Vestibular Disorder

List important information that should be illicited on taking a history in a dizzy patient.

Reference(s):

Friedland, D. R., Tarima, S., Erbe, C., & Miles, A. (2016). Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses. JAMA Otolaryngology– Head & Neck Surgery, 142(4), 351–356.

What are the differences on physical exam between central and peripheral vertigo?

Give the differential diagnosis of vertigo, separate each by symptom duration and onset.

Describe the classic presentation of Meniere’s Disease.

Reference(s):

Goebel, J.A. (2016). 2015 Equilibrium Committee Amendment to the 1995 AAO-HNS Guidelines for the Definition of Ménière’s Disease. Otolaryngol Head Neck Surg, 154(3), 403-4.

Gürkov, R, Pyykö, I, Zou, J, Kentala, E. (2016). What is Menière’s disease? A contemporary re-evaluation of endolymphatic hydrops. J Neurol, S71-81.

What is the suspected pathophysiology of Meniere’s disease?

Discuss the role of diagnostic studies in the work up of Meniere’s disease. When should imaging be ordered?

Reference(s):

Barath, K., Schuknecht, B., Naldi, A. M., Schrepfer, T., Bockisch, C. J., & Hegemann, S. C. A. (2014). Detection and grading of endolymphatic hydrops in Meniere disease using MR imaging. AJNR. American Journal of Neuroradiology, 35(7), 1387–1392.

Provide us with an algorithm including rationale for the treatment of Meniere’s disease.

Reference(s):

Crowson, M.G., Patki, A, Tucci, D.L. (2016). A systematic review of diuretics in the medical management of meniere’s disease. Otolaryngol Head Neck Surg, 154(5), 824-34.

Sood, A.J., Lambert, P.R., Nguyen, S.A., Meyer, T.A. (2014). Endolymphatic sac surgery for Meniere’s disease: a systematic review and meta-analysis. Otol Neurotol, 35(6), 1033-45.

Explain the physiology of benign paroxysmal positional vertigo (BPPV). What are the medical and surgical options?

Reference(s):

Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., … Corrigan, M. D. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 156(3_suppl), S1–S47.

You and (your otologist) are SCUBA diving. During descent, he/she becomes acutely dizzy. What are you worried about and how would you treat him/her?

What is an Epley maneuver? Tell us about other maneuvers and when should they be used? What are the post-treatment patient instructions?

Tell us about refractory and recurrent BPPV.

Reference(s):

Angeli, S. I., Abouyared, M., Snapp, H., & Jethanamest, D. (2014). Utricular Dysfunction in Refractory Benign Paroxysmal Positional Vertigo. Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 151(2), 321–327.

What is Cogan’s syndrome?

Discuss the role of migraines as a cause of vertigo.

Reference(s):

Dieterich, M., Obermann, M., & Celebisoy, N. (2016). Vestibular migraine: the most frequent entity of episodic vertigo. Journal of Neurology, 263 Suppl 1, S82-9.

What are the symptoms and etiology of Wallenberg’s syndrome?

When is vertigo an emergency?

Does vestibular therapy really work?

Educate us on superior canal dehiscence syndrome: presentation, work up, treatment, outcomes.