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HEENT > Vertigo and Tinnitus - Exam 3 > Flashcards

Vertigo and Tinnitus - Exam 3 Flashcards

1
Q

_____ imprecise - symptom used to describe a variety of sensations. Describe some common ones.

A

Dizziness

vertigo, lightheadedness/faintness (presyncope), imbalance, combination

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2
Q

_______ sensation of movement when there is no movement - asymmetry of vestibular inputs

A

Vertigo

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3
Q

______ is the cardinal symptom of vestibular disease. What are the 2 types?

A

Vertigo

Physiologic - sustained head rotation
Pathologic - vestibular dysfunction

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4
Q

_____ feeling faint; about to lose consciousness. Presyncopal sensation

A

Lightheadedness/Faintness

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5
Q

______ feeling off-balance. May be due to CNS lesion or vestibular dysfunction

A

Disequilibrium/Imbalance

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6
Q

What is the squared item called? The item not in the box?

A

Vestibular labyrinth

cochlea

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7
Q

_____ is contained within the vestibular labyrinth. What is contained within them?

A

3 semicircular canals

endolymph is located within the semicircular canals

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8
Q

when endolymph moves _____ information about movement is sent to the brain

A

stereocilia

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9
Q

_____ and ____ are otolith organs within the ______. What motions do they each detect?

A

Utricle: horizontal movements

Saccule: vertical movements

vestibular labyrinth

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10
Q

Within the utricle and saccule hair cells detect movement of _____ to determine movement

A

otoconia

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11
Q

In general terms, what does peripheral vertigo present like?

A

Onset: sudden, with unilateral tinnitus +/- hearing loss
N/V
horizontal nystagmus

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12
Q

In general terms, what does central vertigo present like?

A

gradual onset, no hearing symptoms if present, will be bilateral tinnitus

vertical nystagmus

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13
Q

What are some important historical questions to ask? What is one VERY important one?

A

uni or bilateral?
acute or chronic?
**How long have the symptoms lasted?

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14
Q

What are 3 important s/s that could point towards a brainstem or cerebellar lesion?

A

Double vision, ataxia, and/or numbness

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15
Q

______ involuntary back and forth movement of the eyes. ______ can suppress peripheral nystagmus

A

Nystagmus

visual fixation

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16
Q

_____ assesses vestibulo-ocular reflex. What is a normal and abnormal result?

A

head impulse test

focus on the examiner’s nose and the examiner focuses on the pt’s eyes. then the pt’s head is quickly turned to one side.

normal: the pts eyes remain focused on the examiner’s nose the entire time

abnormal: the pt’s eye have to readjust to the examiner’s nose, does NOT remain focused on the examiner’s nose the entire time

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17
Q

What is the Dix-Hallpike maneuver? When do you use it? What does a positive test look like?

A

head is rotated 45 degrees and then body is leaned backwards with the head taken 30 degrees below horizontal

BBPV: the maneuver should induce nystagmus in BBPV

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18
Q

What is an audiometry test?

A

person sits in a booth and different sounds over various tones, pitches and frequencies are played

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19
Q

What is caloric testing? What does warm and cold water do? What is a normal test? abnormal?

A

Procedure: Cold and/or warm water or air is irrigated into the ear

Warm water mimics a head turn to the ipsilateral side
Cold water mimics a head turn to the contralateral side

NORMAL: will induce nystagmus
warm: same side
cold: opposite side

**ABNORMAL: lack of nystagmus

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20
Q

What does an abnormal caloric test indicate? What are some things that could make it abnormally false?

A

Indicates damage to vestibular system, vestibular nerve, or brain

alcohol, antihistamines, sedatives within 24 hrs

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21
Q

What are some CI to caloric testing?

A

OM, middle ear effusion, TM perforation
epilepsy, psychosis, HTN, severe cardiac disease

2nd generation antihistamines, anxiolytics, antidepressants within the last 48 hrs

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22
Q

What is the helpful saying to remember the nystagmus directions of caloric testing?

A
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23
Q

When would you want to order an MRI on a pt with vertigo/tinnitus?

A

Indicated when H&P suggests a central etiology or an acoustic neuroma

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24
Q

What is an Electronystagmography (ENG)? What is a Videonystagmography (VNG)?

