Vertigo
Prof. Abdulrahman Alsanosi
Program Director, KSU Fellowship in Oto-Neurotology
Department of Otolaryngology ,Head and Neck surgery
King Abdulaziz University Hospital
What are the balance
organs?
• Inner ear (3 semicicular canals
and otolith organ )
• Cerebellum
• Vision (VOR)
• Proprioceptive
Anatomy
Canals are Paired
AC
AC
HC
HC
PC
PC
Types of Spatial Movement
• Rotational – 3 degrees of
freedom Semicircular Canals
•
• Translational – 3 degrees of
freedom
Otolith Organs
Function of vestibular system:
Head acceleration and gravity
biological signals
brain develops subjective awareness of head position
(orientation)
produce motor reflexes
maintains posture and ocular stability
What is Dizziness?
• Illusion of movement of self or
environment
• Exact description is important:
•
• True spinning?
• Lightheadedness?
• Unsteadiness?
• Fainting, passing outه
Management in 5 Minutes
1. Vestibular non Vestibular
2. Central vs peripheral
3. Duration and auditory
system Hearing loss
4. Physical exam (10%)
5. Treatment
Common peripheral diseases(vestibular
apparatus+ VIII)
• Vestibular neuritis
• BPPV
• Menier’s disease
• Labyrinthine fistula
• Superior semicircular canal dehiscence
• Autoimmune inner disease
• Vestibulopathy
• Vestibular nerve tumor( Vestibular schwannoma)
Hint =1Significance of True Spinning
• Almost all true spinning is vestibular
• All vestibular is not true spinning
True Spinning
To and fro rocking
Vestibular etiology
lightheadedness
ataxia
Vestibular vertigo
Features :
• Spinning sensation
• Nausea and vomiting
• Worse with head movement
• Ataxia
• Nystagmus
Hint #2 Central vs
Peripheral
• Central
•
• Neurologic symptoms
•
• New severe headache
• LOC
• Type of nystagmus
• Risk factors
• No improvement within 48 hours
• Peripheral (Ex Menieres )
Ear symptoms
Hint #3Duration & Hearing
loss
VERTIGO With Hearing Without
Loss Hearing Loss
Seconds- BPPV
Minutes
Minutes- Meniere’s RV, MAV
Disease
Hours
Hours- Labyrinthitis Vestibular
Neuronitis
Days (SSHL with
vertigo)
Vestibular neuritis
• Viral infection of vestibular
organ
• Affect all ages but rare in
childern
• spontaneous
nystagmous ,vertigo and
( Benign Paroxysmal Positional Vertigo )
BPPV
BPPV: Pathophysiology
Canalithiasis Theory
Degenerative debris
from utricle (otoconia)
floating freely in
the endolymph
Cupulolithiasis Theory
Debris adhering to
the cupula
BPPV
• The most common cause of
peripheral vertigo in patient > 40
• Repeated attacks of vertigo
usually of short duration less
than a minute .
• Provoked by certain positions
(rolling in beds, looking up ,and
head rotations)
• Not associated with any hearing
Diagnosis
• History
• Dix Hall-pike maneuver
(Meneire’s disease)
(Meneire’s disease)
Pathophysiology :
• Unknown etiology
• ↑ ↓production of fluid
within inner
compartment
Meneire’s disease
• vertigo (minutes to hours )
• fluctuating SNHL
• Tinnitus
• fullness in the ear.
• In 10 - 20% of cases the
disease later involves the
opposite ear
Investigations for dizzy
patient
-Audiology assessment
-Radiology
Radiology
• CPA tumor
Conclusion
• Proper history is the most
important key for diagnosis of a
dizzy patient
• A multi specialty approach is
sometime an appropriate for
some complicated cases .
•
• Investigation should be tailored
to the most likely diagnosis
Thank
