Vertigo

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Vertigo

• Dr. Abdulrahman AlsanosiAssociate professor
  King Saud University Otolaryngology consultant
  Otologist , Neurotologist Skull Base Surgeon
  King Abdulaziz University Hospital / KFMC

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What are the components of balance system ?
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• Inner ear (3 semicicular canals and otolith organ
  )
• Cerebellum
• Vision (VOR)
• Proprioceptive

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How does balance system work ?
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Physiology

• Function of vestibular system
• Transform of the forces associate with head
  acceleration and gravity into a biological
  signals that the brain can use to develop
  subjective awareness of head position in space
  (orientation)
• produce motor reflexes that will maintain
  posture and ocular stability

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It is not surprisingly that vestibular lesion
cause

• Imbalance
• posture and gait imbalance
• visual distortion (oscillopsia ).

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oscillopsia
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What is vertigo?
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VERTIGO

• The word "vertigo" comes from the Latin
  "vertere", to turn the suffix "-igo", a
  condition a condition of turning about).
• It is an allusion of being moving or the world is
  moving too.

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What is nystagmus ?
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What are the questions to ask in history ?

• Onset
• Frequency
• Duration
• Associated auditory symptoms
• Aggrevating and relieving factors
• Ear disease or ear surgery
• Trauma
• Migraine
• Ototoxic drug intake

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Differential diagnosis A) peripheral
vestibular loss B) central vestibular loss
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What are the causes of peripheral vestibular loss
?
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peripheral vestibular loss

• Vestibular neuritis
• Benign paroxysmal positional vertigo ( BPPV)
• Meneires disease (Endolymphatic hydrop )

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Vestibular neuritis

• Viral infection of vestibular organ
• Affect all ages but rare in childern
• Affected patient presents acutely with
  spontaneous nystagmous ,vertigo and nausea
  vomiting
• Patient requires only symptomatic treatment
• It takes 3 weeks to recover from vestibular
  neuritis

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Vestibualr neuritis
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• BPPV( benign paroxysmal positional vertigo )

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BPPV

• The most common cause of vertigo in patient gt 40
  years
• Repeated attacks of vertigo usually of short
  duration less than a minute .
• Provoked by certain positions (rolling in beds,
  looking up ,and head rotations)
• Not associated with any hearing impairment

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BPPV

• Diagnosis
• History
• Dix-Halpike maneuver

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(No Transcript)
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Treatment

• Epley maneuver

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Video
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Endolymphatic hydrop (Meneires disease)

• Pathophysiology
• Unknown etiology
• ? ?production of fluid within inner compartment

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• vertigo (minutes to hours )
• Low frequency fluctuating SNHL
• Tinnitus and fullness in the ear.
• In 10 - 20 of cases the disease later involves
  the opposite ear

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Meneires disease

• Diagnosis
• -History
• -PTA

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Meneires disease

• Management
• -low-salt diet
• -Medical therapy
• - Meniett device's
• -Chemical perfusion
• -Surgery

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SUMMARY
Treatment Course of diseases hearing Duration of attack Diagnosis
Symptomatic Self limited normal Days Vestibular N
Exercise Recurrent normal Seconds BPPV
Medical surgical Recurrent Affected Minutes to hours Meneires diseaseM
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What are the causes of central ?
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• CVA (Cerebero vascular accident)
• Brain tumor ( acoustic neuroma )
• Multiple sclerosis

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CVA

• Elderly patient with chronic disease like (DM
  ,HTN) with sudden attack of vertigo neurological
  symptoms

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Acoustic tumor

• Benign tumor
• Arise from vestibular devision of VIII
• Clinical presenatation
• Unilateral tinnitus
• Hearing loss
• Dizziness

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Acoustic neuroma

• Diagnosis
• History
• PTA ( Unilateral SNHL )
• Radiology

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diagnosis

• History is the most important key to
  diagnosis for a dizzy patient .

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Investiagtions

• PTA
• CLORIC TEST
• ENG
• CT SCAN
• MRI

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Take away message
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Thank you