Clarify the meaning of "dizziness"

Episodic vs. continuous

Duration

Position triggered (head or body)

Assoc. inner ear symptoms

Assoc. neurological symptoms

Benign paroxysmal positional vertigo (BPPV)

Vestibular neuritis

Endolymphatic hydrops (Meniere's dx)

BPPV - clinical syndrome

- Brief episodes of vertigo (5-10 s) when head is moved in the plane of the canal

- Vertigo stops when head is still

- Verticl worse when pt recumbent

- No hearing loss, neuro sx

- Normal gait

- 50+ years

- Head trauma

- Prior inner ear injury

- Prolonged recumbency

- Migraine w/ aura

Peripheral nystagmus

Vs.

Central nystagmus

5

Unidirectional - in the plane of the canal (multi)

Mixed nystagmus (not compatible w/ struct)

Inhibit with visual fixation (not inhibited)

Normal ocular control (abnormal: ex. smooth)

Normal neurological exam (abnormal)

Endolymphatic hydrops - Tx

3 medical, 4 surgical

Medical:

Diuretic (Dyazide, HCTZ, ACTZ), Salt restriction, <2g day, Stress reduction

Surgical: labyrinthectomy, vestibular nerve section, intratympanic gentamycin injection, endolymphatic shunt 

1. Clinical history of isolated prolonged vertigo lasting days with gradual improvement

2 .Vestibular function testing showing caloric paresis

3. Positive head thrust test showing delayed correction of eye movement for head movement

At least two episodes of vertigo > 20 mins

Audiometrically confirmed low freq hearing loss

Tinnitus or fullness