Vertigo, dizziness, hearing problems and the ear Flashcards
Presentation of vertigo
illusion of movement:
- dizziness
- may have difficulty walking/standing
- nausea, vomitting, pallor sweating
assoc. hearing loss implies labyrinth or VIIIth nerve involvement.
DDx of vertigo (3)
NO illusion of movement:
- light-headedness due to anaemia/orthostatic hypotension
- anxiety
- LOC due to epilepsy/syncope.
Inner ear and VIIIth nerve causes of vertigo (8)
Meniere’s disease
vestibular neuronitis/acute labyrinthitis
motion sickness
ototoxic drugs-gent, loop diuretics, cisplatin
tullio phenomenon-sound induced vertigo and dizziness
trauma-petr. temp. bone fracture/cereb. pont. ang.
BPPV
zoster/Ramsay-Hunt
Pathology of Meniere’s disease
excess fluid in middle ear
Presentation of Meniere’s disease (6)
EPISODIC, recurrent attacks of vertigo lasting mins-hrs
sensorineural hearing loss
tinnitus
“roaring” in affected ear
NYSTAGMUS
feeling of fullness in ear
Mx of Meniere’s disease (3)
Rx w. prochlorperazine for Sx (anti-emetic)
prevent w. antihistine
for severe cases: surgery of endolymphatic sac/ablation w. gent.
Presentation and causes of vestibular neuronitis/acute labyrinthitis (4)
sudden, severe vertigo
nausea+vomitting
NO tinnitus/hearing loss
caused by viruses and vascular lesions
Pathology and features of BPPV
due to debris w/i semicircular canals e.g. crystals
improves when head kept still
Dx of BPPV
hallpike manoeuvre:
- sit pt. upright, bend head to 45 degress
- lay pt. flat w. head hanging off
- nystagmus towards affected side=+ve sign (usually unilateral)
Rx of BPPV
Epley manoeuvre to clear debris
Presentation of Ramsay Hunt Syndrome (5)
herpes zoster in external acoustic meatus facial palsy deafness tinnitus vertigo
Pathology of vertigo induced by Ramsay-Hunt Syndrome (6)
occurs when VZV reactivates in geniculate ganglion of VIIth nerve
leads to:
- painful rash in auditory canal
- ipsilateral facial nerve palsy
- loss of taste
- tinnitus
- vertigo
Rx of Ramsay-Hunt (2)
aciclovir+prednisolone
Brainstem, cerebellum and cerebello-pontine angle causes of tinnitus (5)
MS acoustic neuroma stroke/tia migraine haemorrhage (NB look for nystagmus and CN lesions)
Features, assoc., presentation and Rx of acoustic neuromas (6)
vestibular schwannoma
80% of cerebello-pontine angle tumours
assoc. w. NFT2 and is bilateral in these cases
present w. unilateral hearing loss, tinnitus, progressing to vertigo
as they grow, they affect ipsilateral cerebellum, V/VI/IX/Xth nerves
Rx w. microsurgical removal