A

ENG: Placement of electrodes
Tracing of eye movements
Records presence of nystagmus

VNG: ENG while recording the eye movements

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25
_____ applies repetitive sound stimulus to one ear then averaging the reaction of the muscle activity in response to each soundclick or pulse. What does it assess? What are the two different types?
Vestibular Evoked Myogenic Potential (VEMP) Assesses otolith function cervical and ocular
26
______ Loud sound is delivered to one ear Triggers reflex to ipsilateral SCM muscle SCM muscular activity recorded. What part of the vestibular labyrinth?
cervical VEMP saccule
27
_____ Records EOM potentials during head vibration. What part of the vestibular labyrinth?
Ocular VEMP utricle
28
What does BPPV stand for? What is it?
Benign Paroxysmal Positional Vertigo vertigo that comes and goes based on your position due to calcium deposits in the semicircular canals
29
_____ calcium deposits in the semicircular canal. Usually free-floating _____ that have dislodged from utricle. What canal is MC?
Canalithiasis otoconia posterior semicircular canal
30
What are some risk factors for BPPV?
Age >50 Whiplash or trauma to head/ear Chronic otitis media female: due to increased hormonal fluctuations in menopause
31
Acute, Recurrent brief episodes of vertigo (<1 minute) vertigo occurs after changes in head position What am I? What is the testing? What would you expect to see?
BPPV Dix-Hallpike Maneuver: elicits vertigo and nystagmus
32
**Dix-Hallpike Maneuver with upward, rotary nystagmus, where is the stone?
Posterior Canal BPPV - upward, rotary nystagmus
33
**Dix-Hallpike Maneuver with downward, rotary nystagmus, where is the stone?
anterior canal BPPV
34
**Dix-Hallpike Maneuver with nystagmus beating towards floor, where is the stone?
Horizontal Canal BPPV
35
What is the treatment for BPPV?
medications are NOT helpful!! Epley maneuver: repositioning deconditioning: Brandt-Daroff Maneuver and/or Sermont Maneuver
36
Describe the Epley maneuver. When is it used?
rotating the head to maneuver the stone out of the canal to decrease vertigo
37
______ only vestibular division of CN VIII _____ Vestibular and cochlear division of CN VIII
Vestibular Neuronitis vestibular labyrinthitis
38
Asymmetry of labyrinthine inputs, simulating continuous ____
head rotation
39
sudden onset, persistent and continuous vertigo N/V gait instability nystagmus What am I? What side will the gait instability go? What side will the nystagmus go?
Vestibular Inflammation: Neuronitis gait: sway toward affected side nystagmus: horizontal, beating AWAY from affected side Does not change direction, but suppresses with gaze fixation
40
sudden onset, persistent and continuous vertigo N/V gait instability nystagmus unilateral hearing impairment and/or tinnitus What am I? What does these s/s mimic that you need to cautious about?
Labyrinthitis can mimic acute cerebellar or brainstem infarct or hemorrhage!
41
______ test will be normal in a central lesion etiology.
head impulse test
42
What is the tx for Vestibular Neuronitis/Labyrinthitis? What is the timeframe for optimal results?
methylprednisolone or prednisone 10 day to 3 week tapering dose mainly helpful if given with 3 day of onset
43
What is the tx for Vestibular Neuronitis/Labyrinthitis with vertigo? For how long? Why?
methylprednisolone or prednisone 10 day to 3 week tapering dose with: Antihistamines - meclizine (Antivert) Benzodiazepines - diazepam (Valium), lorazepam (Ativan) Avoid after the first few days - may impede recovery
44
_____ etiology is thought to be related to excess fluid (endolymph) in the inner ear. What is two dz is it associated with? MC pt?
Meniere’s Disease Endolymphatic Hydrops syphilis and head trauma Most often seen in women 20-40 y/o
45
**What is the classic triad of Meniere's Disease?
Episodic vertigo - 20 min to several hours Unilateral hearing impairment - sensorineural, usually low-frequency Tinnitus - usually low-tone and “blowing”
46
Episodic vertigo Unilateral hearing impairment Tinnitus Unilateral aural fullness, +/- pain Hearing usually improves between attacks usually unilaterl but can be bilateral chronic and progressive What am I? What will audiometry show? caloric?
Meniere’s Disease Audiometry - will show hearing loss during acute attacks Caloric Testing - reduced or absent nystagmus on affected side
47
What is the clinical criteria to dx Meniere's Dz? What lifestyle recommendation?
2 spontaneous episodes of vertigo lasting at least 20 min each Unilateral sensorineural hearing loss Tinnitus and/or aural fullness Low salt diet Restrict alcohol and caffeine
48
What is the tx for acute Meniere's Disease?
