2019年5月20日星期一

Otogenic Vertigo (耳源性眩暈)

Testing:
Otogenic vertigo is an hallucination or a false sensation of movement. Disease affecting the vestibular apparatus may produce rotatory vertigo accompanied by horizontal nystagmus.

Caloric testing:
Involves stimulating the vestibular apparatus by irrigating the external meatus with water at varying temperatures; the duration of induced nystagmus is recorded, allowing comparison between the two sides.

Positional testing:
Vertigo provoked by head movements may be a feature of inner ear disease, cervical spondylosis or disease affecting central vestibular pathways in the brainstem.


Meniere’s disease

Aetiology:
Unknown. Maybe due to imbalance between production and absorption of inner ear endolymph or disturbance of inner ear immunity.

Clinical features:
Episodic rotatory vertigo, tinnitus and sensorineural deafness may be present. Unilateral in early stages.

Management:
Vestibular sedatives for acute attacks. Surgery may be conservative (endolymphatic sac decompression) or destructive (labyrinthectomy or vestibular neurectomy). Intratympanic gentamicin is also an option.


Sudden unilateral vestibular failure

Aetiology:
Unknown aetiology. Viral infection, ischaemia and inner ear membrane rupture have been postulated.

Clinical features:
Presents with sudden onset of vertigo. Recovery takes place by central compensation.

Management:
Vestibular sedatives are useful in the acute phase.
Other causes of vertigo are syphilis, suppurative labyrinthitis, temporal fractures and ototoxic drugs.


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