Term
| Vertigo is caused by issues with the __ and __ systems. |
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Definition
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Term
| Near-faint dizziness suggests problems with the ___ system. |
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Definition
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Term
| Psychophysiological dizziness has a __ origin. |
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Definition
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Term
| Hypoglycemic index needs __ __. |
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Definition
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Term
| Disequillibrium is caused by issues with the __ __, __ __, __ __, __, and __. |
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Definition
- peripheral nerves
- spinal cord
- inner ear
- vision
- CNS |
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Term
40% Peripheral vestibular dysfunction
10% Central brainstem vestibular lesion
25% Presyncope or disequilibrium
15% Psychiatric disorder
10% Unknown cause |
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Definition
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Term
| Vertigo is the illusion of __, usually __. The patient may perceive that he is moving while the environment is still, or vice versa. |
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Definition
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Term
| Vertigo is caused by a defect in 1 of 3 systems: |
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Definition
- Vestibular system (most common)
- Visual system
- Somatosensory system |
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Term
| Most common system disorder responsible for vertigo? |
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Definition
| vestibular system dysfunction |
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Term
| With vertigo it is important to distinguish between __ and __ vertigo. __ vertigo has a poorer prognosis than __ vertigo. |
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Definition
- central and peripheral vertigo
- Central vertigo has a poorer prognosis than peripheral vertigo. |
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Term
Central vertigo means tumor/cns problem until proven otherwise.
Peripheral is usually self limiting in most cases. |
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Definition
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Term
| History of dizzy patient: |
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Definition
Detailed description of dizziness
Differentiate vertigo from non-vertigo
Determine onset, length, and if recurrent
Associated neurological or systemic signs
Any hearing loss?
Current medications
Differentiate Peripheral vs. Central cause |
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Term
| 3 classes of medications that may cause dizziness: |
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Definition
- Anti-cholinergics
- Diuretics
- Anti-HTN meds |
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Term
| Peripheral vertigo has __ or __ __ __, while central vertigo has __ or __ __ __. |
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Definition
- labyrinth or vestibular nerve dysfunction
- cerebellum or brain stem dysfunction |
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Term
| Peripheral vertigo is __, while central vertigo is ___. |
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Definition
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Term
| Peripheral vertigo shows __ nystagmus, while central vertigo shows ___ nystagmus. |
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Definition
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Term
| Peripheral vertigo tends to be __, while central vertigo is __. |
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Definition
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Term
| Peripheral vertigo tends to __ to __, while central vertigo is __. |
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Definition
- moderate to severe
- mild |
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Term
Peripheral
Labyrinth or vestibular nerve dysfunction
Recurrent
Nystagmus-horizontal
Position change
Moderate to severe vertigo |
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Definition
Central
Cerebellum or brain stem dysfunction
Continuous
Nystagmus-vertical
Mild vertigo
Non-positional |
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Term
| does peripheral or central vertigo cause more patient distress? |
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Definition
peripheral
Peripheral vertigo causes more pt distress even though the episodes are shorter |
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Term
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Definition
Tends to cause more patient distress, although the episodes are briefer. [The central nervous system (CNS) tends to adapt, shortening episodes in patients with peripheral vertigo.]
