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EENT > Vertigo > Flashcards

Vertigo Flashcards

1
Q

Define Vertigo

A
  • produced by vestibular system
  • sensation of movement
  • nausea, emesis, diaphoresis, tachycardia, anxiety, adrenergic response
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2
Q

Define Lightheadedness

A
  • non-vertiginous
  • feel faint or like you will pass out
  • orthostatic +

volume loss, anemia, antihypertensives, diuretics, antidepressants

  • diabetes/hypoglycemia
  • hyperventilation
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3
Q

Define syncope

A
  • non-vertiginous
  • loss of consciousness
  • arrhythmia, sick sinus syndrome, heart valve, reduction in cerebral circulation, subclavian steal syndrome
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4
Q

What do you do in a physical exam for vertigo?

A
  • otologic and vestibular exam (head/neck, tuning forks, nystagmus, Fakuda step test, Dix-Hallpike)
  • neurological exam (CN, cerebellar function, gate)
  • vision
  • proprioception
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5
Q

Benign Paroxysmal Positional Vertigo (BPPV) causes and risk factors

A

multiple quick, recurrent atttacks of vertigo triggered by position changes that quickly resolve with in 10-15 seconds
-most common

  • caused by dislodged utricle otoconia
  • risk factors: CVA, acquired birthdays, previous vestibular neuronitis, Meniere’s Disease, migraine
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6
Q

BPPV signs/symptoms and physical exam

A
  • intense brief (seconds) positional vertigo
  • vertigo fatigues upon repeating position
  • Dix-hallpike maneuver
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7
Q

BPPV treatment

A
  • repositioning (Epley) Maneuver 75%
  • Brandt-Daroff exercise
  • Semont Maneuver
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8
Q

Meniere’s Disease

A 
Episodic vertigo (2 or more events) w/ fluctuating hearing loss, increased tinnitus or aural fullness with no other explination
-common in middle age
  • debilitating, viral or autoimmune etiology
  • endolymphatic hydrops
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9
Q

Meniere’s Disease Signs/Symptoms

A

vertigo that lasts 20 min to 24 hours

unilateral aural fullness, tinnitus, and hearing loss

occurs daily or 2/3years

nausea and emesis

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10
Q

Meniere’s Disease treatments

A

depends on hearing status, labrinthine function, health status, patient wishes

non-destructive and destructive

always start with diet and diuretic (70% control)

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11
Q

Non-destructive treatment for Meniere’s Disease

A

low sodium diet

diuretic

short term vestibular suppressants

oral steroids

immunotherapy

trans-tympanic steroids (90% control 1-2yrs)

endolymphatic mastoid shunt

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12
Q

Destructive treatment for Meniere’s Disease

A

trasntympanic gentamycin (90% control)

sacculotomy

labyrinthectomy (>90%)

vestibular nerve section (>90%)

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13
Q

Vestibular Neuronitis/Acute Labyrinthitis

A

Sudden onset of vertigo lasting minutes to hours followed by several weeks of recovery of equilibrium

aka Epidemic Vertigo

vestibular nerve inflammation-temporal bone histology

virus implications (HSV, flu, epstein-barr, cytomegalovirus)

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14
Q

Vestibular Neuronitis Signs/Symptoms/tests

A

Occasionally recurrent

sudden onset lasting days to week, no hearing loss

nausea, emesis, sever disequilibrium

motion induced disequilibrium for weeks to months

ENG usually reveals unilateral caloric weakness

Test
Fakuda Step Test

falls to side of weakness

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15
Q

Vestibular Neuronitis treatment

A

short term vestibular supressants (benzo, antihist.,anticholi.)

antiemetics

seroids

vestibular rehab ASAP

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16
Q

Labyrinthitis

A

similar presentation to VN

*unilateral hearing loss

inflammation w/in vestibular labyrinth - viral>bacterial

17
Q

Labyrinthitis treatment

A

short term vestibular supressants, antiemetics, steroids.. if bacterial use antibiotics

vestibular rehab

18
Q

Migrainous Vertigo

A

10x more common than peripheral vestibulopathy

young female

history vertigo common

19
Q

Migranious Vertigo Signs/symptoms

A

migraine headaches and episodic vestibular sx and migraine HA together

vestibular symptoms- minutes to hours, possible nausea

photophobia, panophobia

nausea w/ HA

dietary triggers

normal hearing, possible tinnitus

20
Q

Migrainous Vertigo Treatment

A

prophylactic migraine therapy improves HA and vestibular

(CCC, BB,topiramate)

migraine diet

21
Q

Aucoustic Neuroma

A

Benign tumor of vestibular nerve

22
Q

Acoustic Neuroma Signs/Symptoms

A

unilateral SNHL

tinnitus

vestibular symptoms

Unchecked growth

  • HL
  • cranial neuropathies
  • obstructive hydrocephalus
23
Q

Acoustic Neuroma treatment

A

depends on hearing status, age, general health

observation

sterotactic radiosurgery

microsurgical resection

possible vestibular rehabilitation

24
Q

Perilymph Fistual

A

perilymph leak from oval window due to trauma, barotrauma, coughing, congenital

25
Q

Perilymph Fistual signs/symptoms

A

vertgo

nystagmus (fistula test)

disequilibrium

SNHL-unilateral

tinnitus

26
Q

Perilymph Fistual treatment

A

Occurs after a 7 day cruise

females>males, usually subside after 1 month

etiology unclear

rocking motion, still on boat feeling

27
Q

Mal de Debarquement Syndrome

A

Occurs after a 7 day cruise

females>males, usually subside after 1 month

etiology unclear

rocking motion, still on boat feeling

28
Q

Mal De Debarquement prevention and treatment

A

Prevention
-scopolamine, dramamine, meclizine

Treatment

  • vestibular supressants
  • vestibular rehab
29
Q

Multifactorial Dizziness/Disequilibrium of Aging

A

function declines with age

obesity, arthritis, joint replacements, low muscle mass, poor vision, diabetes, CVA, ect

aging affects vestibular, visual, and proprioceptive available

aging affects ability of CNS to process sensory and elicit motor

47% men

61% women

fall over age 65

20-40%

33% significant fall by 80, 50% preceded by vertigo

30
Q

Multifactorial Dizziness/Disequilibrium of aging treatment

A

identify any vestibular disorder and treat

no prolonged vestibular suppressants

night lights, glasses, shoes

vestibular rehab and fall prevention

physical terapy

31
Q

Central Vertigo

A

lesion affects central vestibular pathways

  • multiple sclerosis
  • cerebellar atrophy, stroke, tumor, bleed
  • brain stem stroke
  • vestibular insufficiency
  • Arnold Chiari malformation
  • hydrocephalus; pseudo tumor
  • B12 deficiency, mag depletion, lithium or dilantin toxicity
32
Q

Central Vertigo Signs/Symptoms and treatment

A

signs/symptoms

  • HA, tinnitus/HL, disequilibrium, possible visual changes
  • vertical nystagmus, disequilibrium, severe gait abnormalities, multiple neurological findings

Treatment

  • treat underlying problem
  • vestibular rehab
  • PT
33
Q

Acute Unilateral Peripheral Vestibular Loss

A

caused by sudden asymmetric change in afferent vestibular nerve input

one is sending more info than the other

cerebellum (cerebellar clamp) stops output from both nuclei w/in 24-72 hrs

reduces severe symptoms, disequilibrium and motion induced symptoms continue

EENT (1 decks)

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