Acronyms and Abbreviations

ABR auditory brainstem recording BAER brainstem auditory-evoked response (same as ABR) BPPV benign paroxysmal positional vertigo KHz kilohertz (thousands of cycles per second) MRA magnetic resonance imaging with angiography OSHA Occupational Safety and Health Administration SISI short increment sensitivity index VBI vertebrobasilar insufficiency VRT vestibular rehabilitation therapy

Vertigo

Romberg Assessment

The clinician should find out what the dizzy patient is experiencing, as accurately as possible. A common clinical error is to label all dizziness as vertigo. Is there a sense of motion, either of one's own body or of one's surroundings If so, true vertigo exists. The history in this case is usually clearer than with other forms of dizziness. The patient often vividly recollects when and where the first episode occurred, describing the spinning sensation and, usually, the accompanying nausea....

Circumscribed Labyrinthitis

Circumscribed labyrinthitis may be seen in patients with expanding middle ear and mastoid lesions. It is produced by localized erosion of bone into the labyrinth, without invasion of the endolymphatic portion. The usual cause is a cholesteatoma eating away at the lateral semicircular canal in the mastoid antrum, but any other expanding tumor, such as glo-mus jugulare, can be a cause. The symptom is mild vertigo, which may be aggravated by pushing on the ear or getting water in it. Positional...

Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo

By far the largest number of patients with true vertigo suffer from benign paroxysmal positional vertigo (BPPV). It was first described many years ago by Dix and Hallpike, but Dr. John Epley has re-investigated it more recently. He has developed a reliable curative procedure that can be done in the office. It has been found, with proven anatomic evidence, that the vertigo of these patients is due to otolithic debris (now termed canaliths) in the long limb of the posterior semicircular canal....

Mnieres Disease

It may surprise you that we discuss this topic under auditory disorders, because the vertigo of Meniere's disease is the most notable symptom to the majority of clinicians. Actually, in the earlier stages, most of the patho logic process occurs only in the cochlea. This ailment is characterized by four classic symptoms hearing loss, tinnitus, ear fullness, and vertigo. These symptoms are produced by endolymphatic hydrops, another name for the disorder, which is pathologically descriptive. To...

Disequilibrium

An important fact is that vertigo is the usual, but not the only, symptom pointing to the vestibular system. Disequilibrium unsteadiness or loss of balance , without vertigo, can also be a sign of more chronic, insidious problems. In young and middle-aged patients with this symptom, certain specific diseases of the vestibular system should be ruled out. An acoustic neuroma, chronic luetic labyrinthine disease, or even demyelinating disease in the brainstem i.e., multiple sclerosis , may be...

Nonvestibular Dizziness

Balance and spatial orientation depend on three main systems the vestibular apparatus, vision, and proprioception position sense from the spine and pressure sensors of the extremities . Dizziness may result from problems involving any one, or more, of these systems. Furthermore, disease processes of other bodily systems, such as circulation, respiration, cerebration including anxiety , and endocrine function, may cause dizziness by affecting the former ones Numerous types of nonvertiginous...

Motion Sickness

Motion sickness is an abnormal response of an individual to the stimulus of prolonged motion. Usually it occurs in boats, automobiles, or airplanes. Those affected are prone to become dizzy, diaphoretic, and nauseated after an extended period of travel. Oddly, their dizziness is seldom actual vertigo, but more often a sense of imbalance and lightheadedness. These patients may show positional nystagmus on ENG testing and hip sway on posturography, even when symptoms are not present. Preventative...

Middle Ear Effusions

If the experimental model of eustachian tube obstruction continues for hours or days, the negative pressure will eventually lead to transudation of serous fluid into the middle ear cavity. This is known as serous otitis media. The patient will now complain of increased hearing loss, depending on the remaining air content in the middle ear. High frequencies will also be affected as fluid replaces air. Also, a sensation of moisture in the ear may be noted, with bubbling sounds. This can occur...

Ramsay Hunt Syndrome

Ramsay-Hunt syndrome is caused by the herpes or varicella zoster virus. Like Bell's palsy, it presents with rapid onset of facial paralysis, but also with a vesicular rash as seen with shingles erupting in the external ear or near it. There is almost always severe otalgia, and the virus affects other adjacent cranial nerves as well. Cranial nerve VIII is the most frequently affected, with sensorineural hearing loss and vertigo. Lesions of cranial nerves IX and X may cause pain in the pharynx,...

Cerebellopontine Angle Tumors

The tumors discussed here are located in or near the internal auditory meatus, where cranial nerves VII and VIII exit the petrous temporal bone to enter the brainstem. Acoustic neuroma is the predominant one in this category, comprising about 85 of these tumors. Meningiomas, neurofibromas, and gliomas make up most of the rest. A rare congenital cholesteatoma may also appear as a space-occupying lesion anywhere in the temporal bone. The more accurate term for acoustic neuroma is vestibular...

Cholesteatoma

Epitympanic Cholesteatoma

Cholesteatoma, an otic epidermal cyst, is a complication of adhesive otitis that warrants aggressive surgical attention. Its formation occurs as follows. The posterosuperior retraction pocket of adhesive otitis insidiously inva-ginates deeply behind and around the ossicles, and encystment occurs. The epithelial lining of the invaginated cyst continues to produce keratin within its center, with expansion and bone erosion. Progressive enlargement into the mastoid antrum and or epitympanum attic...

Glossary

Acoustic neuroma a benign tumor of cranial nerve VIII located in the internal auditory canal IAC or at the internal auditory meatus cerebellopontine angle , also called vestibular schwannoma acoustic reflex an involuntary bracing of the stapes by the stapedius muscle in response to a loud noise stimulus, which is measurable during tympanometry acute coalescent mastoiditis a bacterial infection of the mastoid air cell system following a resistant or untreated acute otitis media acute diffuse...