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2017 EENT Clin Med Group > Vestibular Disorders COPY > Flashcards

Vestibular Disorders COPY Flashcards

1
Q

Benign Paroxysmal Positioning Vertigo

What is the:

  1. timeframe,
  2. hearing loss, and
  3. associated symptoms
A
  1. Seconds
  2. None
  3. Posturally evoked
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2
Q

Labyrinthitis​

What is the:

  1. timeframe,
  2. hearing loss, and
  3. associated symptoms
A
  1. Days
  2. Possible (effusion)
  3. URI prodrome
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3
Q

Vestibular Neuronitis​

What is the:

  1. timeframe,
  2. hearing loss, and
  3. associated symptoms
A
  1. Sudden, days to weeks
  2. None
  3. Slow, sometimes incomplete improvement
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4
Q

What is the sensation where the patient senses they are spinning or that the world is spinning around them?

A

Vertigo

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5
Q

What is the sensation where real movement causes the sensation of spinning or discomfort?

A

Dizziness

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6
Q

What is the hallmark of vertigo?

A

nystagmus

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7
Q

Which type of vertigo is this?

  • Characterized by sudden onset
  • Associated with nausea/vomitting
  • Horizontal nystagmus with fast beats away from affected side
  • Fixation causes suppression
A

Peripheral vertigo

(inner ear causes)

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8
Q

What causes Peripheral vertigo?

A

Inner ear causes

______________

  • Characterized by sudden onset
  • Associated with nausea/vomitting
  • Horizontal nystagmus with fast beats away from affected side
  • Fixation causes suppression
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9
Q

Peripheral vertigo _______ with fixation

A

suppresses

Peripheral vertigo (innear ear causes)

  • Characterized by sudden onset
  • Associated with nausea/vomitting
  • Horizontal nystagmus with fast beats away from affected side
  • Fixation causes suppression
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10
Q

Which type of vertigo is this?

  • Characterized by slow onset
  • Vertical nystagmus
  • DOES NOT suppress with fixation
A

Central vertigo (CNS involvement)

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11
Q

What causes Central Vertigo?

A

Central vertigo (CNS involvement)

  • Characterized by slow onset
  • Vertical nystagmus
  • DOES NOT suppress with fixation
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12
Q

Central Vertigo _______ with fixation

A

DOES NOT suppress

Central vertigo (CNS involvement)

  • Characterized by slow onset
  • Vertical nystagmus
  • DOES NOT suppress with fixation
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13
Q

Peripheral vertigo has _______ nystagmus

A

Horizontal nystagmus with fast beats away from affected side

Peripheral vertigo (innear ear causes)

  • Characterized by sudden onset
  • Associated with nausea/vomitting
  • Horizontal nystagmus with fast beats away from affected side
  • Fixation causes suppression
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14
Q

Central Vertigo has _______ nystagmus

A

Vertical nystagmus

Central vertigo (CNS involvement)

  • Characterized by slow onset
  • Vertical nystagmus
  • DOES NOT suppress with fixation
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15
Q

How do you evaluate vertigo?

A
  1. History/physical
  2. Audiometry
  3. Video/Electronystagmography/calorics (COWS)
  4. Electrocochleography
  5. ABR (Auditory brainstem response test)
  6. MRI
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16
Q

What does videonystagmography test?

A

Used to test inner ear and central nervous sytem function

_____

Patient wears infrared goggles to track eye movements during positional changes and visual stimulation

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17
Q

Identify the test: Patient wears infrared goggles to track eye movements during positional changes and visual stimulation

A

Videonystagmography

Used to test inner ear and central nervous sytem function

_____

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18
Q

Identify the test: Cold and warm water or air is used to stimulate the inner ear

A

Caloric Testing

_________

Response is nystagmus in a specific direction: COWS

  • Cold water: Eyes should move away from the cold water and slowly back
  • Warm water: eyes should move toward warm water and then slowly away
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19
Q

You are performing caloric testing. You are applying cold water to stimulate the inner ear. What do you expect to happen?

A

Cold water: Eyes should move away from the cold water and slowly back

_________

Response is nystagmus in a specific direction: COWS

Warm water: eyes should move toward warm water and then slowly away

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20
Q

You are performing caloric testing. You are applying warm water to stimulate the inner ear. What do you expect to happen?

