Related Subjects:
|Assessing Hearing Loss
|Benign Paroxysmal Positional Vertigo (BPPV)
|Cholesteatoma
|Epistaxis (Nosebleeds)
|Acute Mastoiditis
|Nasal polyps
|Acute Sinusitis
|Sudden Sensorineural Hearing loss (SNHL)
|Causes of Vertigo
🌀 Vertigo & Dizziness: OSCE Summary
Quick Pearls
✅ BPPV: Seconds, positional, no hearing loss
🎧 Meniere’s: Minutes–hours, recurrent, hearing loss + tinnitus
🔥 Vestibular neuritis: Hours–days, no hearing loss
🦠 Labyrinthitis: Hours–days, with hearing loss
⚡ Vestibular migraine: Minutes–days, migraine features
🧠 Central causes: Stroke/MS, red flags “5 Ds”
🌀 Benign Paroxysmal Positional Vertigo (BPPV)
- Brief (<30s) vertigo triggered by lying down, rolling, getting up.
- No vertigo at rest, no hearing loss.
- Dx: Dix–Hallpike → rotatory/upbeating nystagmus.
- Tx: Epley manoeuvre, Brandt–Daroff exercises.
🎧 Ménière’s Disease
- Recurrent vertigo (minutes–hours), often in older patients.
- Low-frequency hearing loss, tinnitus, “aural fullness.”
- Dx: Audiometry, vestibular function testing.
- Tx: Low-salt diet, betahistine, diuretics; intratympanic steroids/gentamicin; surgery if refractory.
🔥 Vestibular Neuritis
- Acute, constant vertigo lasting hours–days.
- Gait instability, spontaneous/gaze-evoked nystagmus.
- No hearing loss (key distinction from labyrinthitis).
- Dx: Clinical; abnormal head impulse test.
- Tx: Short course corticosteroids (limited evidence), vestibular rehab, antiemetics short-term only.
🦠 Labyrinthitis
- Vertigo + hearing loss + tinnitus.
- Often post-viral; can follow bacterial otitis media.
- Dx: Audiometry, MRI/CT if atypical.
- Tx: Viral = supportive; Bacterial = IV antibiotics ± steroids.
⚡ Vestibular Migraine
- Recurrent vertigo episodes (minutes–days).
- History of migraines; often with photophobia, phonophobia, ± aura.
- Dx: Clinical link to migraine, exclude stroke with MRI if atypical.
- Tx: Migraine prophylaxis (propranolol, topiramate, candesartan), vestibular rehab, lifestyle trigger control.
🧠 Central Causes (Stroke, MS)
- Posterior circulation stroke may mimic neuritis.
- Red flags = “5 Ds”: dysarthria, diplopia, dysphagia, dysmetria, dysphonia.
- Often with focal neuro deficits (weakness, numbness, ataxia).
- Dx: MRI/CT brain + neuro exam.
- Tx: Stroke protocol, neurology input, disease-specific therapy.
