What is benign paroxysmal positional vertigo?
Peripheral vestibular disorder that manifests as sudden, short lived episodes of vertigo elicited by specific head movements
What is the aetiology of benign paroxysmal positional vertigo
- Approx 50-70% occurs with known cause- PRIMARY BPPV
- SECONDARY BPPV: associated with underlying conditions- head trauma, labryinthitis, vestibular neuronitis, Meniere’s disease, migraines, ischaemic processes and iatrogenic causes
What is the aetiology of benign paroxysmal positional vertigo?
- Primary BPPV has peak incidence in 50-70 yrs but can occur at any age
- Migraine and head trauma more common in younger pts with secondary BPPV
What are the presenting symptoms of benign paroxysmal positional vertigo?
- Specific provoking positions
- Brief duration of vertigo
- Episodic vertigo
- Severe episodes of vertigo
- Sudden onset of vertigo
- Nausea, imbalance and lightheadedness
What are the risk factors for benign paroxysmal positional vertigo?
- Increasing age
- Female sex
- Head trauma
- Vestibular neuronitis
- Labryrinthitis
- Migraine’s
- Inner ear surgery
- Meniere’s disease
What are the signs of benign paroxysmal positional vertigo on examination?
- Absence of associated neurological or otological symptoms
- Normal neurological examination
- Positive Dix-Hallpike manoevre or positive supine lateral head turn
- Normal otological examination
What are the investigations for benign paroxysmal positional vertigo
- Dix-Hallpike manoeuvre: used to diagnose posterior canal BPPV. Shows vertigo with the appropriate position-provoked nystagmus response
- Supine lateral head turns: nystagmus
What is Ménière’s disease?
An auditory disease characterised by an episodic sudden onset of vertigo, low-frequency hearing loss, low frequency roaring tinnitus and sensation of fullness in the affected ear
What is the aetiology of Ménière’s disease?
- Underlying cause unknown
What is the epidemiology of Ménière’s disease?
- Primarily disease of adulthood
- Onset usually occurs in fourth decade
- Slightly more common in females. 1.1:1 ratio
What are the presenting symptoms of Ménière’s disease?
- Presence of risk factors: recent viral infection, genetic predisposition, autoimmune disease
- Vertigo
- Hearing loss
- Tinnitus
- Drop attacks
- Aural fullness
What are the signs of Ménière’s disease on examination?
- Positive Romberg’s test
- Fukuda’s stepping test: Turning towards the affected side when asked to march in place with eyes closed.
What are the investigations for Ménière’s disease?
- Pure-tone air and bone conduction with masking: unilateral sensorineural hearing loss
- Speech audiometry
- Tympanometry/immitance/stapedial reflex levels
- Oto-acoustic emmisions (OAE)
What is a thyroglossal cyst?
An epithelium lined cyst found along the course of descent of the thyroid gland
What is the aetiology of thyroglossal cysts?
- Thyroglossal duct is a tract of embryonic mesoderm that originates between the 1st and 2nd branchial pouches, represented by the foramen caecum of the tongue.
- It descends to a pretracheal site during development to form the thyroid gland
- Duct usually disappears in 6th week however if some tissue remains at any point along its course- may develop into cyst
What is the epidemiology of thyroglossal cysts?
- Presents in children or adolescents
- Mean age of presentation =6 yrs
- 3x more common than branchial cysts
What are the presenting symptoms of a thyroglossal cyst?
- Swelling or lump is noticed in the midline of the anterior neck
- Mostly asymptomatic but in 5% cases there may be tenderness or rapid enlargement due to infection
What are the signs of a thyroglossal cyst on examination?
- Midline smooth rounded swelling, typically between the thyroid notch and hyoid bone, although sometimes found in the submental region
- Moves upwards on protrusion of the tongue and with swallowing
- Can usually be transilluminated
What are the differential diagnosis of a thyroglossal cyst?
- Lymph node
- Epidermal inclusion (dermoid) cysts
- Salivary duct abnormality
- Ectopic thyroid tissue
What are the investigations for thyroglossal cysts?
- None may be necessary in a euthyroid pt
- If cyst is suprahyoid, TFTs and an isotope should be carried out to exclude a lingual thyroid, as its removal may render the pt hypothyroid
- Ultrasound or MRI: To differentiate from other structures: cysts have high signal on T2 weighting
What is tonsillitis?
Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils
What is the epidemiology of tonsillitis?
- Usually viral: most commonly caused by rhinovirus, followed by coronavirus and the adenovirus. Less commonly by influenza virus
- Common bacterial agents include beta-haemolytic and other streptococci
What is the epidemiology of tonsillitis?
- Acute tonsillitis common in children between the ages of 5-15 yrs
- Most commonly seen in winter and early spring in temperate climate though may occur at any time of year
What are the presenting symptoms of tonsillitis?
- Presence of risk factors: age 5-15, contact with infected people in enclosed spaces
- Pain on swallowing
- Sudden onset of sore throat
- Headache
- Abdominal pain
- Nausea and vomiting
- Presence of cough or runny nose
