Vertigo
Inner ear = contents of boney labyrinth (hollow within temporal bone)
- Cochlear: cochlear nerve aka coch branch of vestibulocochlear (VIII)
- Vestibular system: vestibular nerve aka vest branch of vestibulocochlear (VIII)
- Vestibule
- Semi-circular canals
- Vestibule
Peripheral
- hearing loss usually present
Benign paroxysmal positional vertigo
- otoconia disconnect from hair (head injury, inner pathology or age)
- sudden onset short lived related to head position
- Dx with Dix-Hallpike
- Rx with Epley manoeuvre
- If severe and persistent refer to ENT ?surgery
Otitis interna: Vestibular neuritis V labyrinthitis
- vestibular nerve inflammation, often viral (?HSV1 reactivation)
- associated nausea, nystagmus
- IF hearing involved = labyrinthitis
- Prednisolone
- Prochlorperazine (Stemetil), antihistamine
- IVF if significant vomiting
Meniere's
- recurrent attacks of triad of vertigo, tinnitus and aural fullness/hearing loss
- Rx Prochlorperazine (Stemetil), antihistamine
- Rx restrict salt, smoking cessation
- Prophylaxis: Betahistine (Histamine analogue increases blood flow) +/- hydrochlorothiazide
- Refractory cases refer to ENT ?Surgery
V
Central
- hearing usually intact