What is the commonest cause of peripheral vertigo?
BPPV
What happens in BPPV?
Displacement of otoconia in semicircular canals
What are the symptoms of BPPV?
- Attacks of acute rotational vertigo > 30s
- Provoked by head movement (link to occupation)
- N&V
- Reducing hearing and tinnitus
- Horizontal nystagmus
How do you diagnose BPPV?
Positive Dix-Hallpike test (presence of fatiguable nystagmus)
Is Romberg’s test positive or negative in BPPV?
Negative
How do you treat BPPV?
Epley manoeuvre
What is acute labyrinthitis?
Vestibular neuritis - peripheral vertigo post-URTI (can also be caused by vascular lesion)
What are the symptoms of acute labyrinthitis?
- Single attack of severe vertigo that lasts few days (unilateral) and improves within couple weeks
- N&V
- Horizontal nystagmus (away from affected side)
- Prostration (can’t get out of bed)
- No deafness or tinnitus
How do you diagnose acute labyrinthitis?
Positive head thrust/impulse test
How do you treat acute labyrinthitis?
Prochlorperazine (Buccastem) = vestibular suppressant (need to stop these asap bc affects both sides and need other side to compensate)
- Supportive
- Rehabilitation
What is Meniere’s disease?
Peripheral vertigo caused by dilation of endolymphatic spaces of membranous labyrinth and increased pressure
What are the symptoms of Meniere’s disease?
- Recurrent attacks of vertigo lasting > 20 min (2-4h)
- Fluctuating (or permanent) unilateral sensorineural hearing loss esp. in low frequencies
- Unilateral tinnitus - with sense of aural fullness ± falling to one side
- Horizontal nystagmus
How do you diagnose Meniere’s disease?
- Audiometry
- Electrocochleography
- MRI
How do you treat attacks of vertigo in Meniere’s disease acutely?
- Prochlorperazine (Buccastem)
How do you prevent attacks of vertigo in Meniere’s disease?
- Betahistine
- Thiazide diuretics e.g. bendroflumethiazide
- Low salt diet
What is the risk of developing Meniere’s in the other ear?
40%
What surgical options can be used to treat Meniere’s in some patients?
- Intratympanic gentamicin
- Labyrinthectomy
- Vestibular neurectomy
How does an acoustic neuroma/vestibular schwannoma present?
Unilateral sensorineural hearing loss (vertigo occurs later), tinnitus, absent ear reflex
How do you diagnose an acoustic neuroma?
MRI cerebellopontine angle
What are risk factors for development of acoustic neuroma?
- Female
- Neurofibromatosis
What medications are ototoxic and can cause deafness ± vertigo?
- Aminoglycosides e.g. gentamicin
- Loop diuretics e.g. furosemide
- Cisplatin
