ENT

Question 1

Associated Signs & Symptoms of Vertigo (8)

Answer 1

Nausea and vomiting – vomiting can be severe and can cause electrolyte imbalance

*Postural and gait instability – gait and posture impairment: vertigo of central origin > vertigo of
peripheral origin

• Pallor and sweating
• Tinnitus, deafness, headache, photophobia
• Nystagmus (eyes move rapidly and uncontrollaby) – oscillation of the eyes

Question 2

Pathophysiology of Vertigo

1. CNS receives signals from both…
2. Vestibular labyrinth – relays…

Answer 2

CNS receives signals from both the right and left labyrinths and compares these signals with one
another

• Head is still – tonic discharges in both vestibular afferents = balanced
• During motion – right and left labyrinths are alternately excited and inhibited -> left-right difference in
  eighth nerve activity, which is recognized as motion
• Acute unilateral peripheral vestibular disorder – also interpreted by the CNS as motion or vertigo due to left-right differences

*Vestibular labyrinth – relays information via the vestibular portion of CN VIII to the brainstem
vestibular nuclei and from there to the cerebellum, ocular motor nuclei, and spinal cord

• Vestibuloocular connections – responsible for coordinated eye movements during head motion
• Vestibulospinal pathways – maintain upright posture
• Cerebellar connections – modulate activities by the vestiboocular and vestibulospinal connections

Question 3

Vestibuloocular connections –

Answer 3

responsible for coordinated eye movements during head motion

Question 4

Vestibulospinal pathways –

Answer 4

maintain upright posture

Question 5

Cerebellar connections

Answer 5

modulate activities by the vestibuloocular and vestibulospinal connections

Question 6

Presence of vertigo – likely suggests an abnormality….

Answer 6

*Presence of vertigo – likely suggests an abnormality of the semicircular canals or the central nervous system structures that process
signals from the semicircular canals

Question 7

Semicircular canals and the otolith organs –

Answer 7

end organs of the vestibular system

Question 8

Semicircular canals

Answer 8

sense angular motion

Question 9

Otolith organs

Answer 9

sense linear motion

Question 10

Management of Vertigo

Answer 10

Disease-specific treatment
* Management of the condition that causes the vertigo

Symptom-specific treatment
* Use of medications that target the symptoms
* Anti-histamines
* Anti-emetics
* Benzodiazepines

Vestibular rehabilitation

• Exercise-based program, designed by a specialty-trained vestibular physical therapist, to improve
  balance and reduce problems related to dizziness
• Encourages patients to perform challenging balance exercises with several potential benefits

Question 11

General Nursing Considerations Vertigo (5)

Answer 11

Assist the patient to make sure he/she is in a comfortable position

• Closely monitor vital signs and level of consciousness of patient
• Provide fall precaution
• Keep the patient calm and the room darkened to ensure the patient’s comfort, if possible
• Administer medications to reduce the patient’s signs and symptoms

Question 12

Otitis Media

Answer 12

*Inflammation of the middle ear which can present as Acute Otitis Media (AOM) or Otitis Media
with Effusion (OME)

• Acute Otitis Media – abrupt onset; related to middle ear inflammation and effusion

*Otitis Media with Effusion – (+) fluid in the middle ear without signs and symptoms of acute
infection; can be due to poor Eustachian tube function

Question 13

Chronic Otitis Media

Answer 13

inflammation of the middle ear lasting more than 12 weeks; irreversible damage has occurred

• Perforation of the tympanic membrane
• Calcification of the ossicles
• (+) cholesteatomas
• (+) purulent drainage from the ear
• Can be a consequence of AOM
• Pain is an uncommon finding; hearing loss

Question 14

Clinical Manifestations of AOM (5)

Answer 14

Otalgia

• Fever
• Hearing loss
• Younger children may have non-specific signs and symptoms
• Otitis Media with Effusion – usually an asymptomatic condition

Question 15

Management of Acute Otitis Media

Answer 15

Symptom control and management of underlying pathologic process

• Pain management
• Myringotomy/ Tympanocentesis
• Observation – uncomplicated AOM
• Antibiotics

Question 16

Meniere Disease Pathophysiology

Answer 16

Pathogenesis
 Meniere disease is an excessive accumulation of endolymph in the membranous labyrinth

 The volume of endolymph increases with distention
of the scala media until the membrane ruptures.

 Consequently, the neural end organs of the cochlea
degenerate.

Etiology

Many conditions including allergies, viral and bacterial infections (such as syphilis), head trauma, metabolic
derangements, and chronic stress have been suggested as causative
agents

Question 17

Symptoms Meniere Disease

Answer 17

Tinnitus

• Fluctuating hearing loss,
• Severe vertigo + progressive sensorineural hearing loss.
• Vertigo may improve as hearing impairment worsens.

Question 18

The most common cause of peripheral episodic vertigo is:

Answer 18

Benign paroxysmal positional vertigo.

Question 19

A 24-year-old male with vertigo and tinnitus has Meniere’s disease. He has fallen many times and injured his body. He refused operative intervention, but agrees to a trial of medication. Which one of the following substances is most likely to be prescribed?

Answer 19

Lasix

Question 20

A 66 years old patient complains of left ear hearing loss, fullness, tinnitus, headache and drainage for one year. These symptoms are concurrent most of the time. The ear exam reveals left eardrum perforation. The weber test lateralizes to the left ear, and the Rinne test is negative in the left ear and positive in the right ear. The diagnosis is peripheral vestibular system disease. All of the following symptoms support the diagnosis except:

tinnitus

hearing loss

ear fullness

headache

Answer 20

headache