Vertigo

Question 1

what are the two types of vertigo?

Answer 1

peripheral or central

Question 2

what are the clinical features of peripheral vertigo?

Answer 2

Severe, accompanied by loss of balance, nausea, vomiting, reduced hearing, tinnitus, nystagmus (usually horizontal) and diaphoresis

Question 3

what are the clinical features of central vertigo?

Answer 3

• Hearing loss and tinnitus are less common, less severe, nystagmus may be horizontal or vertical

Question 4

what are the causes of peripheral vertigo?

Answer 4

Menieres disease, BPPV, vestibular failure, labyrinthitis, superior semi-circular canal dehiscence

Question 5

what are the causes of central vertigo?

Answer 5

acoustic neuroma, MS, head injury, migraine, vertebrobasilar insufficiency

Question 6

what is the duration of BPPV?

Answer 6

Mins

Question 7

what is the duration of Meniere’s

Answer 7

Hours

Question 8

what is the duration of Labyrinthitis?

Answer 8

Days-weeks

Question 9

what is the duration of VN?

Answer 9

Days-weeks

Question 10

is there associated HL or Tinnitus in BPPV?

Answer 10

No

Question 11

is there associated HL or Tinnitus in Meniere’s?

Answer 11

Yes

Question 12

is there associated HL or Tinnitus in Labyrinthitis?

Answer 12

Yes

Question 13

is there associated HL or Tinnitus in VN?

Answer 13

No

Question 14

is there aural fullness in BPPV?

Answer 14

No

Question 15

is there aural fullness in Meniere’s?

Answer 15

Yes

Question 16

is there aural fullness in labyrinthitis?

Answer 16

No

Question 17

is there aural fullness in VN?

Answer 17

No

Question 18

is there a clear positional trigger to BPPV?

Answer 18

Yes

Question 19

is there a clear positional trigger to Meniere’s?

Answer 19

No

Question 20

is there a clear positional trigger to Labyrinthitis?

Answer 20

No

Question 21

is there a clear positional trigger to VN?

Answer 21

No

Question 22

what are the causes of BPPV?

Answer 22

head trauma, ear surgery, idiopathic

Question 23

What is the pathophysiology of BPPV?

Answer 23

otolith material from utricle displaced into the semi-circular canals (crystals float into fluid, displaced on movement)

Question 24

what are the clinical features of BPPV?

Answer 24

o Induced by change in position
o Episodes – a few seconds to a few minutes
o No associated hearing loss, tinnitus, aural fullness
o nausea + vomiting
o May have visual disturbance – torsional nystagmus

Question 25

how is BPPV diagnosed?

Answer 25

Hallpike Test

Question 26

what is the management of BPPV?

Answer 26

Epley Manoeuvre Brandt-Daroff Drugs – antihistamines and anticholinergic Surgery – vestibular nerve section

Question 27

what is the cause of Menieres Disease?

Answer 27

unknown

Question 28

what is the pathophysiology of Meniere's disease

Answer 28

o Inner ear o Inflammatory causes that contribute to the development of endolymphatic hydrops = excess fluid in the inner ear leads to dilation of the endolymphatic spaces of the membranous labyrinth

Question 29

what are the clinical features

Answer 29

o History of recurrent, spontaneous, rotational vertigo with at least 2 episodes > 20mins o nausea and vomiting o Recurrence +/- worsening of tinnitus on affected side o aural fullness on affected side o SNHL – lower frequencies, gets progressively worse o Rare – drop attacks – falls without loss of consciousness

Question 30

how is Meniere's disease diagnosed?

Answer 30

through exclusion, electrocochleography, posterior fossa MRI

Question 31

how is Meniere's disease managed?

Answer 31

o Acute Attack: Prochlorperazine (vestibular sedative) o Prophylaxis – betahistine o Also: grommet insertion of gentamicin, labyrinthectomy

Question 32

What is the cause of vestibular neuronitis?

Answer 32

viral – link to herpes, prior URTI

Question 33

what is the difference between pathophysiology of VN and labyrinthitis?

Answer 33

VN - infection of vestibular nerve | Labyrinthitis - affects ear or 8th nerve as a whole

Question 34

what are the clinical features of VN?

Answer 34

* Sudden onset, prolonged vertigo – days to weeks * Associated Nausea/vomiting * Causes horizontal nystagmus * Vestibular Neuritis – no associated tinnitus/hearing loss * Labyrinthitis – may have associated tinnitus/hearing loss * Viral prodromal symptoms

Question 35

what is the management of VN and labyrinthitis?

Answer 35

* Generally self limiting * Vestibular sedatives – prochloperazine (dopamine rector antagonist) * If prolonged – further investigations, rehab