Vertigo Flashcards
An illusion of motion is called
true vertigo, a peripheral vestibular disorder
What is the disorder caused by sediment, such as otoconia (calcium carbonate crystals) that have become free floating within the inner ear?
benign paroxysmal positional vertigo (BPPV), a common peripheral vestibular disorder
When the patient turns his or her head quickly or into a certain position, this free-floating material moves the balance canal fluid (endolymph) in the inner ear and stimulates the vestibular division of the eighth cranial nerve. This motion creates an intense feeling of vertigo that lasts less than 60 seconds and passes when the material settles. Patients are usually able to describe the precise motion that precipitates this intense, brief episode of vertigo. This disorder can occur without any specific inciting event, but is often seen after significant head trauma or an episode of vestibular neuronitis.
How is BPPV diagnosed?
Dix-Hallpike test
How is BPPV treated?
Dislodging free-floating otoliths repositioned into the vestibule (a portion of the inner ear), which is about 80 percent effective in eliminating symptoms of BPPV. After a period of time, symptoms may recur, requiring retreatment. Retreatment is equally effective in relieving symptoms.
Medical therapy with vestibular suppressants is ineffective because the episodes of vertigo are so fleeting, and should be discouraged.
Canolith reposition maneuvers include Epley or Semont maneuver, and the Brandt-Daroff exercises are a home method of treating BPPV. They can be effective, but may take more time to be effective.
How are intractable cases of BPPV treated?
Surgical treatments , such as transtympanic gentamycin injections, posterior semicircular canal plugging, vestibular nerve sectioning, sacculotomy, and labyrinthectomy.
Vertigo that is associated with recent flu is likely … ?
vestibular neuritis or labyrinthitis
The patient will usually awaken with room-spinning vertigo that will gradually become less intense over 24–48 hours. During this period, the patient’s hearing is generally unchanged, and nausea with or without emesis is common.
vestibular neuritis or labyrinthitis is treated in what way?
Treatment is symptomatic, including vestibular suppressant medications, antiemetic medications, and a short, tapering course of oral steroids. It may take several weeks for the symptoms to completely resolve. Residual vestibulopathy that persists for months or even years is not uncommon, and is best managed with vestibular rehabilitation.
What is the likely diagnosis in a patient that develops intense, episodic vertigo, usually lasting from 30 minutes to four hours, and associated with fluctuating hearing loss, roaring tinnitus, and the sensation of aural fullness, where even after the episode is over, some hearing loss often remains?
Ménière’s Disease, believed to be secondary to a distention of the endolymphatic space within the balance organs of the inner ear.
This is different from BPPV, where in BPPV the vertigo is in short bursts of 60 seconds or less.
What is the first-line treatment for Ménière’s Disease?
Salt restriction and thiazide diuretics are frequently used as first-line agents.
How is retractable Ménière’s Disease treated?
Vestibular ablation by instillation of ototoxic medication (i.e., gentamicin) into the middle ear for absorption through the round window membrane and into the inner ear has also been used with success, and has a low incidence of hearing loss.
Surgical options for incapacitated patients include endolymphatic sac decompression into the mastoid cavity, vestibular nerve section, and labyrinthectomy. Labyrinthectomy disrupts the aberrant vestibular signals without the risks associated with an intracranial procedure, but it destroys any hearing in the operated ear.
Vestibular nerve section is an intracranial procedure that involves transecting the vestibular portion of the eighth cranial nerve near the brainstem. This procedure disrupts the aberrant vestibular signals from the affected ear, while preserving the patient’s current hearing thresholds.