A

Warm water: eyes should move toward warm water and then slowly away

_________

Response is nystagmus in a specific direction: COWS

Cold water: Eyes should move away from the cold water and slowly back

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21
Q

Identify the test: Measures the electric potentials in the cochlea in response to sound stimulation

A

Electrocochleography

_______

  • Used to determine fluid pressure of inner ear
  • Used to diagnose Meniere’s or endolymphatic hydrops
22
Q

What does Electrocochleography test?

A
  • Used to determine fluid pressure of inner ear
  • Used to diagnose Meniere’s or endolymphatic hydrops

_______

Measures the electric potentials in the cochlea in response to sound stimulation

_______

23
Q

Identify the test: Electrodes placed on the head monitor electrical activity in response to click stimulus and displays them as waves

A

Auditory Brainstem Response (ABR)

Used to determine brainstem function and to rule out an acoustic neuroma

24
Q

What does Auditory Brainstem Response (ABR) test?

A

Auditory Brainstem Response (ABR)

Used to determine brainstem function and to rule out an acoustic neuroma

__________

Electrodes placed on the head monitor electrical activity in response to click stimulus and displays them as waves

25
Q

Treatment of Vertigo

A
  1. Benzodiazepines (valium, xanax)
  2. Meclizine/Transdermal scopolamine
  3. Oral steroids
  4. Salt/caffeine restriction
  5. Vestibular rehabiliation
  6. Interventional and surgical therapies available for persistant causes
    • Intratympanic steroids
    • Endolymphatic shunt
26
Q

Causes of PERIPHERAL vertigo: identify

  • Room spinning sensation with changes in head position, usually in one direction
  • Peaks and resolves in seconds
  • INTACT HEARING
A

​Peripheral vertigo: Benign Paroxysmal Positional Vertigo

Pathophysiology

  • crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
  • Otoconia (small crystals of calcium carbonate) from utricle > posterior semicircular canal
  • May be associated with head injury, car accident, or idiopathic

Diagnosis

  • Dix-hallpike maneuver

Treatment

  • Epley maneuver (particle repositioning procedure)
27
Q

Causes of PERIPHERAL vertigo: identify

  • Primary cause of PERIPHERAL vertigo
A

​Peripheral vertigo: Benign Paroxysmal Positional Vertigo

Presentation

  • Room spinning sensation with changes in head position, usually in one direction
  • Peaks and resolves in seconds
  • INTACT HEARING

Pathophysiology

  • crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
  • Otoconia (small crystals of calcium carbonate) from utricle > posterior semicircular canal
  • May be associated with head injury, car accident, or idiopathic

Diagnosis

  • Dix-hallpike maneuver

Treatment

  • Epley maneuver (particle repositioning procedure)
28
Q

Causes of PERIPHERAL vertigo: Benign Paroxysmal Positional Vertigo

  • Presentation
A

​Peripheral vertigo: Benign Paroxysmal Positional Vertigo

Presentation

  • Room spinning sensation with changes in head position, usually in one direction
  • Peaks and resolves in seconds
  • INTACT HEARING

Pathophysiology

  • crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
  • Otoconia (small crystals of calcium carbonate) from utricle > posterior semicircular canal
  • May be associated with head injury, car accident, or idiopathic

Diagnosis

  • Dix-hallpike maneuver

Treatment

  • Epley maneuver (particle repositioning procedure)
29
Q

Causes of PERIPHERAL vertigo: Benign Paroxysmal Positional Vertigo

  • Pathophysiology
A

​Peripheral vertigo: Benign Paroxysmal Positional Vertigo

Pathophysiology

  • crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
  • Otoconia (small crystals of calcium carbonate) from utricle > posterior semicircular canal
  • May be associated with head injury, car accident, or idiopathic

Diagnosis

  • Dix-hallpike maneuver

Treatment

  • Epley maneuver (particle repositioning procedure)

Presentation

  • Room spinning sensation with changes in head position, usually in one direction
  • Peaks and resolves in seconds
  • INTACT HEARING
30
Q

Causes of PERIPHERAL vertigo: Benign Paroxysmal Positional Vertigo

  • Diagnosis and treatment
A

​Peripheral vertigo: Benign Paroxysmal Positional Vertigo

Diagnosis

  • Dix-hallpike maneuver

Treatment

  • Epley maneuver (particle repositioning procedure)

