trigger words (vertigo and tinnitus) Flashcards
CNS lesion or vestibular disease
causes of disequilibrium
often 1st sign of MS
disequilibrium
aural fullness
menieres
abnormal of this type of eye movement suggests cerebellar pathologies
pursuit or saccade eye movements
snapping a patient’s head from 45 degree angles back to face while they watch your nose
head impulse test
if there is no nystagmus this test is positive
the caloric test
indicates vestibular, nerve or brain damage
what should you do if you suspect central etiologies or an acoustic neuroma w vertigo
an MRI
performed w caloric or chair tilt/movement testing
ENG/VNG tests
this test specifically tests otolith function
VEMP
measures muscle reaction in response to sound stimulus
VEMP
saccule sound response triggers what response
ipsilateral SCM contraction
utricle sound response triggers what response
EOM potential during head vibraiton
otolith in the possterior semicircular canal
BPPV
women past menopause
frequent OM
age>50
whiplash/trauma
risk factors for BPPV
vertigo spells lasting less than 1 minute
BPPV
could also be perilymphatic fistulas and semicircular canal dehiscence (this lasts only seconds)
short vertigo resulting from turning over in bed
BPPV
BPPV subtype w vertical nystagmus
horizontal/lateral canal
upward torsional nystagmus
BPPV in posterior canal
downward, torsional nystagmus
superior/anterior canal BPPV
epley manuever
BPPV Otolith REPOSITIONING
semont maneuver
BPPV DECONDITIONING
Brandt-Daroff maneuver
BPPV deconditioning
treatment used for posterior canal nystagmus on dix-hallpike
epley maneuver (otolith repositioning)
deconditioning by turning your head and laying down repeatedly till vertigo goes away
Brandt-Daroff maneuver
involving vestibular division of CN8
vestibular neuronitis
involving vestibular and cochlear division of CN8
vestibular labyrinthitis
due to viral or post-inflammation
vestibular inflammation
asymmetrical labyrinthine inputs
vestibular neuronitis/labyrinthitis
stimulates continuous head rotation.
gait instability TOWARDS the affected side
vestibular inflammation
horizontal nystagmus AWAY from affected side
vestibular inflammation
what test is used to rule out central etiologies
head impulse test
in very suspicious cases you can use MRI
corticosteroids w/i 3 days onset and acyclovir/valacyclovir or ABX
treatment for underlying causes of vestibular inflammation
promethazine, zofran
meclizine
diazepam/lorazepam
treats symptoms of vertigo (N/V, anxiety, inflammation)
im assuming the antihistamine is for inflammtion but tbh idk
vestibular rehabilitation therapy
used for vestibular inflammation
can be for months to years
endolymphatic hydrops
menieres
Endolymphatic hydrops thought to be due to excess endolymph in the inner ear.
head injury/trauma, syphilis, female gender
suspected etiologies for menieres
also associated w the age 20-40 as well as blocked endolymphatic ducts.
unilateral sensorineural hearing loss, tinnitus, vertigo lasting 20min-1 hour
triad for menieres disease
low frequency sensorineural hearing loss and “blowing” tinnitus
menieres
episodic NV w vertigo, hearing improves between episodes
menieres
Clinically diagnosed.
Menieres
barotrauma
low salt diet, decrease caffeine and alcohol.
menieres
chronic treatment includes diuretics such as acetazolamide or HCTZ
menieres
positive pressure pulsation into inner ear as treatment
non destructive treatment for refractory meniere’s
Intratympanic corticosteroid injections
non destructive treatment for refractory meniere’s
can also be used to treat tinnitus!
Endolymphatic shunt
non destructive treatment for refractory meniere’s
vestibular nerve resection
destructive intervention treatment for refractory meniere’s
Surgical labyrinthectomy
destructive intervention treatment for refractory meniere’s
Intratympanic gentamicin injections
destructive intervention treatment for refractory meniere’s
leaking perilymphatic fluid from inner to middle ear
perilymphatic fistula
thinning/absence of the bone above the superior semicircular canal
semicircular canal dehiscence
can be caused by valsalva, barotrauma or trauma.
risk factors for semicircular canal dehiscence or perilymphatic fistula
semicircular canal dehiscence hearing loss type
conductive
perilymphatic fistulas hearing loss type
sensorineural
tullio phenomenon
dizziness induced by sound
seen in perilymphatic fistulas and semicircular canal dehiscence
MRI/CT shows fluid accumulation in round window recess
perilymphatic fistula
MRI/CT shows thin or absent bone above superior semicircular canal
Semicircular canal dehiscence
bed rest with head elevated. PRN symptomatic meds
perilymphatic fistula or semicircular canal dehiscence
refractory tx = surgical patch
perilymphatic fistula or semicircular canal dehiscence
buildup of pressure between middle and inner ear
barotrauma
negative pressure in middle ear
barotrauma
eustachian tube dysfunction
barotrauma
inward bulge of eardrum towards inner ear
blocked eustachian tube w barotrauma
ear pressure/pain, vertigo, hearing loss unilateral (can be bilateral), tinnitus
barotrauma
on exam you see hemorrhage behind TM
barotrauma
on exam you see TM perforation
barotrauma
myringotomy
barotrauma
tympanoplasty
barotrauma
use decongestants
prevention for barotrauma
vascular, neuromuscular, or eustachian tube etiologies
pulsatile tinnitus
tumor of middle ear w HIGH vascularity
paraganglioma/glomus tumor
significant weight loss
cause of open eustachian tube leading to
patulous eustachian tube
autophony
patulous eustachian tube
mucosal irritants or surgery as tx
patulous eustachian tube
“roaring” tinnitus
patulous eustachian tube
PE: ENT, CV, CN
tinnitus PE
MRI to r/o vascular abnormalities
tinnitus
worsened by depression and insomnia
tinnitus
TRT
tinnitus retraining therapy
used for tinnitus
CBT
tinnitus
stress reduction as treatment
tinnitus
Noise inducing generators + counseling.
tinnitus
TMS
tinnitus
