This is an extract of our Balance Disorders document, which we sell as part of our ENT Notes collection written by the top tier of University Of Leicester students.
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Balance Disorders Vertigo = illusion of movementNormal balance requires o Accurate sensory information from
? Eyes (vision)
? Proprioceptive receptors
? Vestibular labyrinth o Co-ordination of information in brain o Normal motor output from CNS to intact musculoskeletal system
A fault in any of the above impairs balanceVertigo is always a symptom of vestibular defects o Severe if accompanied by nausea and vomiting Can be caused by o Peripheral vestibular disorders (BPPV, Menieres', labrynthitis) o Spread of infection from middle ear disease to labyrinth o Central vestibular disorders e.g MS, tumours, infarcts o External insults by drugs, anaemia, hypoglycaemia etc
Benign Paroxysmal Positional Vertigo (BPPV) Commonest cause of vertigo
PathophysiologyDetachment of otoconia (calcium carbonate crystals) from the otolith organ of the utricle - fall into posterior semicircular canal (loose inside canal) Cause symptoms on movement of the head
AetiologyHead injury Viral infection Degenerative changes with aging Idiopathic
Clinical featuresEpisodic attacks or vertigo provoked by head movements e.g rolling over in bed/looking upwards Violent symptoms but last only seconds No auditory symptoms Episodes usually last for several months before disappearing but often recur Both labyrinths may be affected
ManagementReassurance, advice to avoid provoking head position until recovery Avoid alcohol Epley maneuvers may help reposition otoconia away from the posterior canal Medication o Betahistine
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