Ears 4

Question 1

Quickly lower pt to supine position, head extended over edge and placed 30 degrees lower than rest of body, head turned L or R.

• What test is this?
• What is a + test for central and peripheral causes?

Answer 1

Dix-Hallpike maneuver to determine if vertigo is from a central or peripheral cause.

• Peripheral cause: latency, fatigable nystagmus
• Central cause: no latency, non-fatigable nystagmus

Question 2

What is the most common type of BPPV? What type of nystagmus will be seen?

Answer 2

Posterior, will see horizontal nystagmus

Question 3

What are the 3 conditions which cause Vertigo?

Answer 3

• BPPV
• Labyrinthitis
• Meniere Disease

Question 4

Caused by sediment in semicircular canals (otoliths)

Answer 4

BPPV (benign paroxysmal positional vertigo)

Question 5

• Type of vertigo provoked by changs in head position
• 10-15 second latency period
• Acute vertigo for 10 - 60 seconds
• Imbalanced for several hours
• Brief episodes, recurrent
• Appear in clusters for several days

Answer 5

BPPV

Question 6

• Particle repositioning maneuver
• What is it used to tx?
• Describe how it’s done

Answer 6

Epley Maneuver to tx BPPV

1. Pt seated upright, legs extended, head rotated 45 towards + Dix Hallpike test side
2. Quickly / passively force pt down into supine position w/ head in 30 extension
3. Observe eyes for primary nystagmus, remain here for 1 - 2 mins
4. Rotate 90, remain for 1 - 2 mins
5. Role pt onto shoulder, rotate 90 (looking down at 45 angle) Observe for secondary nystagmus. Remain 1 - 2 mins
6. Slowly bring pt back to seated, maintaining 45 rotation. Stay seated for 30 seconds

Question 7

• Inflammation disorder of vestibular portion of CN VIII
• Occurs after URI

Answer 7

Labyrinthitis

Question 8

• Acute onset of continuous vertigo
• Hearing loss/tinnitus are common
• N/V
• Gait impaired

Answer 8

Labyrinthitis

Question 9

In which condition should you be careful to not miss a cerebellar hemorrhage or stroke?

Answer 9

Labyrinthitis

Question 10

• Abx given if pt is febrile or sxs of bacterial infection
• Give vestibular suppressants (2 days maximum)
  
  • Anticholinergics
  • Antihistamines
  • Benzodiazepines
• Anti-emetics (Zofran)
• Corticosteroids

Answer 10

Tx for Labyrinthitis

Question 11

• Reassure pt that condition is benign and self limited
• Recovery is gradual (several weeks)
• Refer to PT for vestibular rehabilitation

Answer 11

Tx for Labyrinthitis

Question 12

Vertigo syndrome due to peripheral lesion (sorta)

• Distention of endolymphatic compartment of inner ear
• Sxs wax/wane as pressure rises and falls
• Can permanently damage inner ear structures

Answer 12

Meniere disease

Question 13

Endolymphatic hydrops

Answer 13

Meniere Disease

Question 14

• Episodic vertigo w/ discrete spells lasting 20 mins to several hours
• Fluctuating sensorineural hearing loss of low frequency sounds
• Low tone tinnitus “blowing/roaring”
• Unilateral ear pressure

Answer 14

Meniere Disease

Question 15

• Refer to ENT/Audiology
• Caloric testing is positive if pt does not have nystagmus w/ cold water in ear

Answer 15

Dx for Meniere Disease

Question 16

Difficult to tx because course is unpredictable

Answer 16

Meniere Disease

Question 17

• Diuretics (acetazolamide)
• Low salt diet

Answer 17

Tx for Meniere Disease

Question 18

Acoustic Neuroma

Answer 18

Vestibular Schwannoma

Question 19

One of the most common intracranial tumors

Answer 19

Vestibular Schwannoma

Question 20

Describe a Vestibular Schwannoma

• Unilateral or Bilateral?
• Benign or Metastatic?
• Where does it begin?
• What does it do?

Answer 20

• Usually unilateral
• Benign tumor of CN VIII
• Begins in internal auditory canal
• Grows gradually, compressing pons
• Causes hydrocephalus

Question 21

• Unilateral hearing loss
• Continuous dysequilibrium
• Tinnitus

Answer 21

Presentation of Vestibular Schwannoma

Question 22

• What is the primary test for diagnosing Vestibular Schwannoma?
• Secondary test?

Answer 22

• MRI w/ contrast
• Audiometry

Question 23

• Observation
• Surgical excision (main tx)
• Radiotherapy

Answer 23

Tx for Vestibular Schwannoma