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Terms in this set (78)
Is vertigo a diagnosis or symptom?
What causes vertigo?
Asymmetry in the vestibular system due to damage to or dysfunction of the:
Central vestibular structures in the brainstem
This is a feeling that you or the room is spinning or moving
Vertigo (a type of dizziness)
This is Lightheadedness, feeling like you might faint or presyncope
What causes lightheadedness?
When there is not enough blood getting to the brain
This can happen if there is a sudden drop in your BP or you are dehydrated from vomiting, diarrhea, fever, or other causes.
Many people, especially as the elderly, experience lightheadedness if they get up too quickly from a lying or seated position.
Although dizziness and vertigo are often used interchangeably, they are not the same. So what is the difference?
While all vertigo is dizziness, not all dizziness is vertigo
So what is true vertigo?
It is the illusion that you - or your surroundings - are moving
Why do Otolaryngologists tend to focus on disease processes that produce true vertigo (the illusion of motion)?
Because it is primarily associated with the balance organs of the inner ear
What is the number one thing to figure out what kind of vertigo is happening with the patient?
The timing (seconds, minutes, hours, or days)
** This Vertigo is caused by problems with labyrinth or vestibular nerve
What are some other names for Peripheral vertigo?
otologic" or "vestibular
*****What are some causes of peripheral vertigo?
BPPV: the most common cause
Labrynthitis (vestibular neuritis)
Chemical insults like ototoxic drugs
***What is it called if vertigo arises from the balance centers of the brain, it is usually milder, and has accompanying neurologic deficits, such as slurred speech, diplopia, or pathologic nystagmus
What are some causes of central vertigo?
**This type of vertigo is described as the following:
So severe, pt is unable to stand or walk
Frequent accompanied by N/V, excessive
Tinnitus and HL may be associated (otologic?)
If a patient has Nausea/Vomiting, should I think Central or Peripheral Vertigo?
Describe the Nystagmus in peripheral vertigo
HORIZONTAL with torsional component
Suppressed by visual fixation
What is the best prognostic sign of nystagmus?
Whether or not it is fatiguable
**This type of vertigo is described as the following:
Becomes progressively more severe and debilitating
Associated CNS deficit(s)
Auditory function generally spared
Diplopia, dysarthria, headache, altered mental status or cerebellar, motor, or sensory abnormalities
Describe the Nystagmus in Central Vertigo
Unsuppressed with visual fixation (and often worsened)
What imaging study do I need to get with Central Vertigo?
What is Caused by otoconia (calcium carbonate crystals) or other sediment that have become free floating and enter one of the balance canals
Benign Paroxysmal Positioning Vertigo (BPPV)
What happens when a patient with BPPV turns their head quickly or into a certain position
Free-floating material moves the balance canal fluid (endolymph) and stimulates the vestibular nerve
**In BPPV, what happens as a result of the vestibular nerve being stimulated?
This motion creates an intense feeling of vertigo that lasts less than 30 sec but not > 1 minute until the material settles in place
Patients with BPPV usually able to describe the precise motion that precipitates this intense, brief episode of vertigo. Give an example
Rolling over in bed is a movement that frequently initiates an episode
**How do the symptoms of BPPV present?
They occur in clusters that persist for several days
**What physical exam tool can I use to test for BPPV?
Dix-Hallpike maneuver (Diagnostic, NOT treatment)
**What is the most common cause of BPPV?
Canalithiasis of the posterior semicircular canal
What is the point of doing the Dix Hallpike Maneuver?
It is designed to reproduce vertigo and elicit nystagmus in patients with a h/o positional dizziness
I am testing the ear that is facing down
What causes BPPV?
Can occur without any specific inciting event, but is often seen after significant head trauma or an episode of vestibular neuronitis
How is BPPV treated?
Particle repositional maneuver (Epley's Maneuver) in the office
Dislodged, free-floating sediment that has entered the balance organs can be repositioned into the vestibule by rolling the patient 270 degrees from supine
**Do we use medications for BPPV?
Medical therapy with vestibular suppressants is ineffective because episodes of vertigo are so fleeting
Their use should be discouraged
What imaging study do we need to recurrent cases of BPPV?
warrant MRI of the head: r/o vertebrobasilar insufficiency
This is a Common cause of vertigo
Thought to be from inflammation of the vestibular nerve or labyrinth
*Frequently associated with or follows a viral infection (URI)
Labrynthitis aka. vestibular neuronitis
What will a patient experience with Labrynthitis aka. vestibular neuronitis
Patient will usually awaken with room-spinning vertigo that will continue, but gradually become less intense over 24-48 hours
- May take weeks for the symptoms to completely resolve
Is the patients hearing affected in Labrynthitis aka. vestibular neuronitis?
Hearing may return to normal or be permanently damaged
If a patient had a COLD, and they have had NONSTOP vertigo
They have Labrynthitis aka. vestibular neuronitis
What physical exam must be done in a patient with Labrynthitis aka. vestibular neuronitis?
What is the treatment for Labrynthitis?
Vestibular suppressant, antiemetic, and a short tapered course of oral steroids during acute phase
Discontinue as soon as is feasible to avoid long-term disequilibrium from inadequate compensation. NO MORE THAN A WEEK
---Then rehabilitation exercises
This is thought to be secondary to a distention of the endolymphatic space within the balance organs of the inner ear
Meniere's Disease aka. endolymphatic hydrops
What is the classic presentation of Meniere's Disease aka. endolymphatic hydrops?