Presentation

  • Room spinning sensation with changes in head position, usually in one direction
  • Peaks and resolves in seconds
  • INTACT HEARING

Pathophysiology

  • crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
  • Otoconia (small crystals of calcium carbonate) from utricle > posterior semicircular canal
  • May be associated with head injury, car accident, or idiopathic
31
Q

Causes of PERIPHERAL vertigo: identify

  • Distinct episodic attacks
  • Prolonged vertigo
  • Fluctuating hearing loss-low frequency tilt is common
  • Tinnitus
  • Aural fullness
A

Meniere’s Disease

Etiology

  • Etiology unknown–maybe allergic, AI, migraine variant

Treatment

  • Salt/caffeine restriction
  • Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
  • Benzodiazepines (acute phase)
  • Oral steroids (acute phase)
  • Intratympanic steroid injections

Types

  1. Classical Meniere’s
  2. Cochlear Meniere’s (not dizzy)
  3. Vestibular Meniere’s (no auditory symptoms)
  4. Bilateral Meniere’s (autoimmune IED)
  5. Subclinical endolymphatic hydrops (aural fullness)
  6. Post traumatic (SNHL and years later get symptoms of Meniere’s)
32
Q

Causes of PERIPHERAL vertigo: identify

  • What disease is hallmarked by tinnitus, vertigo, and hearing loss?
A

Meniere’s Disease

Presentation

  • Distinct episodic attacks
  • Prolonged vertigo
  • Fluctuating hearing loss-low frequency tilt is common
  • Tinnitus
  • Aural fullness

Etiology

  • Etiology unknown–maybe allergic, AI, migraine variant

Treatment

  • Salt/caffeine restriction
  • Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
  • Benzodiazepines (acute phase)
  • Oral steroids (acute phase)
  • Intratympanic steroid injections

Types

  1. Classical Meniere’s
  2. Cochlear Meniere’s (not dizzy)
  3. Vestibular Meniere’s (no auditory symptoms)
  4. Bilateral Meniere’s (autoimmune IED)
  5. Subclinical endolymphatic hydrops (aural fullness)
  6. Post traumatic (SNHL and years later get symptoms of Meniere’s)
33
Q

Causes of PERIPHERAL vertigo: Meniere’s Disease

  • Presentation
A

Meniere’s Disease

Presentation

  • Distinct episodic attacks
  • Prolonged vertigo
  • Fluctuating hearing loss-low frequency tilt is common
  • Tinnitus
  • Aural fullness

Etiology

  • Etiology unknown–maybe allergic, AI, migraine variant

Treatment

  • Salt/caffeine restriction
  • Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
  • Benzodiazepines (acute phase)
  • Oral steroids (acute phase)
  • Intratympanic steroid injections

Types

  1. Classical Meniere’s
  2. Cochlear Meniere’s (not dizzy)
  3. Vestibular Meniere’s (no auditory symptoms)
  4. Bilateral Meniere’s (autoimmune IED)
  5. Subclinical endolymphatic hydrops (aural fullness)
  6. Post traumatic (SNHL and years later get symptoms of Meniere’s)
34
Q

Causes of PERIPHERAL vertigo: Meniere’s Disease

  • Etiology
A

Meniere’s Disease

Etiology

  • Etiology unknown–maybe allergic, AI, migraine variant

Treatment

  • Salt/caffeine restriction
  • Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
  • Benzodiazepines (acute phase)
  • Oral steroids (acute phase)
  • Intratympanic steroid injections

Types

  1. Classical Meniere’s
  2. Cochlear Meniere’s (not dizzy)
  3. Vestibular Meniere’s (no auditory symptoms)
  4. Bilateral Meniere’s (autoimmune IED)
  5. Subclinical endolymphatic hydrops (aural fullness)
  6. Post traumatic (SNHL and years later get symptoms of Meniere’s)

Presentation

  • Distinct episodic attacks
  • Prolonged vertigo
  • Fluctuating hearing loss-low frequency tilt is common
  • Tinnitus
  • Aural fullness
35
Q

