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Otolaryngology > Vertigo > Flashcards

Vertigo Flashcards

1
Q

What is dizziness?

A
  • Non-specific term which may cover vertigo, pre-syncope, disequilibrium, etc
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2
Q

What is vertigo?

A

A sensation of movement, usually spinning

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3
Q

What are the 4 inputs to the balance system?

A
  • Visual
  • Proprioceptive
  • Cardiovascular
  • Vestibular
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4
Q

What are the 2 outputs of the balance system?

A

Vestibulospinal tract
Vestibular-ocular reflex

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5
Q

What are some questions required for dizziness history?

A

Describe it in 1 word that isn’t dizzy
Duration of episode
Associated symptoms

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6
Q

Give the cause:
Patient feels lightheaded, syncope, palpitations

A

Cardiac cause

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7
Q

Give the cause:
Patient describes blackouts, visual disturbance, paraesthesia, weaknes, speech and swallow problems

A

Neurological cause

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8
Q

Give the cause:
Patient describes vertigo

A

Vestibular cause

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9
Q

Duration of vertigo episode: Seconds

A

Benign positional paroxysmal vertigo (BPPV)

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10
Q

Duration of vertigo episode: Hours

A

Meniere’s disease

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11
Q

Duration of vertigo episode: Days

A

Vestibular neuritis

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12
Q

Duration of vertigo episode: Varying

A

Migraine associated vertigo

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13
Q

Patient gets dizzy rolling over in bed (Give cause)

A

BPPV

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14
Q

First attack was severe, lasting hours with nausea and vomiting (Give cause)

A

Vestibular neuritis

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15
Q

Patient gets light-sensitive during the dizzy spells (Give cause)

A

Vestibular migraine

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16
Q

One ear feels full and there is a change of hearing during dizzy spell (Give cause)

A

Meniere’s disease

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17
Q

What is nystagmus?

A

Repetetive jerky eye movements

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18
Q

In which direction does nystagmus occur in relation to the affected ear?

A

Nystagmus occurs away from the affected ear

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19
Q

What test is used to track nystagmus?

A

Head impulse test

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20
Q

What are the main causes of vertigo?

A

Benign positional paroxysmal vertigo (BPPV)
Vestibular neuritis
Labyrinthitis
Meniere’s disease
Migraine associated vertigo
Vertebrobasilar insufficiency

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21
Q

Which causes of vertigo are associated with hearing loss or tinnitus?

A

Meniere’s disease
Labyrinthitis

22
Q

What is BPPV?

A

Vertigo caused by the presence of otoconia in the semi-circular canal instead of the utricle; most common cause of vertigo on looking up

23
Q

What are some possible causes of BPPV?

A
  • Head trauma
  • Ear surgery
  • Idiopathic
24
Q

How does BPPV occur?

A

Once in the canal, movement of the patient’s head will result movement of the otoliths, causing an abnormal movement of endolymph which results in vertigo

25
Q

What will be some possible triggers of vertigo in BPPV?

A
  • Looking up
  • Turning in bed - often worse to one side
  • First lying down in bed at night
  • Getting out of bed in the morning
  • Bending forward
  • Rising from bending
  • Moving head quicky - often only in one direction
  • Attacks will last seconds
26
Q

What are some symptoms of BPPV?

A
  • Vertigo
  • Nausea
  • Vomiting
27
Q

What is the main diagnostic test in BPPV?

A

Dix-Hallpike manoeuvre

28
Q

How is the Dix-Hallpike manoeuvre performed?

A
  • Sit up
  • Lie down
  • Will be symptomatic or show eratic nystagmus for 10-60 seconds
29
Q

What are the management options used in BPPV?

A
  • Epley manoeuvre (Shown)
  • Selmont manoeuvre
  • Brandt-Daroff exercises
30
Q

What is labyrinthitis?

A

Inflammation of the labyrinth

31
Q

What is vestibular neuritis?

A

Inflammation of the vestibular nerve

32
Q

What is the most common cause of labyrinthitis and vestibular neuritis?

A

Viral infection

33
Q

How will labyrinthitis and vestibular neuritis present?

A
  • 1st attack lasting hours
  • Prolonged vertigo lasting days
  • Nausea and vomiting
  • Viral symptoms
34
Q

What is a symptom of labyrinthitis specifically?

A

Tinnitus or hearing loss

35
Q

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

A
  • In bed 3 days
  • Off work 3 weeks
  • Off balance 3 months
36
Q

How is vestibular neuritis and labyrinthitis managed?

A
  • Supportive management with vestibular sedatives
  • Generally self-limiting
  • May require further investigation if prolonged or atypical
  • May be helped by rehabilitation exercises if prolonged
37
Q

What is Meniere’s disease?

A

Idiopathic disorder causing vertigo

38
Q

What is though to be the cause of Meniere’s disease?

A

Excess of endolymph within the membranous labryth

39
Q

What is thought to cause symptoms in Meniere’s disease?

A

Increase in endolymphatic pressure due to dysfunctioning sodium channels

40
Q

How does Meniere’s disease present?

A
  • Severe paroxysmal vertigo (At lease 2 episodes > 20 minutes)
  • Sensorineural hearing loss
  • Tinnitus
  • Aural fullness
41
Q

How will Meniere’s disease present on audiometry?

A

Typically low frequency sensorineural hearing loss

42
Q

What condition is shown?

A

Meniere’s disease

43
Q

How is Meniere’s disease managed?

A
  • Supportive treatment during episodes
  • Tinnitus therapy
  • Hearing aids
  • Lifestyle advice
44
Q

What lifestyle advice should be given in Meniere’s disease?

A

Reduce salt intake
Avoid chocolate
Avoid caffeine
Avoid stress

45
Q

What is meant by migraine associated vertigo?

A

Episode of vertigo in someone who has a history of migraines - about 25% of migraine sufferers have spontaneous attacks of vertigo and ataxia

46
Q

How will migraine associated vertigo present?

A
  • Light-sensitive during dizzy spells of variable duration
  • Phonophobia
  • Fluctuating hearing loss, acute permanent hearing loss occur in a small percentage
  • Motion sensitivity with bouts of motion sickness
47
Q

How can migraine associated vertigo be managed?

A
  • Lifestyle modification
  • Avoid triggers
  • Abortive agents (E.g. triptans)
  • Prophylaxis (E.g. Propranolol)
48
Q

What is vertebrobasilar insufficiency?

A

Describes a temporary set of symptoms due to ischaemia in the posterior circulation of the brain

49
Q

What causes vertebrobasilar insufficiency?

A

Narrowing of the posterior circulation arteries, most commonly due to arteriosclerosis

50
Q

How will vertebrobasilar insufficiency present?

A
  • Vertigo on looking up
  • Visual disturbance
  • Weakness
  • Numbness
51
Q
A

Otolaryngology (23 decks)

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