Intense, episodic vertigo, usually lasting from 30 min to 2-4 hours
REMEMBER: BPPV VERTIGO LASTS < 1 MINUTE
FLUCTUATING HEARING LOSS (diagnostic)
Sensation of aural fullness
What happens during severe attacks of Meniere's Disease aka. endolymphatic hydrops?
Treatment of Meniere's Disease can be very difficult because its course is unpredictable. Treatment strategies focus on decreasing the endolymphatic fluid pressure within the vestibular portion of the inner ear, but how is it done?
Low salt diet
Bed rest with eyes closed during attacks / protect from falling
What is the treatment of Severe and prolonged symptoms?
Vestibular ablation by instillation of ototoxic medication (i.e., gentimicin) into the middle ear for inner ear absorption through the round window
Surgical options are available for incapacitated individuals
What is the main cause of vertigo s/p head injury.
How long do vertigo symptoms last in Labyrinthine Concussion?
Generally diminish within several days but may linger for a month or more
Describe vertigo Basilar skull FX loss of hearing
Severe vertigo lasting several days to a week with deafness in the involved ear
This is Leakage of perilymphatic fluid into middle ear
**When is vertigo worse with a Perilymphatic Fistula?
What causes Perilymphatic Fistula?
Physical injury (eg, blunt head trauma, hand slap to ear);
Extreme barotrauma during airflight or scuba diving;
Vigorous valsalva maneuvers (eg, weightlifting)
Post Surgical complication - stapedectomy
What is the treatment of Perilymphatic Fistula?
Middle ear exploration and window sealing with a tissue graft
This is described as:
A normal response to a situation in which sensory conflict about body motion exists among visual receptors, vestibular receptors, and body proprioceptors
N/V, diaphoresis, pallor, hypersalivation, yawning, anxiety, dizziness...
How can I premedicate motion sickness?
Scopolamine patch should be applied at least 4 hrs before travel (effective 6-12 hrs prior)
PO meds 30 min - 1 hr prior to travel
What other measures can a patient to avoid motion sickness?
Decrease oral intake or freq small feedings
Avoid reading while actively traveling
What are the most common causes of central vertigo?
Ya, but what kind of drugs
Antihypertensive, diuretic, or dopaminergic agents
What is the most direct way of making the distinction is to inquire, then evaluate brainstem symptoms. What are they?
T or F. Evidence of brainstem involvement rules out peripheral lesion
BUT, absence of brainstem sx's DOES NOT r/o a central lesion
A Pattern of recurrent long standing episodes followed by remissions suggests
This central lesion is almost ALWAYS unilateral and almost ALWAYS found incidentally
Acoustic Neuroma aka. Vestibular Schwannoma
Describe Acoustic Neuroma aka. Vestibular Schwannoma
Benign lesion; arise in the auditory canal; gradually grows to involve the cerebropontine angle; eventually compressing the pons
**Describe the hearing loss in Acoustic Neuroma aka. Vestibular Schwannoma
slowly progressive sensory hearing loss
What nerves are affected by Acoustic Neuroma aka. Vestibular Schwannoma?
8th (5th, 7th) cranial nerves
What is the GOLD STANDARD for diagnosing Acoustic Neuroma aka. Vestibular Schwannoma if it is SMALLER than 2 cm?
MRI with gadolinium
What will detect Acoustic Neuroma aka. Vestibular Schwannoma if it is > 2 cm?
What is the treatment for symptomatic Acoustic Neuroma?
2) Radiotherapy ( with a followup annual MRI)
What is the treatment for asymptomatic neuroma?
(annual MRI for slow growing
Early signs of extension outside internal auditory meatus?
Slowly progressive asymmetric HL/decline of speech discrimination
Corneal reflex decreased/absent
This is described as the following:
Major cause of disability in young adults
Inflammatory and degenerative disorder involving the CNS
20-40 yo, F>M, strong genetic component
Multiple Sclerosis (MS)
What is the severity o the symptoms in MS?
What is the specific diagnostic test for MS?
There isn't one.
Have clinical suspicion and get a (CT/MRI/LP)
Describe the hearing loss associated with MS
1) Sensory Hearing loss
3) Rapid onset
This type of vertigo most common occurs elderly with arteriosclerosis
What causes Vertebrobasilar Insufficiency?
Reduced flow in the vertebrobasilar system (MRA)
Often triggered by changes in posture or extension of the neck
What are the signs and symptoms of vertigo associated with vertebrobasilar insufficiency?
Vertigo in conjunction with diplopia, sensory loss, dysarthria, dysphasia, hemiparesis, and other brain stem deficits
****What is the treatment of vertebrobasilar insufficiency?
Empiric treatment with vasodilators and aspirin
****What is the most common early manifestation of AIDS?
Serous Otits Media (That is persistent and asymmetric)
*****What must I do with an adult that has unilateral serous otitis media that is not going away?
R/O a cancerous tumor pressing on the Eustachian Tube
THIS SET IS OFTEN IN FOLDERS WITH...
ENT (Disease of the External Ear)
ENT (Diseases of the MIddle Ear)
ENT (Hearing Loss)
ENT (Diseases of the Nose & Paranasal Sinuses)
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