CM- ENT-4- disorders of inner ear
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| What is vertigo | illusion that the body or environment is tumbling or spinning
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| What are the two types of vertigo | central or peripheral
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| What is central vertigo | vertigo caused by disruption of the CNS this will often present with cranial nerve findings
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| What is peripheral vertigo | vertigo involving the inner ear vestiublar system. Often accompanies ear related head trauma, hearing loss, tinnitus, barotrauma, labyrinthitis, Benign paroxysmal positional vertigo (BPPV)
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| Pt presents with a complaint that the it feels like the room is spinning around them the feeling happened after they got hit in the head by a ball. If this disorder is being caused by displaced otoliths what is the problem | benign paroxysmal positional vertigo
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| What is meniere's triad | fluctuating low frequency sensorineural hearing loss, fluctuating tinnitus and episodic vertigo can last days with episodes lasting from 30 minutes to several hours
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| If you hear that someone has a low frequency senorineural hearing loss what disorder should come to mind | meniere's disease
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| This is causd by a nonspecific viral illness that damages the vestiublar nerve causing severe vertigo, and possible permanent vestibular and hearing impairement. | Labyrinthitis
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| If the viral infection that caused vestibular nerve damage doesn’t cause hearing loss it is not called labyrinthitis but what | it is called vestibular neuronitis
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| Pt presents with a complaint of hearing loss, tinnitus, vertigo, dysequilibrium, fullness or pressure in the ears and facial numbness/paralysis what condition may they have | Acoustic neuroma
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| What is the Gold standard way to dx acoustic neuroma | MRI
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| What is the tx for an acoustic neuroma | 1. observe, 2. microsurgical removal, 3. stereotactic radiation therapy
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| You suspect pt has peripheral vertigo what on the Hx would help lead you to this conclusion | Hx of draining ear, ear disease, ear surgery, ear pain, hearing loss, acute infection, barotrauma or head trauma with complaint of vertigo
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| You suspect pts vertigo is central vertigo what in the Hx would sway you toward this conclusion | Hx of headaches, visual symptoms, sensory or motor deficits, muscle weakness, and incoordination
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| If the vertigo is not a vestibular disease what would you expect on the hx | Hx of drug use, cardiac symptoms, hypoglycemia, psychiatric disorders, secondary gain issues, and anxiety
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| What is the one question you absolutely have to ask about the vertigo | how long does it last (duration)
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| If the vertigo lasts for seconds what is the likely dx | BPPV
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| If the vertigo last for minutes what is the likely Dx | TIA
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| If the vertigo lasts for hours what is the likely DX | Meniere's
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| If the vertigo lasts for days what is the likely Dx | Labyrinthitis
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| If the vertigo lasts for inconsistent time it varies how long it lasts what is the likely cause | migraines
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| What exam would you perform on physical exam if you suspected BPPV and what results would you expect | perform the Dix-Hallpike maneuver. Nystagmus should be evident after maneuver if BPPV is present
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| What PE findings will be unique to labyrinthitis | unilateral weakness on fukuda testing
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| If you suspect the vertigo is do to a congenital abnormaility of the ear what test would be better to order MRI or Temporal bone CT | Temporal Bone CT
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| What is the tx for BPPVq | epley maneuver or canalith repositioning this is 90% effective if performed correctly
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| What is the tx for menire's disease | low sodium diet, diuretics, meclizine or benzos for acute phase of illness. Hearing conservation is imperative, audiogram during acute illness makes the dx
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| What is the tx for labyrinthitis | admission, benzos, steroids, antivirals, antiemetics and acute hearing test. Pt should be very sick and may have permanent hearing loss and vertigo
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