Dr.

Ayman Yakout
Otolaryngologist-MD

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 Vertigo
• Definition
• Causes
• History Taking
• Examination
• Investigations
• Treatment

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 Definition
“ It is a subjective sense of imbalance,
where the person feels that either his
surroundings are rotating or he himself
is rotating. “

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 Causes
1. Inside the Ear causes
2. Outside the Ear causes
3. Non-pathological causes
4. Functional cause

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 Inside the Ear causes
1) External Ear Causes:
-Wax in ear
- Furuncle

2) Middle Ear causes:

- ET tube blockage
- Otitis MediaLabyrinthitis

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 Inside the Ear causes…
3) Inner Ear : a) Trauma:
1. Head injury with temporal
bone injury
2. Surgical trauma – mastoidectomy
3. Acoustic trauma – Loud sound – Minier’s
4. BaroTrauma – Rupture of Round window
membrane.
b) Infection:
- Labyrinthitissecondary to Otitis Media ,
Meningitis, Syphilisor Viral infection 6
 Inside the Ear causes…
c) Vascular:
- Thrombosis / embolism of Blood vessle
d) Tumour:
- Acoustic Neuroma
e) Miscelenius:
- Minier’s Disease
- Positional Vertigo
- Vestibular Neuronitis
-Ototoxic Drugs : Aminoglycoside,
Barbiturate, ChlorPheniramine Maleat, Digoxin
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 Outside the Ear causes
1). CVS: 1. Hypertension with Athrosclerosis
2. Hypotension
3. Cardiac disease like AS, BBB
2) CNS: 1. vertebrobasilar Artery Syndrom
2. Tumor/ Abscess in Cerebellum/ brainstem
3. Increased Intra Cranial
Tension (ICT)
4. Head Injury
3) Metabolic Disorders:
1. DM with neuritis of 8th nerve
2. Hypoglycemia 8
 Outside the Ear causes…
4) Anemia
5) Ophthalmic Causes: 1. Diplopia
2. Refractory error
3. Glucoma
6) Cx Spondylosis: - compress vertebral artery

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Non Pathological Cause

1). 2). Spinning

Height

Functional Cause

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 History Taking
Rotating Peripheral Vestibular
sensation system
Explain Vertigo
Central Vestibular
Instability
System

Precipitating Factors:
1. Change of Position – BPPV
2. Head Twisting in perticular position causes Vertigo –
Cx origine.
3. URTI – Vestibular neuronitis
4. Cough – Perilymph Fistula
5. Loud sound – Menier’s Disease

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 History Taking…
• Onset: Sudden: Menier’s /Vest.Neuronitis/BPPV
Gradual: Ototoxicity/ CP Angle tumor
• Duration: Few Seconds : BPPV/ Labyrinthine
fistula Few Minutes: Menier’s Disease
Continue : Labyrinthitis / Vestibular Neuritis
• Other Ear symptoms :
1.Deafness / Tinitus : Menier’s / Acostic Neuroma,
otosclerosis/ ototoxicity / Labyrinthitis.
2. No Deafness/ Tinitus : Vestibular Neuritis / BPPV
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 History Taking…
• Other CNS Symptoms : Headache / blurring of
vision / unconsciousness.
• Past H/O : DM / HT / Syphilis / Drugs /
Trauma/ surgery
Examination
G/E : BP. / Anemia
ENT Examination
Neck Examination
CNS Examination
CVS Examination
 Investigations
• Heamatological: Hb, TC, DC
- Bl. Sugar
- VDRL
• Audiological: - PTA
-ENG With Caloric Test
• Radiological: - X-Ray cervical spine
- X-Ray for I.A.M.
- CT scan of Brain
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 Treatment
1) Eliminate the cause:
Do not go to the
height. Do not travel by
bus.
2) Suppress the
Vestibular system:
Labyrinthain sedatives:
1). Cinnarazine (stugeron)
2) P
r
o 15
 Treatment
4) Wait for compensation:
Nature has a marvelous way of compensation for any
imbalance. Cawthorne Excercise
5) Eliminate the offending Labyrinth:
Labyrinthectomy
Vestibular nerve section
6) Acceptance of the
problem: Walking stick
7) Surgery for Vertigo:
Saccus decompression (
for Mineir’s Disease)
Labyrinthectomy
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Vestibular Neurectomy
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