Causes of PERIPHERAL vertigo: Meniere’s Disease

  • Treatment
A

Meniere’s Disease

Treatment

  • Salt/caffeine restriction
  • Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
  • Benzodiazepines (acute phase)
  • Oral steroids (acute phase)
  • Intratympanic steroid injections

Types

  1. Classical Meniere’s
  2. Cochlear Meniere’s (not dizzy)
  3. Vestibular Meniere’s (no auditory symptoms)
  4. Bilateral Meniere’s (autoimmune IED)
  5. Subclinical endolymphatic hydrops (aural fullness)
  6. Post traumatic (SNHL and years later get symptoms of Meniere’s)

Presentation

  • Distinct episodic attacks
  • Prolonged vertigo
  • Fluctuating hearing loss-low frequency tilt is common
  • Tinnitus
  • Aural fullness

Etiology

  • Etiology unknown–maybe allergic, AI, migraine variant
36
Q

Causes of PERIPHERAL vertigo: Meniere’s Disease

  • 6 subtypes
A

Meniere’s Disease

Types

  1. Classical Meniere’s
  2. Cochlear Meniere’s (not dizzy)
  3. Vestibular Meniere’s (no auditory symptoms)
  4. Bilateral Meniere’s (autoimmune IED)
  5. Subclinical endolymphatic hydrops (aural fullness)
  6. Post traumatic (SNHL and years later get symptoms of Meniere’s)

Presentation

  • Distinct episodic attacks
  • Prolonged vertigo
  • Fluctuating hearing loss-low frequency tilt is common
  • Tinnitus
  • Aural fullness

Etiology

  • Etiology unknown–maybe allergic, AI, migraine variant

Treatment

  • Salt/caffeine restriction
  • Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
  • Benzodiazepines (acute phase)
  • Oral steroids (acute phase)
  • Intratympanic steroid injections
37
Q

Causes of PERIPHERAL vertigo:

  • What is the pathophysiologic link between migraines and meniere’s that leads to vertigo?
A
  • Vasospasm of the internal auditory artery causes ischemia to the labyrinth
  • This leads to isolated infarction of the inner ear (probably through vasospasm of small arteries)
  • Migraine may cause vasospastic microvascular ischemic damage to inner ear resulting in hearing loss and susceptibility to developing endolymphatic hydrops (ELH)
38
Q

Causes of PERIPHERAL vertigo: identify

  • Sudden, violent vertigo
  • Commonly associated with nausea and intense vomiting
  • Last for hours to days
  • may, may not have hearing loss
  • Usually preceded by viral URI
A

Vestibular Neuritis/Labyrinthitis

Treatment

  • Steroids
  • Benzodiazepines
  • Meclizine
  • Vestibular rehab (some)
39
Q

Causes of PERIPHERAL vertigo: Vestibular Neuritis/Labyrinthitis

  • Characteristics
A

Vestibular Neuritis/Labyrinthitis

Characteristics

  • Sudden, violent vertigo
  • Commonly associated with nausea and intense vomiting
  • Last for hours to days
  • may, may not have hearing loss
  • Usually preceded by viral URI

Treatment

  • Steroids
  • Benzodiazepines
  • Meclizine
  • Vestibular rehab (some)
40
Q

Causes of PERIPHERAL vertigo: Vestibular Neuritis/Labyrinthitis

  • treatment
A

Vestibular Neuritis/Labyrinthitis

Treatment

  • Steroids
  • Benzodiazepines
  • Meclizine
  • Vestibular rehab (some)

Characteristics

  • Sudden, violent vertigo
  • Commonly associated with nausea and intense vomiting
  • Last for hours to days
  • may, may not have hearing loss
  • Usually preceded by viral URI
41
Q

Causes of PERIPHERAL vertigo: Identify

  • Dizziness
  • Tinnitus
  • Hearing loss
  • Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity
A

Perilymphatic fistula

​Pathophysiology

  • Defect in one or both of the windows separating the middle and inner ear
  • Perilymph fluid leaks into middle ear
  • Usually caused by head trauma

Treatment

  • Some self-healing, others surgical
42
Q

Causes of PERIPHERAL vertigo: Perilymphatic fistula

  • Presentation
A

Perilymphatic fistula

Presentation

  • Dizziness
  • Tinnitus
  • Hearing loss
  • Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity

