Vertigo Flashcards
What is vertigo?
The illusion of movement. It is important to clarify with patient whether it feels like things are spinning or they feel lightheaded etc
what are the causes of peripheral vertigo?
Benign paroxysmal positional vertigo,
Meniere disease,
Acute labyrinthitis
Vestibular neuronitis,
Otosclerosis,
Vestibular nerve tumours,
Ramsay hunt syndrome
What are the causes of central vertigo?
STROKE - posterior circulation infarct,
Tumour,
MS,
Vestibular migraine.
The vertigo will be sustained and non positional.
Describe features of BPPV (cause, presentation, Ix and Rx)
Cause - Crystals called otoconia becoming displaced in semicircular canals.
Presentation - vertigo triggered by change in head position +/- nausea, episodes last 10-20s.
Ix - Dix-Hallpike maneuvre which recreates symptoms and rotatory nystagmus.
Rx - Epley manoeuvre
Describe features of Meneires disease (cause, presentation, Ix and Rx)
Causes - excess endolymph.
Presentation - Recurrent episodes (mins to hours) of vertigo, tinnitus, hearing loss, aural fullness, , nystagmus, romberg’s positive.
Ix - ENT referral
Rx - Inform DVLA, buccal/IM prochlorperazine for acute attacks and betahistine for prevention.
Describe features of Vestibular neuronitis (cause, presentation, Ix and Rx)
Cause - Inflammation of vestibular nerve. Often following a viral infection.
Presentation - recurrent vertigo attacks (hours-days), nausea and vomiting, horizonal nystagmus and NO hearing loss/tinnitus
Ix - HiNTs exam to distinguish from posterior circulation stroke.
Rx - Buccal/IM prochlorperazine for rapid relief. Short oral course of prochlorperazine for milder cases and vestibular rehabilitation if chronic
Describe features of Labyrinthitis (cause, presentation)
Cause - viral infection causing inflammation of inner ear.
Ix - clinical diagnosis but preform HiNTS exam to exlude central cause.
Presentation - Sudden onset of vertigo, N+V, hearing loss.
Rx - Prochlorperazine/antihistamines
Explain the HiNTS exam
Head Impulse test - Turn head quickly while getting pt to focus on nose. Positive in vestibular vertigo (eyes will saccade to fix back on nose). Negative in central/brain vertigo.
Nystagmus - Unidirection and horizonal/torsional in vestibular vertigo. Vertical with changing direction if central vertigo.
Test of Skew - cover eye while pt focuses on nose, alternate covering the eye. No skew divation in vestibular vertigo. Skew deviation (occular misalignment) if central vertigo
Head shake nystagmus - worsens with vestibular, no change with central
What are the different symbols on an audiogram?
The normal reading and what happens in sensorineural and bone conduction hearing loss.
X - left air conduction.
] - left bone conduction.
O - right sided air conduction
[ - Right sided bones conduction
Normal hearing is between 0-20dB
Sensorineural hearing loss - both air and bone conduction over 20bB.
Conductive hearing loss - Bone conductive hearing normal but air conduction > 20dB
What is glue ear and its risk factors?
What - otitis media with effusion.
Risk factors - Male sex, siblings with glu ear, winter/spring months, bottle feeding, nursary, parental smoking
Presentation and management of otitis media with effusion?
Features - Peak incidence at 2 years old. Hearing loss is the presenting feature which if left can result in secondary problems like speech and language delay.
Management - Active observation for 3 months for first presentation, often resolved. Otherwise Grommet insertion +/- adenoidectomy.
