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Disorders Of Balance – Otological Causes (Vertigo)

Disorders Of Balance – Otological Causes (Vertigo). Wong Pik Wa Carrie Wong On Kit Wong Sze Nga Yeung Yat Sing Kevin 22nd December 2006. Scenario. Mrs. Lee, 55/F C/O Dizziness for 3 months HPI Sudden onset Rotatory in nature Episodic, last up to 1 min a/w head movement

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Disorders Of Balance – Otological Causes (Vertigo)

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  1. Disorders Of Balance – Otological Causes (Vertigo) Wong Pik Wa Carrie Wong On Kit Wong Sze Nga Yeung Yat Sing Kevin 22nd December 2006

  2. Scenario • Mrs. Lee, 55/F • C/O • Dizziness for 3 months • HPI • Sudden onset • Rotatory in nature • Episodic, last up to 1 min • a/w head movement • Nausea & vomiting +ve • No symptoms between episodes • 2 episodes of URTI recently • ? Subjective hearing loss

  3. PMH • HT on adalat for 5 years • Poorly controlled DM on insulin • NKDA • Social history • Retired factory worker • NSND • O/E • TM intact • No focal neurological deficit

  4. 1. What is your top ddx? • Benign paroxysmal positional vertigo • Ménière’s disease • Vestibular neuronitis • Hypoglycemia • Acoustic neuroma

  5. 2. Which one is not a feature of BPPV? • Lasts for seconds • No acoustic symptoms • Associates with nausea & vomiting • Asymptomatic between attacks • Provoked by head movements

  6. 3. What one is associated with BPPV? • Sinusitis • Cervical spondylosis • Use of aminoglycosides • Whiplash injury • CSOM

  7. 4. Which one is not a feature of A +ve Dix Hallpikemaneuver? • Geotropic nystagmus • Diplopia • Fatiguability • Latency • Coherence

  8. 5. What is the most appropriate management? • Vestibular neurectomy • Urgent MRI IAM • Observation • Transtympanic aminoglycoside application • Epley maneuver

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