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Otorhinolaryngology > Vertigo > Flashcards

Vertigo Flashcards

1
Q

What normally precedes labyrinthitis?

A

usually an URTI

However also:

middle ear infection
intrcranial sepsis
bactereamia

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2
Q

What are the main symptoms of labyrinthitis?

A

Disabling vertigo lasting days to weeks

Residual vertigo due to rapid movements for some months

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3
Q

What is the worst outcome in labyrinthitis?

A

Total destruction of the vestibule (the bit between the labyrinth and cochlea)

causing deafness

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4
Q

What is the treatment of labyrinthitis?

A

antibiotics

vestibular sedatives (Prochlorperazine)

rest

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5
Q

What is vestibular neuronitis?

A

Inflammation of the vestibular portion of the 8th nerve

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6
Q

What is thought to be the cause of vestibular neuronitis?

A

Viral infection

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7
Q

What is the treatment for vestibular neuronitis?

A

Same as for labyrinthitis:

antibiotics

vestibular sedatives (Prochlorperazine)

rest

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8
Q

In vestibular neuronitis how is hearing affected?

A

It is usually NOT

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9
Q

Describe the characteristics of benign paroxysmal positional vertigo (BPPV).

A

episodic vertigo

occurring when the head is moved in a certain position;

classically by turning in bed or

looking up at an object

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10
Q

How long to episodes in benign paroxysmal positional vertigo (BPPV) usually last?

A

usually a few minutes

can remain for hours

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11
Q

How often do episodes in benign paroxysmal positional vertigo (BPPV) usually occur?

A

Weeks or months

before settling

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12
Q

How common is benign paroxysmal positional vertigo (BPPV) and which age group is it most common in?

A

most common cause of vertigo

occurs at any age

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13
Q

How is benign paroxysmal positional vertigo (BPPV) diagnosed?

A

Clinically:
Hallpike manoeuvre

Nystagmus

Vertigo symptoms

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14
Q

How does one perform the Hallpike manoeuvre?

A

sitting up to lying down

and tilting head down 30 degrees quickly

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15
Q

Describe the nystagmus seen in benign paroxysmal positional vertigo (BPPV).

A

rotary towards affected ear

has a latent period before starting

It then: fatigues (slowly settles)

and shows adaptation (lessens with consecutive tests)

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16
Q

What is thought to be the cause of benign paroxysmal positional vertigo (BPPV)?

A

dislodged otoliths

settling in the posterior semicircular canal

and causing irritation with particular movements

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17
Q

How is benign paroxysmal positional vertigo (BPPV) treated?

A

Reassurance

Special head excercises (Epsley’s manoeuvre or cooksey-cawthorne exercises)

Rarely surgery on semi-circular canal

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18
Q

When should vestibular sedatives (e.g. prochlorperazine) be used in BPPV?

A

They SHOULDNT be as they slow the compensation process

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19
Q

What is presbystasis also known as?

A

disequilibrium

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20
Q

What is presbystasis?

A

a momentary feeling of unsteadiness

particularly in elderly people

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21
Q

What is thought to be the cause of presbystasis?

A

Small vessel disease in the brain

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22
Q

Which symptoms can rule out a potential diagnosis of presbystasis?

A

N+V

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23
Q

What is the prognosis of presbystasis and how is it treated?

A

Usually self-limiting

There are no good treatments

24
Q

What is vestibular migraine?

A

Essentially a migrane

with vestibular symptoms (e.g. dizziness)

25
Q

How long do symptoms of vestibular migraine usually last?

A

5 - 20 mins

26
Q

How is vestibular migraine diagnosed?

A

It is a diagnosis of exclusion.

Must rule out things like BPPV

27
Q

What is the relationship of vestibular migraine and auditory symptoms?

A

They do not normally occur in vestibular migraine

28
Q

How is vestibular migraine normally treated?

A

Same as normal migraines (Pizotifen – this is an antihistamine and 5-HT antagonist)

29
Q

What are the three types of dizziness?

