosed?
By ruling out - persistent vertigo, Speech visual and sensory problems, tinnitus, headache, nystagmus
Hallpike test is positive
How is BPPV treated?
Usually self limiting, epley manouvre 70-80% effective
Home repositing manouvres can help
Vasibular supressant medication does not stop the vertigo but can help
What is the pathogenesis of menieres disease?
This is dilation of the endolymphatic spaces in the membranous labyrinth causes sudden vertigo
What are the clinical features of menieres disease?
Sudden vertigo that always comes with nystagmus, lasts 2-4 hrs commonly, often becomes bilateral
What is the treatment of menieres disease?
prochlorperazine is a short term vestibular sedative
Prophylaxis is with betahistine
Labyrinthectomy (cochlear and semi circular canals) is 95% effective but causes ipsilateral deafness
What is acute vestibular failure? what are the clinical features?
This is labyrinthitis - causes sudden attacts of unilateral vertigo and vomiting
Lasts 1-2 days
Nystagmus away from the affected side
What is the treatment for acute vestibular failure?
Vestibular supressants e.g. prochlorperazine or cyclizine
How do you perform the hallpike test?
Get the patient to sit up and look forwards
Then turn their head 45 degrees towards the test ear
Then quickly lie them back with their head 30 degrees below horizontal
This causes maximum stimulation and will cause dizziness or nystagmus if positive
How many episodes of tonsillitis should occur a year to elicit a tonsilectomy?
Should be more than 5
What is sialadenitis?
This is inflammation of a salivary gland likely secondary to obstruction by a stone impacted in the duct
How do you differentiate vestibular neuronitis and labyrinthitis?
Vestibular neuronitis usually has preserved hearing whereas labyrinthitis you can get tinnitus and hearing loss
How long should vestibular sedatives e.g. cyclizine be used in acute vestibular failure?
Should be used for the acute phase 24-72 hours but then stopped after this as this is the period of compensation. During this time they should be stopped to allow optimal compensation and patients should be encouraged to return to normal activity