​Pathophysiology

  • Defect in one or both of the windows separating the middle and inner ear
  • Perilymph fluid leaks into middle ear
  • Usually caused by head trauma

Treatment

  • Some self-healing, others surgical
43
Q

Causes of PERIPHERAL vertigo: Perilymphatic fistula

  • When do symptoms worsen?
A

Perilymphatic fistula

Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity

__________________

Presentation

  • Dizziness
  • Tinnitus
  • Hearing loss
  • Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity

​Pathophysiology

  • Defect in one or both of the windows separating the middle and inner ear
  • Perilymph fluid leaks into middle ear
  • Usually caused by head trauma

Treatment

  • Some self-healing, others surgical
44
Q

Causes of PERIPHERAL vertigo: Perilymphatic fistula

  • Pathophysiology and usual cause
A

Perilymphatic fistul

​Pathophysiology

  • Defect in one or both of the windows separating the middle and inner ear
  • Perilymph fluid leaks into middle ear
  • Usually caused by head trauma

Treatment

  • Some self-healing, others surgical

Presentation

  • Dizziness
  • Tinnitus
  • Hearing loss
  • Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity
45
Q

Causes of PERIPHERAL vertigo: Perilymphatic fistula

  • treatment
A

Perilymphatic fistula

Treatment

  • Some self-healing, others surgical

Presentation

  • Dizziness
  • Tinnitus
  • Hearing loss
  • Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity

​Pathophysiology

  • Defect in one or both of the windows separating the middle and inner ear
  • Perilymph fluid leaks into middle ear
  • Usually caused by head trauma
46
Q

Causes of CENTRAL vertigo: Identify

  • unilateral SNHL
  • tinnitus (if progression)
  • dizziness (if progression)
  • Romberg/Tandem romberg towards affected side
A

Acoustic Neuroma

Pathophysiology

  • Benign slow growing tumor of the acoustic nerve

Diagnosis

  • MRI

Treatment

  1. Surgery
  2. Stereotactic radiation
47
Q

Causes of CENTRAL vertigo: Acoustic Neuroma

  • Presentation
A

Acoustic Neuroma

Presentation

  • unilateral SNHL
  • tinnitus (if progression)
  • dizziness (if progression)
  • Romberg/Tandem romberg towards affected side

Pathophysiology

  • Benign slow growing tumor of the acoustic nerve

Diagnosis

  • MRI

Treatment

  1. Surgery
  2. Stereotactic radiation
48
Q

Causes of CENTRAL vertigo: Acoustic Neuroma

  • Pathophysiology
A

Acoustic Neuroma

Pathophysiology

  • Benign slow growing tumor of the acoustic nerve

Diagnosis

  • MRI

Treatment

  1. Surgery
  2. Stereotactic radiation

Presentation

  • unilateral SNHL
  • tinnitus (if progression)
  • dizziness (if progression)
  • Romberg/Tandem romberg towards affected side
49
Q

Causes of CENTRAL vertigo: Acoustic Neuroma

  • Diagnosis
A

Acoustic Neuroma

Diagnosis

  • MRI

Treatment

  1. Surgery
  2. Stereotactic radiation

Presentation

  • unilateral SNHL
  • tinnitus (if progression)
  • dizziness (if progression)
  • Romberg/Tandem romberg towards affected side

Pathophysiology

  • Benign slow growing tumor of the acoustic nerve
50
Q

Causes of CENTRAL vertigo: Acoustic Neuroma

  • Treatment
A

Acoustic Neuroma

Treatment

  1. Surgery
  2. Stereotactic radiation

Presentation

  • unilateral SNHL
  • tinnitus (if progression)
  • dizziness (if progression)
  • Romberg/Tandem romberg towards affected side

Pathophysiology

  • Benign slow growing tumor of the acoustic nerve

Diagnosis

  • MRI
51
Q

List 7 causes (other than acoustic neuroma) of central vertigo

A
  1. Lyme disease
  2. Demyelinating disease
  3. CVA (especially basilar or cerebellar)
  4. Psychogenic
  5. CNS infection
  6. CNS tumors
  7. Drugs (polypharmacy for elderly/street drugs in teens/young adults)
52
Q

Identify the audiogram

A

Classic Meniere’s Audiogram

2017 EENT Clin Med Group (13 decks)

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