A

Central
CV
Peripheral

30
Q

Which bits of anatomy are included in central dizziness?

A

vestibular nuclei, brainstem and upwards

can be of a central nervous system

or cardiovascular origin (probably small vessel disease)

31
Q

What does central dizziness essentially equate to and what is it due to?

A

presbystasis

ischemic small vessel disease of the brain

32
Q

What are CV dizziness symptoms like?

A

General syncopal symptoms

33
Q

What are some causes of CV dizziness?

A

postural hypotension

arrhythmias

vasovagal

34
Q

What parts of anatomy are related to peripheral dizziness?

A

The labyrinth and

vestibular nerve

35
Q

What are the symptoms of peripheral dizziness?

A

Sudden episodes of vertigo

almost always associated with N+V

Hearing loss

Tinnitus

36
Q

Which symptoms of peripheral dizziness point towards a cochlear issue (with regards to peripheral dizziness)?

A

Hearing loss and

tinnitus

37
Q

What are some examples of peripheral dizziness?

A

BPPV

Meniere’s disease (triad of vertigo, tinnitus and hearing loss)

vestibular neuronitis

38
Q

What is nystagmus a clinical sign of?

A

vestibular abnormality (i.e. inner ear except the cochlear)

39
Q

What type of nystagmus points towards a peripheral cause?

A

rotary

or horizontal nystagmus

40
Q

What type of nystagmus ALWAYS points towards central causes?

A

vertical nystagmus or

nystagmus that changes direction

41
Q

How can you tell that there is a DESTRUCTIVE lesion in the labyrinth (regarding nystagmus)?

A

the nystagmus is always AWAY FROM the damaged ear

42
Q

How can you tell that there is a IRRITATIVE lesion in the labyrinth (regarding nystagmus)?

A

the nystagmus is always TOWARDS the damaged ear

43
Q

How many degrees of nystagmus are there?

A

3

44
Q

Describe the degress of nystagmus using examples and what do they indicate?

A

(they indicate the acuteness of the lesion, with 3rd being the most acute)

1st: when looking left (1 direction)
2nd: when looking left and straight ahead (2 direction)
3rd: nystagmus when looking left, right and straight ahead (3 direction)

45
Q

What are the symptoms of Meniere’s disease?

A

triad of vertigo (15mins-24hrs)

tinnitus

flucutant hearing loss

46
Q

What are the 3 inputs for balance?

A

Proprioceptors

Vision

Labyrinth

47
Q

What is the nature of nystagmus due to a cerebellar lesion?

A

Nystagmus is only the ispilateral side

48
Q

What happens to nystagmus over time?

A

It reduces as the body compensates

49
Q

How can you tell is someones labyrinth has ever been damaged?

A

Use Frenzel’s glasses and this will elicit the first degree nystagmus that was caused when the labyrinth was originally damaged.

50
Q

How long does it take for BPPV to get better?

A

Over 12-18 months

51
Q

How common is Meniere’s disease?

A

Rare (ENT doctors see about 2-5 per year)

52
Q

What is the typical age of onset of Meniere’s disease?

A

Middle age

53
Q

What is the treatment of Meniere’s disease?

A

Reassurance, should spontaneously resolve (in 70%)

Bendroflumethiaze is first line treatment too

Can ablate the labyrinth surgically in extreme cases

54
Q

What is an important differential to Meniere’s disease and how should it be investigated?

A

Acoustic neuroma, investigate using MRI.

55
Q

What is benign vestibulopathy?

A

Like Meniere’s disease but:

without hearing loss or tinnitus

and benign vestibulopathy takes about 2 years to spontaneously resolve

56
Q

What is the most common cause of acute labyrinthine faliure?

A

Fracture of temporal bone through labyrinth

57
Q

What are the symptoms of vestibular neuronitis (and what symptoms does it not have)?

A

Sudden onset vertigo

N+V

nystagmus

(No hearing loss or tinnitus)

Otorhinolaryngology (7 decks)

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