Hearing And Dizziness

Front 1

Define vertigo

Back 1

illusion of rotational, linear, or tilting movement of self or environment
Spinning sensation

Can also be sense of swaying or tilting
Produced by peripheral (inner ear) or central (brainstem-cerebellum) stimulation

Front 2

What are the 3 most common peripheral causes of vertigo?

Back 2

BPV
vestibular neuritis
Meniere's disease

Front 3

What is BPV?

Back 3

acute attacks of transient vertigo lasting second to minutes initiated by certain head positions, accompanied by torsional nystagmus

Front 4

Management of BPV?

Back 4

Process resolves spontaneously
2 particle repositioning manouvres - Epley's, Brandt-Daroff exercises
surgery for refractory cases

Front 5

What is vestibular neuritis?

Back 5

acute onset of disabling vertigo often accompanied by N/V and imbalance without hearing loss that resolves after days leaving a residual imbalance that lasts days to weeks
Thought to be due to a viral infection (e.g., measles, mumps, herpes zoster)
= vestibular equivalent of Bell's palsy (sudden hearing loss and acute vocal cord palsy)

Front 6

There are 2 phases in vestibular neuritis. Describe the symptoms associated with each?

Back 6

Acute phase:
Severe vertigo with N/V and imbalance, nystagmus (fast phase towards offending ear)
pt veers towards affected side
Convalescent phase
imbalance and motion sickness lasting days to weeks, spontaneous nystagmus away from affected side, gradual vestibular adaptation requires weeks to months

Front 7

How do you manage vestibular neuritis?

Back 7

Acute phase: bed rest, vestibular sedatives (Gravol), diazepam
Convalescent phase: progressive ambulation, vestibular exercises

Front 8

What is meniere's disease

Back 8

episodic attacks of tinnitus, hearing loss, aural fullness, vertigo lasting minutes to hours

Front 9

Symptoms of meniere's disease

Back 9

Attacks come in clusters, may be triggered by stress
Tinnitus, aural fullness, vertigo +/-
Drop attacks, N/V
early stages: fluctuating sensorineual hearing loss
laster stages: persistent tinnitus and low frequency hearing loss

Front 10

What is tinnitus?

Back 10

auditory perception in the absence of an acoustic stimuli, likely related to loss of input to neurons in central auditory pathways and resulting in abnormal firing

Front 11

What is the differenve between conductive and sensorineural hearing loss?

Back 11

Sensorineural - due to defect in the conversion of sound into neural signals of in the transmission of those signals to the cortex - inner ear, cochlea or the auditory nerve, brainstem or cortex

Conductive - any cause that in some way limits the amount of external sound from gaining access to the inner ear - caused by external and middle ear disease

Front 12

HOw do you tell the difference between vertigo caused by a peripheral lesion or central lesion?

Back 12

Peripheral lesion - vertigo only lasts for a couple of weeks because compensation occurs
Central lesion - lasts for a lot longer

Front 13

What are some central causes of vertigo?

Back 13

Cerebrovascular disorders (TIA, vertebrobasilar insufficiency, cerebellar infarction)
Migrainous vertigo
MS

Front 14

What are the 2 most common causes of tinnitus?

Back 14

presbycusis (age-related hearing loss)
Aspirin

Front 15

What is the difference in how long vertigo lasts between BPV, Meniere's disease, vestibular neuronitis?

Back 15

BPV - seconds
Meniere's disease - mins - hours
vestibular neuronitis - hours to days

Front 16

What is the aetiology of BPV?

Back 16

calcium debris within the posterior semicircular canal = canalithiasis

Front 17

Which canal is most commonly affected in BPV?

Back 17

posterior in 90% of cases

Front 18

Causes of BPV?

Back 18

head injury
viral infection URTI
degenerative disease
idiopathic