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39 Cards in this Set
- Front
- Back
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What is the most common peripheral vestibular disorder?
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Benign Paroxysmal Positional Vertigo
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What is the cause of Benign Paroxysmal Positional Vertigo?
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Otoconia from the UTRICLE migrate into a semicircular canal
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What are the two mechanisms by which Benign Paroxysmal Positional Vertigo occurs?
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Canalithiasis: floating freely
Cupulolithiasis: the stones stick to the cupula |
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What's the classic history of someone with Benign Paroxysmal Positional Vertigo?
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Brief spells of vertigo TRIGGERED BY POSITION CHANGES!
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If someone has Benign Paroxysmal Positional Vertigo, where will the vertigo be worse?
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When they're lying on the side with the disorder
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What semicircular canal is most common for Benign Paroxysmal Positional Vertigo to show pathology?
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The posterior guy
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What test do you use to provoke Benign Paroxysmal Positional Vertigo?
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Dix-Halpike test
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What is the pattern of nystagmus in Benign Paroxysmal Positional Vertigo?
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Upbeat torsional
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What are the steps involved in the Dix-Hallpike test? What is it used for?
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1. Turn head 45 degrees
2. Put them on back, head 30 degrees below table 3. Look for the typical nystagmus: upbeat, torsional Benign Paroxysmal Positional Vertigo of the posterior semicircular canal |
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In Benign Paroxysmal Positional Vertigo, what direction does the torsion take place?
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TOWARDS THE AFFECTED SIDE!
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If you keep on doing the Dix-Hallpike test, what will happen to the effect?
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It will decrease!
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What is the treatment for Benign Paroxysmal Positional Vertigo?
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Problem with R ear:
1. Do the hix test (head to R); wait for nystagmus to go away 2. Move head slowly to L, wait 30 s 3. Put patient on their L side, wait 30 s You're trying to position the otoconia back on the utricle |
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If there's recurrent Benign Paroxysmal Positional Vertigo, what do you do?
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SURGERY!
You just completely plug the membranous canal. |
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What is the cause of vestibular neuritis?
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Viral inflammation of the vestibular nerve with a decrease/absence of activity
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What are the symptoms of vestibular neuritis?
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Vestibular crisis WITHOUT hearing loss
Vertigo is folowed by weeks of disequilibrium aggravated by head movement The presentation is quite dramatic |
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What are the medical treatments for vestibular neuritis? How long should you give the meds; why?
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Drugs that suppress the vestibular system: BZDs, Meclizine. Use them only for 72 hours; you don't want to damage compensation of the vestibular system
Corticosteroids improve recovery of peripheral function, but it's not clear that they help out with symptoms |
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What is the function of vestibular rehabilitation therapy?
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Promote central vestibular compensation
Improve functionality (balance, gait) |
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Who is a good candidate for vestibular rehabilitation therapy?
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STABLE peripheral vestibular defecit with incomplete compensation
Benign Paroxysmal Positional Vertigo Old people |
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What is the definition of labyrinthitis?
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Vestibular crisis + sudden sensorineural hearing loss
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What are causes of labyrinthitis?
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Viruses
Suppurative causes |
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What are the most common cause of medication induced ototoxicity?
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AMINOGLYCOSIDES
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What are the clinical features of Meniere's disease?
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Spontaneous vertigo associated with fluctuating hearing loss, roaring tinnitus, aural fullness
30% are bilateral Ear feels "full" |
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What is the common histopathologic finding in Meniere's disease?
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Endolymphatic hydrops
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What frequencies of hearing is lost in Meniere's?
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Low frequency sensorineural hearing loss
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What's the end point of Meniere's?
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Severe hearing loss
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If someone comes in with Meniere's like symptoms, what should you do initially? Why?
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You should get an MRI to rule out neoplasm
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What's the 1st line treatment of Meniere's?
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1. Low salt diet
2. Diuretic 3. Ativan (sublingual) to abort a vertigo attack |
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What are some more radical treatments for Menieres?
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Destructive processes:
-Gentamycin to destroy vestibular hair cells -Section of the vestibular nerve -Labyrinthectomy (only if there's SNHL too) |
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Who should you not perform a destrucitve procedure for Meniere's?
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People who have a loss of function in the other ear!
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What are the signs/symptoms of an acoustic neuroma?
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Dizziness!
Progressive asymmetric sensorineural hearing loss of the HIGHER frequencies Unilateral tinnitus |
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What do you use to diagnose an acoustic neuroma?
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MRI with and without contrast
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What is a cholesteatoma?
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A benign neoplasm; a squamous epithelial cyst
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What condition predisposes you to a cholesteatoma?
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Chronic otitis media
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What are the symptoms of a cholesteatoma?
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Hearing loss
Otorrhea Dizziness |
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What are the symptom of superior semicircular canal dehiscence?
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Dizziness exacerbated by sounds, straining
Hearing loss Autophony Aural fullness Pulsatile tinnitus |
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What are the requirements for a diagnosis of SSCD?
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Dehiscence (no bony covering) on a CT
One sign that it's affecting ear function: -Eye movements with loud sound/pressure changes in the external ear -Lowered cVEMP threshold -conductive hearing loss |
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What does the audiogram of someone with SSCD oo like?
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Conductive hearing loss with intact acoustic reflexes
Supranormal bone thresholds |
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What is the cause of nystagmus in SSCD?
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There's a shunting of the endolymph ampulofugally in the superior canal; excitatory. The body interprets this as looking DOWN and TOWARDS the affected ear. As a resutlt, there's a downward nystagmus that rotates away from that ear.
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What is the treatment for SSCD?
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You plug the canal: SURGERY FTW!
Completely curative. My Uncle Kevin had this for five years and it was completely debilitating. He was in and out of the ER 12 times/year to deal with the vertigo and he finally came to U of M for treatment. He got a bone plug and he has been symptom free since. Lesson 1: If you've got a problem, fix the cause, don't treat the symptoms Lesson 2: The super rare diseases that we learn about actually happen to people and are usually pretty horrid. Lesson 3: Surgery FTW! |