There are no brain stem, cerebellar, or cerebral hemispheric signs. |
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Term
| Peripheral horizontal nystagmus is inhibited by __ __, central vertigo is not. |
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Definition
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Term
| Peripheral vertigo has ___, __, and has its fast component towards the the side of the __ ear. |
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Definition
- unidirectional, horizontal
- normal |
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Term
| Tinnitus or hearing loss are often associated with __ vertigo. |
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Definition
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Term
| Brain stem, cerebellar/cerebral hemispheric signs that occur with central vertigo: |
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Definition
- headache
- limb ataxia
- true weakness
- paresthesias
- dysarthria
- diplopia |
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Term
| __ or __ __ are NOT associated with central vertigo. |
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Definition
| Tinnitus or hearing loss are NOT associated with central vertigo |
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Term
| Peripheral Vestibular Disorders: |
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Definition
- BPPV
- Labrynthitis
- Meniere's disease
- Acoustic neuroma
- Motion sickness
- Cervicogenic
- Perilymphatic fistula
- Vestibular neuronitis
- Semicircular canal infection
- Semicircular canal water penetration |
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Term
| Pneumonic to remember most common causes of Peripheral vertigo: |
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Definition
AMPLITUDE
- Acoustic neuroma
- Meniere's disease
- Positional vertigo
- Labrynthitis
- Infection of the middle or inner ear
- Trauma
- Unconventional-psycogenic (consider when normal neuro exam)
- Drugs
- Endocrine disorders |
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Term
| Central Vestibular Disorders: |
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Definition
- Brain stem lesion
- Basilar artery migraine
- TIA
- Stroke
- MS
- Cerebellar lesions
- Metastatic tumor
- Meningioma |
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Term
| Mneumonic to remember causes of central vertigo: |
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Definition
SPIN
- Sclerosis (MS)
- Pretty bad migraine (especially basilar)
- Ischemia or CNS lesion (especially basilar transient ischemic attack )
- Neuroma (acoustic neuroma) |
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Term
| 3 physiologic components of balance: |
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Definition
- Vestibular: labyrinth, vestibular nuclei
- Visual- CN III, IV, and VI
- Proprioceptive: upper cervical ms and joints |
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Term
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Definition
| patient feels that they are spinning |
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Term
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Definition
| - patient feels still but objects around them seem to be spinning |
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Term
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Definition
- Ear disease
- Toxic conditions (alcohol, food poisoning)
- Postural hypotension
- Infectious disease
- Cervicogenic
- Disease of the eye or brain
- Psychological |
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Term
| BPPV (Benign Paroxysmal Positional Vertigo): |
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Definition
- BRIEF EPISODES
- RECURRENT
- ASSOCIATED WITH HEAD POSITION
- NO HEARING LOSS
- POSITIVE NYLEN-BARANY MANEUVER
- CAUSED BY OTOCONIA DEBRIS FLOATING IN PSC
- moderate to severe
- gradually diminishes over a month or two
- latency or delayed onset of s/s |
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Term
| Nylen Barany maneuver aka __ __ maneuver. |
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Definition
Dix-Hallpike
Patient seated, head turned 45 degrees
Patient quickly lays supine
Latency period, then horizontal or rotational nystagmus
Nystagmus decreases after 10-20 seconds
Affected ear is the side head is turned toward when nystagmus and vertigo occurs |
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Term
| With the Dix-Hallpike maneuver, the affected ear which one? |
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Definition
| the affected ear is the side the head is turned towards when nystagmus occurs |
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Term
| Treatment options for BPPV: |
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Definition
- Epley's
- Sermont's
- Habituation exercises (Brandt-Daroff)
- Cervical adjusting |
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Term
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Definition
Patient placed supine with head turned 45 degrees toward the affected ear (30 sec.)
Dr. turns head 90 degrees so affected ear is up. (30 sec.)
Patient rolls on to side, head looking toward the floor (30 sec.)
Patient is lifted into sitting position
Procedure is repeated until no nystagmus |
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Term
| Sermont's maneuver can be done at home. Explain how to do this: |
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Definition
Patient turns head 45 degrees away from the affected side
Quickly lays down maintaining head position (4 minutes)
Brought up and placed on other side with same head position. (4 min) Sit up normal |
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Term
| Post Maneuver Instructions: |
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Definition
Patient waits 10 min. before leaving office.
Other person drives them home.
Sleep half-reclined 2-3 days.
Avoid laying on bad side.
