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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
Q

_____ 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?

A

Vestibular Evoked Myogenic Potential (VEMP)

Assesses otolith function

cervical and ocular

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26
Q

______ Loud sound is delivered to one ear
Triggers reflex to ipsilateral SCM muscle
SCM muscular activity recorded. What part of the vestibular labyrinth?

A

cervical VEMP

saccule

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27
Q

_____ Records EOM potentials during head vibration. What part of the vestibular labyrinth?

A

Ocular VEMP

utricle

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28
Q

What does BPPV stand for? What is it?

A

Benign Paroxysmal Positional Vertigo

vertigo that comes and goes based on your position due to calcium deposits in the semicircular canals

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29
Q

_____ calcium deposits in the semicircular canal. Usually free-floating _____ that have dislodged from utricle. What canal is MC?

A

Canalithiasis

otoconia

posterior semicircular canal

30
Q

What are some risk factors for BPPV?

A

Age >50
Whiplash or trauma to head/ear
Chronic otitis media
female: due to increased hormonal fluctuations in menopause

31
Q

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?

A

BPPV

Dix-Hallpike Maneuver: elicits vertigo and nystagmus

32
Q

**Dix-Hallpike Maneuver with upward, rotary nystagmus, where is the stone?

A

Posterior Canal BPPV - upward, rotary nystagmus

33
Q

**Dix-Hallpike Maneuver with downward, rotary nystagmus, where is the stone?

A

anterior canal BPPV

34
Q

**Dix-Hallpike Maneuver with nystagmus beating towards floor, where is the stone?

A

Horizontal Canal BPPV

35
Q

What is the treatment for BPPV?

A

medications are NOT helpful!!

Epley maneuver: repositioning

deconditioning: Brandt-Daroff Maneuver and/or Sermont Maneuver

36
Q

Describe the Epley maneuver. When is it used?

A

rotating the head to maneuver the stone out of the canal to decrease vertigo

37
Q

______ only vestibular division of CN VIII

_____ Vestibular and cochlear division of CN VIII

A

Vestibular Neuronitis

vestibular labyrinthitis

38
Q

Asymmetry of labyrinthine inputs, simulating continuous ____

A

head rotation

39
Q

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?

A

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
Q

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?

A

Labyrinthitis

can mimic acute cerebellar or brainstem infarct or hemorrhage!

41
Q

______ test will be normal in a central lesion etiology.

A

head impulse test

42
Q

What is the tx for Vestibular Neuronitis/Labyrinthitis? What is the timeframe for optimal results?

A

methylprednisolone or prednisone
10 day to 3 week tapering dose

mainly helpful if given with 3 day of onset

43
Q

What is the tx for Vestibular Neuronitis/Labyrinthitis with vertigo? For how long? Why?

A

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
Q

_____ etiology is thought to be related to excess fluid (endolymph) in the inner ear. What is two dz is it associated with? MC pt?

A

Meniere’s Disease
Endolymphatic Hydrops

syphilis and head trauma

Most often seen in women 20-40 y/o

45
Q

**What is the classic triad of Meniere’s Disease?

A

Episodic vertigo - 20 min to several hours
Unilateral hearing impairment - sensorineural, usually low-frequency
Tinnitus - usually low-tone and “blowing”

46
Q

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?

A

Meniere’s Disease

Audiometry - will show hearing loss during acute attacks

Caloric Testing - reduced or absent nystagmus on affected side

47
Q

What is the clinical criteria to dx Meniere’s Dz? What lifestyle recommendation?

A

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
Q

What is the tx for acute Meniere’s Disease?

A

Meclizine, diazepam, promethazine

49
Q

**What is the tx for chronic Meniere’s Disease? Why?

A

**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
Q

What is the nondestructive interventions for refractory Meniere’s dz? destructive?

A

Nondestructive:
Intratympanic corticosteroid injections
Positive pressure pulse generator (Meniett)
Endolymphatic shunt

destructive:
Intratympanic gentamicin injections
Surgical labyrinthectomy
Vestibular nerve resection

51
Q

______ leakage of perilymphatic fluid from inner ear into middle ear

______ abnormal thinning, or
absence of bone above the superior
semicircular canal

A

Perilymphatic Fistula

Semicircular Canal Dehiscence

52
Q

What are some risk factors for Perilymphatic Fistula and Semicircular Canal Dehiscence?

A

injury: blunt head trauma, hand slap to ear
barotrauma: scuba diving, flying
Vigorous Valsalva maneuvers: weight lifting

53
Q

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?

A

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
Q

______ is dizziness or vertigo induced by sounds

A

Tullio phenomenon

55
Q

What is the tx for Perilymphatic Fistula and Semicircular Canal Dehiscence? Tx for refractory cases?

A

Treatment:
Prompt ENT referral
Bed rest
Head elevation
Avoidance of straining
Symptomatic meds PRN

Refractory cases: surgical patch

56
Q

______ is the leakage of fluid from the ____ to ____ due to trauma/pressure change with hearing loss and equilibrium issues

A

perilymph fistula

FROM inner ear INTO middle ear

57
Q

_____ is the build-up of pressure between middle and inner ear. What are some risk factors?

A

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
Q

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?

A

barotrauma

treat the s/s:
pain relievers (most defects will heal over time)

refractory tx:
surgery
Myringotomy, tympanoplasty

59
Q

What are some ways to prevent barotrauma?

A

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
Q

______ sensation of sound in the absence of an exogenous sound source aka ringing in the ears. What is the difference between pulsatile and nonlulsatile?

A

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
Q

What is the a major neuromuscular reason for pulsatile tinnitus?

A

Spasm - tensor tympani and/or stapedius muscle

62
Q

______ benign vascular neuroendocrine tumor of middle ear. What does it arise from?

A

Paraganglioma (Glomus tumor)

Arises from paraganglia (collection of cells that come from nervous tissue) of the middle ear

63
Q

______ is the MC neoplasm of the middle ear

A

Paraganglioma (Glomus tumor)

highly vascular

64
Q

Reddish or bluish mass
May see bulging TM on exam
Pulsitile tinnitus, conductive hearing loss, vertigo

What am I?
What is the tx?

A

Paraganglioma (Glomus tumor)

surgery

65
Q

_____ tube stays open inappropriately. What is MC seen after? What is the classic symptom?

A

Patulous Eustachian Tube

significant weight loss

“Roaring” tinnitus and autophony

66
Q

_____ unusually loud hearing of one’s own voice. When do symptoms improve?
What is the tx?

A

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
Q

____ 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?

A

Sensorineural Hearing Loss

Associated with loss or dysfunction of hair cells in cochlea

tx: hearing aids

68
Q

_____ is very important to control for a pt who also has tinnitus

A

HTN

69
Q

What are some exacerbating factors for tinnitus? What are some tx?

A

Depression
Insomnia

Tinnitus Retraining Therapy (TRT)
reduce stress, CBT
BZDs, intra-TM steroid shots, misoprostol
masking devices
Transcranial magnetic stimulation

70
Q
A

HEENT (12 decks)

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