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Dizziness, Tinnitus, Menieres, Acoustic Neuroma
Terms in this set (55)
Presyncope Dizziness described as
impending faint, about to pass out
lighteaded, diaphoresis (sweating), Blurring, Pallor
Causes of Presyncope
Arrhymias, Aortic Stenosis, Large Heart, Cough, Orthostatic HTN, Illness, Anxiety, Seizures, Drugs
Hx and PE for Presyncope based off of
Cardiac blue card stuff
Educate to rise slowly,
Disequilibrium described as
Sense of Imbalance
Hx for Disequilibrium
Dizzy with walking, standing etc. Weakness, Numbness, Paresthesia?
PE for Disequlibrium
Observe Gait, Neuro Exam (Cranial Nerves, Reflexes, Sensation, Strength)
Cause for Disequilibrium
Peripheral Neuropathy, Vestibular Disorder, Parkinson's, Musculoskeletal disorder, Cervical Spondylosis (age related wear and tear of spinal disks in neck)
Nonspecific Dizziness described as
I am Dizzy.
Potential Causes of Nonspecific Dizziness
Psych, Hyperventilation, Fibromyalgia
PE for Nonspecific Dizziness
Neuro, Cardio, HEENT, Have pt purposefully hyperventilate to replicate sx.
Common Contributors to Dizziness
anxiety, Depression, Past MI, Postural Hypotension, Polypharmacy (5 mends or more), Impaired Hearing
What is Tinnitus?
Perception of Sound without external source
Tinnitus described as
water running through pipes, buzzing, ringing etc.
Tinnitus may indicate
hearing loss, cochlear injury, CNS lesion
3 History Questions about Tinnitus
heard close/distant, continuous/intermittend, pulsatile or non-pulsatile
If tinnitus is pulsatile possible Tx
Occlude Vascular Origin
3 Possible Pathogenic Locations for Tinnitus
Somatic, CNS, Cochlea (always stimualted)
Vascular disorders that cause tinnitus
arterial bruits, arteriovenous vistulas, paraganglioma (vascular neoplasm of paraganglia cells), venous hums,
Neurologic disorders that cause tinnitus
MS (spasms of tensor tympani or stapedius muscle)
Other disorders that cause tinnitus
Somatic Disorders, Ototoxic Meds (ASA in kids), Eustachian dysfunction, Otosclerosis, Acoustic Neuroma, Meneire's Disease, Presbycusis
Examples of Ototoxic Meds
ASA in Kids
Presbycusis is what?
age related hearing loss, progressively by lateral
Hx taking for tinnitus
Describe, noise exposure, injury, hearing status, HTN, surgery, anxiety
Cranial Nerves, Auscultatefor bruit (neck, periauricular, temple, orbit, mastoid)
Tests for tinnitus pt
If vascular lesions suspected in tinnitus then what labs?
MRI w/ contrast, CT w/ contrast or angiography
Tx for Tinnitus
No Cure, Cochlear Implants (overcome ringing sound), Treat Depression etc.,,, train to focus on different sounds,
Possible Rx for Tinnitus
What is Amitriptyline
Amitriptyline (Elavil ®) TCA, SNRI, sedating, high doses --> easily kill yourself,
What is Nortriptyline
Nortriptyline (Pamelor ®) TCA, SNRI, sedating, high doses--> easily kill yourself
4 Cardinal Sx of Meniere's Disease
Recurrent Vertigo (2 episodes lasting more than 20 min, possible nystagmus)... Fluctuant Hearing Loss........ Tinnitus..........Sense of Fullness in Ear
Cause of Meniere's
pressure and volume changes in endolymph that affect inner ear..... Real cause unknown
Risks of Meniere's
family Hx, allergies, autoimmune disease, head trauma
Additional Sx of Meniere's
Usually Unilateral, impaired hearing of low frequencies, plus the 4 Cardinal Sx
Habitual Changes that can help Meniere's
Decrease Salt, Caffeine, Nicotine, EtOH
Two Drug Classes Meniere's is usually treated with
Phenothiazines and Benzodiazepines also Antihistamines
Drug that may help prevent chronic refractory Sx in Meniere's
Diuretic (HCTZ) 25 mg po once/day or Acetazolamide (Diamox ®) .............High BP is related to some Sx of Meniere's
How does HCTZ work?
inhibits reabsorption on distal convoluted tubule. Promotes excretion of Na and Cl...
How does Acetazolamide work?
Carbonic Anhydrase Inhibitors--- decreases NaCl and bicarb reabsorption in proximal tubule
block dopamine receptors in CTZ
Prochlorperazine (compazine ®), Promethazine (Anergan ®)
Name one Short, Intermediate and Long acting Benzo
Short -----Alprazolam (Xanax ®)................Intermediate Lorazepam (Ativan).........................Long Diazepam (Valium)
Surgical Options forMenere's
intratympanic gentamicin injection (chemical labrynthectomy) ,,, labrynthectomy (only when hearing loss is profound) , vestibular neurectomy (cures vertigo in 95% and usually preserves hearing)
What is Acoustic Neuroma
Schwann Cell derived tumor from 8th Cranial Nerve
Acoustic Neuroma may compress
5,7, Cranal Neres. Brainstem (thus increase ICP)
Risk Factors for Acoustic Neuroma
Long term acoustic trauma, neurofibromatosis, bialteral neuromas --> autosomal dominant
What is Neurofibromatosis?
genetic disorder that distrubs cell growth in nervous system
Two Primary Sx of Acoustic Neuroma and other sx
Progressive Unilateral Hearing Loss, Tinnitus...............Balance, Vertigo, Facial Pain, Difficulty Swallowing, Fullness in ear, headache
Workup for Acoustic Neuroma
Audiogram (shows asymmetric hearing loss) ..... MRI w/ gadolinium.............. CT with Contrast
What is Gadolinium
Gadolinium is used in about 30% of MRIs.Given IV it improves contrast.
Tx for Acoustic Neuroma
Refer to Neurosurgeon
If Acoustic Neuroma is < _____ cm then radiation instead of surgery
Similarities and Differences of Sx of Meneire's and Acoustic Neuroma
Both can have tinnitus, vertigo, hearing loss........ Differences -Acoustic Neuroma hearing loss is progressive and Meneire's is fluctuant.......... Acoustic Neuroma big sign is unilateral hearing loss, facial pain and weakness.
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