Avoid extreme head extension for 2-3 days |
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Term
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Definition
| Meclizine (Antivert) 12.5 to 50 mg orally every 4-8 hours |
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Term
| Common medications used for BPPV and vertigo: |
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Definition
Meclizine* (Antivert) 12.5 to 50 mg orally every 4 to 8 hour
Dimenhydrinate* (Dramamine) 25 to 100 mg orally, IM, or IV every 4 to 8 hours
Diazepam (Valium) 2 to 10 mg orally or IV every 4 to 8 hours
Lorazepam (Ativan) 0.5 to 2 mg orally, IM, or IV every 4 to 8 hours
Metoclopramide (Reglan) 5 to 10 mg orally every 6 hours
5 to 10 mg by slow IV every 6 hours
Prochlorperazine (Compazine) 5 to 10 mg orally or IM every 6 to 8 hours 25 mg rectally every 12 hours (nausea and vomiting)
5 to 10 mg by slow IV over 2 minutes
Promethazine (Phenergan) 12.5 to 25 mg orally, IM, or rectally every 4 to 12 hours
also can do scopalamine |
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Term
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Definition
- hx of neck trauma/muscle spasm
- limited cervical ROM
- positive chair rotation test (Fitz-Ritson)
- complain more of dysequilibrium (tilt) more than rotational vertigo
- overstimulation of upper cervical proprioceptors
- may overlap with BPPV or Meneire's disease |
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Term
| Vertebrobasilar Insufficiency TIAs: |
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Definition
- vertigo with associated neurological signs
- diplopia
- ataxia
- drop attacks
- dysarthria
- paralysis/weakness/numbness
- headache
- risk factors (HTN, Diabetes, Coronary Disease) |
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Term
| Meniere's Disease presenting symptoms: |
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Definition
- SUDDEN AND RECURRENT (PAROXYSMAL) ATTACK OF SEVERE VERTIGO
- LOW TONE HEARING LOSS
- LOW TONE TINNITUS
- SENSE OF FULLNESS IN THE EAR
- VERTIGO LASTS FOR HOURS TO DAYS AND THEN BURNS OUT
- HEARING LOSS MAY PROGRESS |
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Term
| 4th leading cause vertigo: |
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Definition
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Term
| Meniere's disease is caused by __ or __ of __, possible __ etiology, __ __, __ __. ___ __ are more prone. |
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Definition
- overproduction or retention of endolymph
- autoimmune etiology
- head trauma
- previous infection
- Pregnant females |
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Term
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Definition
- salt-restriction diet
- diuretic therapy
- cervical adjusting (overlaps with cervicogenic vertigo) |
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Term
| Perilymphatic fistula pts usually have a history of __ __ __ like an __ or __ __. |
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Definition
- barometric pressure changes
- airplane
- weight lifting |
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Term
| With a perilymphatic fistula an __ develops between the __ and __ ear, called an __ __ __. This is a rare cause of __. __ __ reproduces signs and symptoms. Treatment is __. |
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Definition
- opening
- middle and inner ear
- oval window rupture
- rare cause of vertigo
- Bearing down
- surgery |
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Term
| Labrynthitis is __ __ vertigo that lasts __ to __. Pts may have __ and __. If the cause is viral, there is __ __ __. If the cause is __ there is __ __. |
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Definition
- sudden severe
- days to weeks
- nausea and vomiting
- viral> no hearing loss
- bacterial> hearing loss |
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Term
| Acoustic Neuroma has __ but __ hearing loss. Pts will have __ and possible __. The onset is __. |
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Definition
- mild but constant hearing loss
- dizziness with possible tinnitus
- gradual |
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Term
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Definition
| Benign schwannoma of 8th CN |
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Term
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Definition
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Term
| Cerebral hemorrhage presents with __ vertigo and ___. Often there is __ associated with a __. List more symptoms. |
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Definition
- sudden vertigo
- nausea
- vomiting associated with headache
- nystagmus
- nuchal rigidity
- facial paralysis
- ataxia
- dysrhythmia
- small reactive pupils |
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Term
| There is a history of __ in 2/3 of pts with cerebral hemorrhage. |
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Definition
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Term
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Definition
