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Disorders Of Balance – Otological Causes (Vertigo). Wong Pik Wa Carrie Wong On Kit Wong Sze Nga Yeung Yat Sing Kevin 22nd December 2006. Definition. Hallucination of movement. Scenario. Mrs. Lee, 55/F C/O Dizziness for 3 months HPI Sudden onset Rotatory in nature

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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. Definition • Hallucination of movement

    3. 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

    4. 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

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

    6. Causes • Peripheral (lesion in vestibular system) • Benign paroxysmal positional vertigo (BPPV) • Ménière’s disease • Vestibular neuronitis • Central (lesion in brainstem vestibular nerve nuclei) • Migraine • Cerebral vascular accident • Multiple sclerosis • Tumour • Ototoxic drug • Infection • Hyperventilation • Acoustic neuroma

    7. Approach • History • Onset • Duration • Headache • Vertigo • Tinnitus • Hearing loss • Ear fullness, pressure • Nausea & vomiting • Physical Examination • Extraocular movement, nystamus • CN VII, VIII • Otological exam • Dix Hallpike maneuver • Investigations • CBC, RBG, U&E • MRI IAM • ENG

    8. BPPV • Average age of onset: 51 y.o. • Typical features • Rotatory vertigo last for seconds • a/w positional change • No tinnitus/ hearing loss • Treatment of choice • Epley maneuver • Vestibular sedatives

    9. BPPV • Pathophysiology • Cupulolithiasis theory • Canalithiasis theory

    10. Follow up Q.1Which one is not a feature of BPPV? • Lasts for seconds • No acoustic symptoms • Associates with nausea & vomiting • Asymptomatic between attacks • Provoked by head movements

    11. Follow up Q.2What one is associated with BPPV? • Sinusitis • Cervical spondylosis • Use of aminoglycosides • Whiplash injury • CSOM

    12. Follow up Q.3Which one is not a feature of A +ve Dix Hallpikemaneuver? • Geotropic nystagmus • Diplopia • Fatiguability • Latency • Coherence

    13. Follow up Q.4What is the most appropriate management? • Vestibular neurectomy • Urgent MRI IAM • Observation • Transtympanic aminoglycoside application • Epley maneuver