Meclizine, diazepam, promethazine
49
**What is the tx for chronic Meniere's Disease? Why?
**HCTZ or Acetazolamide Vestibular Rehab hearing aid Loss of salt and water into the urine will shrink the amount of fluid in the body generally as well as inner ear
50
What is the nondestructive interventions for refractory Meniere's dz? destructive?
Nondestructive: Intratympanic corticosteroid injections Positive pressure pulse generator (Meniett) Endolymphatic shunt destructive: Intratympanic gentamicin injections Surgical labyrinthectomy Vestibular nerve resection
51
______ leakage of perilymphatic fluid from inner ear into middle ear ______ abnormal thinning, or absence of bone above the superior semicircular canal
Perilymphatic Fistula Semicircular Canal Dehiscence
52
What are some risk factors for Perilymphatic Fistula and Semicircular Canal Dehiscence?
injury: blunt head trauma, hand slap to ear barotrauma: scuba diving, flying Vigorous Valsalva maneuvers: weight lifting
53
Sensorineural hearing loss Recurrent brief episodes of vertigo (seconds) usually after: sneezing, coughing, heavy lifting, constipation, loud noises etc etc What am I? What is the next step? What will the result be?
Perilymphatic Fistula and Semicircular Canal Dehiscence CT or MRI Perilymphatic Fistula - fluid accumulation in round window recess Semicircular Canal Dehiscence - thin or absent bone above canal
54
______ is dizziness or vertigo induced by sounds
Tullio phenomenon
55
What is the tx for Perilymphatic Fistula and Semicircular Canal Dehiscence? Tx for refractory cases?
Treatment: Prompt ENT referral Bed rest Head elevation Avoidance of straining Symptomatic meds PRN Refractory cases: surgical patch
56
______ is the leakage of fluid from the ____ to ____ due to trauma/pressure change with hearing loss and equilibrium issues
perilymph fistula FROM inner ear INTO middle ear
57
_____ is the build-up of pressure between middle and inner ear. What are some risk factors?
Barotrauma: results from a negative pressure in the middle ear aka pulling ear down inward from negative pressure Eustachian tube dysfunction Barometric stressors: flight**
58
Ear pressure → pain Vertigo Hearing loss Tinnitus May see hemorrhage behind TM May see TM perforation What am I? What is the tx? refractory tx?
barotrauma treat the s/s: pain relievers (most defects will heal over time) refractory tx: surgery Myringotomy, tympanoplasty
59
What are some ways to prevent barotrauma?
Decongestants - several hours (oral) or 1 hour (nasal) before anticipated event Diving - change depths slowly and in stages swallow, yawn, autoinflate frequently Chewing gum or pacifier in infants
60
______ sensation of sound in the absence of an exogenous sound source aka ringing in the ears. What is the difference between pulsatile and nonlulsatile?
tinnitus pulsatile: usually vascular: occurs with the heart beat and tends to be vascular in nature nonpulsatile: usually due to sensorineural Hearing Loss: Ototoxic medications Noise-induced HL Presbycusis
61
What is the a major neuromuscular reason for pulsatile tinnitus?
Spasm - tensor tympani and/or stapedius muscle
62
______ benign vascular neuroendocrine tumor of middle ear. What does it arise from?
Paraganglioma (Glomus tumor) Arises from paraganglia (collection of cells that come from nervous tissue) of the middle ear
63
______ is the MC neoplasm of the middle ear
Paraganglioma (Glomus tumor) highly vascular
64
Reddish or bluish mass May see bulging TM on exam Pulsitile tinnitus, conductive hearing loss, vertigo What am I? What is the tx?
Paraganglioma (Glomus tumor) surgery
65
_____ tube stays open inappropriately. What is MC seen after? What is the classic symptom?
Patulous Eustachian Tube significant weight loss “Roaring” tinnitus and autophony
66
_____ unusually loud hearing of one’s own voice. When do symptoms improve? What is the tx?
Patulous Eustachian Tube Symptoms improve when lowering head below level of heart application of mucosal irritants such as premarin drops (estrogen) -> Causes mucosal swelling or surgery
67
____ is seen with high-frequency hearing loss. May occur with pathologic hearing loss or presbycusis. What is the loss association with? What is the tx?
Sensorineural Hearing Loss Associated with loss or dysfunction of hair cells in cochlea tx: hearing aids
68
_____ is very important to control for a pt who also has tinnitus
HTN
69
What are some exacerbating factors for tinnitus? What are some tx?
Depression Insomnia Tinnitus Retraining Therapy (TRT) reduce stress, CBT BZDs, intra-TM steroid shots, misoprostol masking devices Transcranial magnetic stimulation
70

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