Serious vertigo that is disabling
Ataxia out of proportion to vertigo
Vertigo longer than 4 weeks
Changes in hearing
Vertical nystagmus
Focal neurological signs
Systemic disease or psychological origin |
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Term
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Definition
- perception of sound produced involuntarily within the body
- symptom of life threatening disease or benign annoyance
- psychological effects can be severe |
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Term
| Objective tinnitus is __ to the __ or __. This encompasses all ___ causes. It can be __ or ____. |
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Definition
- audible to the physician or observer
- parauditory
- pulsatile or non-pulsatile |
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Term
| Vascular abnormalities that may cause objective tinnitus: |
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Definition
- neoplasm
- Arteriovenous malformations (AVM)
- arterial bruit
- venous hum |
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Term
| ____ is a fast spasm/contraction of the muscles of the roof of the mouth that may cause tinnitus. |
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Definition
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Term
| H&P of objective tinnitus: |
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Definition
Relation to the heart rate, light exercise
Thorough ENT exam, particulary otoscopy
Exam for retrotympanic mass
Auscultate ext. canal, orbit, mastoid, skull, and neck
Audiogram |
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Term
| Subjective tinnitus originates in the __ system. |
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Definition
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Term
| Is subjective or objective tinnitus more common? |
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Definition
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Term
| There is little known about the physiologic cause of subjective tinnitus, proposed theories suggest the following 3 causes: |
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Definition
- hyperactive hair cells/nerve fibers
- chemical imbalance
- reduced suppressive influence of CNS
Etiologic factors - otologic, cardiovascular, metabolic, neurologic, pharmacologic, dental, psychological
H/O noise exposure and related symptoms - hearing loss, vertigo
Exact characterization of tinnitus quality
Perceptual location |
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Term
| More possible causes of subjective tinnitus: |
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Definition
Head injury, whiplash injury, meningitis, multiple sclerosis
Medications - aspirin, aspirin compounds, aminoglycoside antbiotics, NSAIDS, heterocycline antidepressants
TMJ, dental abnormalities prevalent
Psychologic factors, somatoform disorder, Depression |
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Term
| Medications that may cause subjective tinnitus: |
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Definition
- Aspirin
- Aminoglycoside antibiotics
- NSAIDS
- Heterocycline antidepressants |
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Term
| Overdose of ASA> ringing of the ears. ASA is a huge culprit. BC powder= buffered ASA- causes this too. |
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Definition
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Term
| tinnitus treatment counseling: |
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Definition
Etiologic factors
After work-up, unlikelihood of tumor or life-endangering disease
25% improve or go away, 50% decrease, 25% persist, very small portion increase
Avoid loud noise, wear ear protection
Avoid caffeinated beverages, stimulants (coffee, tea, colas, chocolate)
Stop smoking |
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Term
| environmental masking of tinnitus; |
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Definition
For mild tinnitus esp. bothersome in quiet
Home environmental maskers
Broad-band noise, between FM stations
Particularly useful at night
Required noise soft usually does not disturb family members |
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Term
| Hearing aids and maskers for tinnitus: |
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Definition
Saltzmann and Ersner (1947) - hearing aids amplified background noise, mask tinnitus
If hearing loss try HA, less interference with speech, no noise to produce damage, improve speech understanding
Commercial tinnitus maskers with or without HA
Complete or partial mask
No clear guidelines for use |
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Term
| Surgery can be effective if cause of tinnitus is __, __ __, or __ __. Literature discusses __ __ and __ __ of the cochlear nerve. BUT RESULTS ARE NOT CONSISTENT AND FEW OTOLOGISTS ADVOCATE FOR SURGERY. |
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Definition
- otosclerosis
- acoustic neuroma
- glomus jugulare
- cochlear neurectomy
- microvascular decompression of the cochlear nerve |
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