Vertigo and Tonsils Flashcards
What are otoliths
Calcium carbonate crystals located in the saccule and utricle of the inner ear
Function of saccule and utricle
Detect linear movements of the head hence contribute to balance and equilibrium
What is benign positional paroxysmal vertigo
Vertigo caused by the detachment of the otoliths hence loose otoliths move around in semicircular canals
Risk factors of BPPV
Elderly
Causes of BPPV
Head trauma
Cholelithiasis - deposits of calcium
idiopathic
How does BPPV cause vertigo
Once the otolith is in the canal, movement of the head will result in movement of the otoliths hence causing an abnormal movement of endolymph -> abnormal stimulation of hair cells
Triggers of vertigo in BPPV
Looking up
Turning in bed
First lying down in bed
Getting out of bed
Bending forward
Moving head quickly in one direction
How long does BPPV last
30sec - 1 min
Episodes will disappear but reappear again within a few weeks / months
Does BPPV have any ear symptoms
No
Investigations for BPPV
Dix-Hallpike manouevre
What would suggest a positive Dix-hallpike manoeuvre
Causing vertigo
Torsional nystagmus
What is nystagmus
Eyes make repetitive, uncontrolled rotatory movements
Management of BPPV
Epley manoeuvre
Selmont manoeuvre
Brandt-Daroff exercises
Describe the epley manoeuvre
- Patient sitting up with their heads 45 degress turned to the affected side
- Keep the head turned and lay the patient down
- Turn head 90 degrees to the opposite side
- Turn head another 90 degrees by rolling body towards unaffected side
- Sit patient up while keeping head turned
What is vestibular neuritis
Inflammation of the vestibular nerve
Symptoms of vestibular neuritis
First attack is severe - lasts hours
Prolonged vertigo - days or weeks
horizontal nystagmus
Symptoms of labrynthitis
Prolonged vertigo - days or weeks
Tinnitus / hearing loss
Horizontal nystagmus
vestibular neuritis is commonly preceded by
viral illness
How to differentiate between vestibular neuritis and labrynthitis
Vestibular neuritis does not cause tinnitus / hearing loss whereas labrynthitis does
Management of vestibular neuritis / labrynthitis
Self-limiting, resolves in a month
May be helped by rehabilitation exercises if prolonged
What is vestibular migraine
Episode of vertigo in someone who has a history of migraines
Symptoms of vestibular migraine
Light sensitive during dizzy spells
Phonophobia
Fluctuating hearing loss
Motion sensitivity
Management of vestibular migraine
Lifestyle modifications, avoid triggers
Propanolol
CCB
Amitriptyline
Pathophysiology of Ménière’s disease
Dilatation of endolymph spaces -> excess endolymph in the membranous labryinth
Symptoms of Ménière’s disease
Severe paroxysmal vertigo
Sensorineural hearing loss
Tinnitus
Sensation of ear being full
What type of vertigo does Ménière’s disease cause
Rotational vertigo
Pattern of attacks of Ménière’s disease
Recurrent
Spontaneous
Lasts for hours
What is the pattern on audiometry for Ménière’s disease
Sensorineural hearing loss
Affecting low frequency
management of Ménière’s disease
Supportive
Tinnitus therapy
Hearing aids
Lifestyle modifications
Prochlorperazine - for acute attacks
What are the lifestyle modifications suggested for patients with Ménière’s disease
Reduce salt
Avoid chocolate
Avoid caffeine
Avoid stress
What is a possible prophylactic therapy for Ménière’s disease
Betahistine
Which type of vertigo has a positional trigger
BPPV
Which types of vertigo causes tinnitus
Labrynthitis
Meniere’s
Most common type of vertigo
BPPV
Most common cause of obstructive sleep apnea in children
Adenotonsillar hypertrophy
How does adenotonsillar hypertrophy cause obstructive sleep apnoea
Disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in narrowed upper airway
At what age do tonsils and adenoids grow the most
between 2-8 years old
Symptoms of adenoid hypertrophy
Hyponasal voice
Snoring
Sleep disturbances
Acute otitis media
Otitis media with effusion
How does adenoid hypertrophy cause otitis media / otitis media with effusion
Blocks the Eustachian tube opening causing Eustachian tube dysfunction
Symptoms of tonsil hypertrophy
Muffled voice
Snoring
Sleep disturbances
Visibly enlarged tonsils
Management of adenotonsillar hypertrophy
Adenoidectomy / tonsillectomy if indicated
When is adenoidectomy indicated
Recurrent AOM / OME
Upper airway obstruction (snoring, obstructive sleep apnoea)
Dysphagia
Speech difficulty
Where is the most common site of head and neck cancer
Larynx
Types of head and neck cancers
Squamous cell carcinoma
Nasopharyngeal carcinoma
Laryngeal carcinoma
Oropharyngeal carcinoma
Oral cavity carcinoma
Most common type of head and neck cancer
Squamous cell carcinoma
Squamous cell carcinoma of the head and neck is associated with
Smoking
Alcohol
HPV type 16
How may HPV type 16 cause squamous cell carcinoma
Produce proteins E6 and E7 which disrupts p53 -> cellular immorality
Risk factors of head and neck cancers
Male
>55
Smoking
Alcohol
HPV, EBV
Radiation exposure
Immunosuppression
Occupational exposure (acid mists, asbestos, wood dust)
Family history
Which type of head and neck cancer is associated with EBV
Nasopharyngeal carcinoma
Who does HPV related oropharyngeal carcinoma typically affect
NON-SMOKER
Higher socio-economic class
Multiple sexual partners
What is the route of spread for head and neck cancers
Lymphatic spread
Which lymph nodes does supraglottic tumours drain into
Drains into the superior deep cervical nodes
Which lymph nodes does subglottic tumours drain into
Drains into paratracheal nodes
What is special about glottic tumours
Most stay on the vocal cords instead of spreading
Symptoms of head and neck cancer
Dysphonia
Dysphagia
Unilateral otalgia
Neck lump
Stridor
Hoarseness
Lymphadenopathy
Symptoms of nasopharyngeal carcinoma
Unilateral symptoms
Symptoms of eustachian tube obstruction
Nasal obstruction
Blood-stained nasal discharge
Persistent epistaxis
May develop a glue ear
Investigations for head and neck cancer
Urgent referral if symptoms occurred for more than 3 weeks
US + Fine needle aspiration
Panendoscopy + biopsy
Staging
What is used to stage head and neck cancer
CT neck, chest
MRI
PET
Management for early laryngeal cancer T1-T2
Transoral laser surgery
Radiotherapy
Management for late laryngeal cancer T3-T4
Partial / total laryngectomy
Chemo and radiotherapy
Management for early oropharyngeal cancer T1-T2
Transoral laser surgery
Radiotherapy
Management for late oropharyngeal cancer T3-T4
Chemo and radiotherapy
Management for nasopharyngeal cancer
Chemo and radiotherapy
