Vertigo and Tinnitus Flashcards
Peripheral vs central vertigo location
Peripheral: vestibular system, inner ear CNVIII
Central: cerebellum, brainstem, high centers of cortical functioning
Peripheral vs central vertigo history
Peripheral: Sudden onset, N/V, hearing loss, tinnitus; horizontal nystagmus
Central: gradual vertigo; vertical nystagmus
Physical exam acronym
H-I: head impulse
N- nystagmus (unilateral horizontal - P; vertical/changes direction - V)
T-S: test of skew (brainstem involvement, + test is vertical deviation of the covered eye)
Peripheral vertigo DDx
BPPV
Labyrinthitis
Meniere’s disease
Otitis media
Acoustic neuroma
Vestibular neuritis
Ototoxicity/otosclerosis
Central vertigo DDx
Brainstem hemorrhage/infarction
Cerebellar hemorrhage/infarction
Migraines
Multiple sclerosis
Vertebral artery dissection
Vertebrobasilar insufficiency
Brain tumors
Neurogenerative disorders
onset difference of 3 peripheral causes
seconds - BPPV
hours - Meniere’s disease
days - Labyrinthitis
Vestibular suppressants to treat peripheral causes
Anticholinergics - scopolamine
Antihistamines - meclizine
Sedatives/Benzos - diazepam, clonazepam
Antiemetics for vertigo
Promethazine and ondansetron
Vertigo red flags
Focal neuro deficits
Chest pain, SOB, numbness/tingling
Severe head/neck pain
Loss of consciousness/syncope
What is the most common cause of dizziness esp in older populations
BPPV
What is the etiology of BPPV
Displacement of Otoconia
What is the hallmark of BPPV
Brief episode of vertigo assoc with head position changes
BPPV symptoms
Vertigo lasting seconds to a minute
Head movement/position change
Episodes over several days
Nausea, +/- vomiting
NO HEARING LOSS
BPPV physical exam
PE consistent with peripheral vertigo
+ Dix Hallpike maneuver - vertigo with rotary nystagmus with delayed onset fatiguability
How is BPPV treated?
Epley maneuver
What is typically the cause of labyrinthitis
Viral*
Bacterial
Autoimmune disorder manifestation
What can maternal CMV or rubella lead to
Congenital deafness
Labyrinthitis symptoms
Acute onset of vertigo
Symptoms last several days then gradually improve
Assoc. N/V, unilateral tinnitus, HEARING LOSS
R/O CVA
Labyrinthitis PE
+ nystagmus, horizontal and away from effected ear
Rinne and Weber - SN hearing loss
Neuro exam - ataxia, r/o cerebellar or meningeal involvement
PE consistent with underlying cause
Labyrinthitis treatment
based on underlying cause
Viral - hydrate, rest
Bacterial - Abs
Autoimmune - CS
Vestibular suppressants
Antiemetics
Labyrinthitis prognosis
Symptoms should resolve in a few days to a week but residual symptoms may remain
Vestibular rehabilitation for chronic symptoms
What is Meniere’s disease also known as
Idiopathic endolymphatic hydrops
What is the etiology of Meniere’s disease
Increased pressure within the endolymphatic system secondary to increased fluid
Exact cause of increase fluid unknown
Meniere’s disease symptoms
Acute spontaneous episodes of vertigo
Episodes last minutes to hours with assoc fluctuation unilateral low frequency hearing loss and low tone roaring tinnitus
Ear pressure, fullness, N/V
May relate episodes to diet, stress, or menstrual cycle
Meniere’s disease PE
+nystagmus, horizontal or rotary
Rinne and Weber - SN hearing loss
Neuro exam - ataxia
What test evaluates inner ear pressure
Electrocochleography
Treatment of Meniere’s disease
Lifestyle modifications: sodium restricted diet to 2g/day, limit caffeine and alcohol intake
Med: Diuretics - acetazolamide, triamterene, spironolactone
Treatment of refractory Meniere’s disease
Intratympanic steroid injections
Intratympanic gentamycin injections (end stage)
Meniett device
Shunt placement
Labyrinthectomy
Which of the 3 is most likely to have constant vertigo vs episodic
Labyrinthitis
Which is the 3 is least likely to have erratic eye movements
Meniere’s disease
Which of the 3 will not have hearing loss or tinnitus
BPPV
What is the common etiology of objective tinnitus
vascular or muscular in origin
Describe tonal tinnitus
Ringing, blowing, roaring, high-pitched, white noise
Subjective
Can have assoc hearing loss and stress
DDx of tonal tinnitus
Medications
Noise trauma
Presbycusis
Stress
Define pulsatile tinnitus
Perception of pulsing sound, like a heartbeat
Can be subjective or objective
DDx of pulsatile tinnitus
AVM
Aneurysms
Carotid artery disease
HTN
DDx of staccato tinnitus
Middle ear muscle spasms
Palatal myoclonus
TMJ dysfunction
Define staccato tinnitus
Clicking, popping, tapping sound that can be intermittent
Can be subjective or objective
Common causes of tinnitus
Acoustic neuroma
Medications
Trauma
Age - presbycusis
AOM
Obstruction - cerumen impaction, FB
Meniere disease
Tinnitus treatment
Treat underlying pathology
Hearing aids/cochlear implants if hearing loss
Tinnitus maskers
Cognitive behavioral therapy
Stress reduction
Biofeedback therapy
Avoid loud stimuli
Avoid stimulant use (caffeine, tobacco)
