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Session 3 CM- ENT-4

CM- ENT-4- disorders of inner ear

What is vertigo illusion that the body or environment is tumbling or spinning
What are the two types of vertigo central or peripheral
What is central vertigo vertigo caused by disruption of the CNS this will often present with cranial nerve findings
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)
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
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
If you hear that someone has a low frequency senorineural hearing loss what disorder should come to mind meniere's disease
This is causd by a nonspecific viral illness that damages the vestiublar nerve causing severe vertigo, and possible permanent vestibular and hearing impairement. Labyrinthitis
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
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
What is the Gold standard way to dx acoustic neuroma MRI
What is the tx for an acoustic neuroma 1. observe, 2. microsurgical removal, 3. stereotactic radiation therapy
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
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
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
What is the one question you absolutely have to ask about the vertigo how long does it last (duration)
If the vertigo lasts for seconds what is the likely dx BPPV
If the vertigo last for minutes what is the likely Dx TIA
If the vertigo lasts for hours what is the likely DX Meniere's
If the vertigo lasts for days what is the likely Dx Labyrinthitis
If the vertigo lasts for inconsistent time it varies how long it lasts what is the likely cause migraines
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
What PE findings will be unique to labyrinthitis unilateral weakness on fukuda testing
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
What is the tx for BPPVq epley maneuver or canalith repositioning this is 90% effective if performed correctly
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
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
Created by: smaxsmith