![Page 2: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/2.jpg)
DIZZINESS
HistoryDizziness
VertigoINNER EAR
Single episode Multiple episodes
DisequilibriumPresyncope
Other
• Spinning • History of 1st episode• Predisposing factors• Associated symptoms• How long?• Single or recurrent
![Page 3: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/3.jpg)
able: Summary of typical clinical features of common causes of vertigo
Onset Duration Precipitants
Associations
Vestibular neuronitis (neuritis)
Sudden Constant for many hours or even a day
Viral illness (occasionally)
Nausea and vomiting
BPPV Intermittent
Episodes up to 60 seconds
Head movements
None
Ménière's disease
Intermittent
Unpredictable, episodes may last hours
- DeafnessTinnitusAural fullness
Recurrent vestibulopathy
Intermittent
Episodes lasting minutes to hours
- -
able: Summary of typical clinical features of common causes of vertigo
Onset Duration Precipitants Associations
Vestibular neuronitis (neuritis)
Sudden Constant for many hours or even a day
Viral illness (occasionally)
Nausea and vomiting
BPPV Intermittent Episodes up to 60 seconds
Head movements
None
Ménière's disease
Intermittent Unpredictable, episodes may last hours
- DeafnessTinnitusAural fullness
Recurrent vestibulopathy
Intermittent Episodes lasting minutes to hours
- -
![Page 4: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/4.jpg)
Homework
• Chondrodermatitis nodularis chronica helicis
• Hallpike test• Epley’s manouver
![Page 7: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/7.jpg)
Anatomy
![Page 9: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/9.jpg)
![Page 10: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/10.jpg)
Epistaxis
![Page 11: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/11.jpg)
![Page 12: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/12.jpg)
Septal perforation
![Page 13: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/13.jpg)
Septal perforation
• Trauma ,iatrogenig,Wegner’s ,sarcoidosis,TB,Syphilis, COCAINE,NEOPLASTIC.
• Asynptomatic, wistling,blockage,epistaxis• FBC,ESR,CANCA,ACE level?VDRL.Biopsy• Saline nasal douches ,surgical
![Page 15: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/15.jpg)
Rhinitis• 2 out of 3 for >1 hour every day for >2 weeks. -Nasal congestion -rhinorrhoea (Ant. Or Post.) -sneezing - itching (nasal cavity),facial pain ,anosmia*RAST *steroides (beclomethazone,fluticasone,mometasone) *Antihistaminics*Oral steroides*Montelukast*saline douches*surgical
NB Rhinits and sinusits usually coexist and areconcurrent in most individuals; thus, the correctterminology is now rhinosinusits.
![Page 16: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/16.jpg)
Sinusitis
• Acute:<4 weeks 1-Broad spectrum antibiotics 2-Betnesol nasal drops(2 drops BD) 3-Steam inhalation 4-Xylometazoline 0.5% 2 drops tds
• Chronic >12 weeks RAST ,ESR,CANCA,ACE,CT scan Sinuses
Medical treatment for 3 months mild :fluticasone 2 puffs OD Severe (polyps) :Betamethasone 2 drops for 6 weeks followed by steroides sprayOral antihistaminics (if allergic)Oral steroids (very severe)Oral antibiotics (clarythromycin)Surgical: FESSReferral: failure of treatment red flags patient willing to have surgery.
![Page 18: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/18.jpg)
Nasal polyps
• What are they?• Paediatric polyps?• ?Unilateral polyps?( neoplastic until proven otherwise)• Associated withAsthma (particularly late-onset asthma)Aspirin sensitivity.......... Samter's triadinfective sinusitiscystic fibrosisKartagener's syndromeChurg-Strauss syndrome• all patients with suspected nasal polyps should be referred to ENT for a
full examination• topical corticosteroids shrink polyp size in around 80% of patients
Around in 1% of adults in the UK have nasal polyps. They are around 2-4 times more common in men and are not commonly seen in children or the elderly.
![Page 20: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/20.jpg)
![Page 21: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/21.jpg)
Red flags
Unilateral blockageUnilateral dischargeBlood stained dischargeEye signs /symptomsFacial swelling (smokers, elderly)
![Page 22: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/22.jpg)
SNORING
• Causes• Epworth sore...?sleep apnoea(is it witnessed)• Day time somnolesence • Treatment Wight lossSurgical UVPPPCPAP• DLVA Patient’s responsibility to inform DVLA when OSA
suspected/investigated. Doctors responsibility to inform DVLA if untreated OSA pt is witnessed driving
![Page 23: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/23.jpg)
![Page 25: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/25.jpg)
Throat
![Page 28: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/28.jpg)
![Page 29: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/29.jpg)
Acute tonsillitis
Acute tonsillitis
![Page 30: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/30.jpg)
NICE indications for antibiotics• features of marked systemic
upset secondary to the acute sore throat
• unilateral peritonsillitis• a history of rheumatic fever• an increased risk from acute
infection (such as a child with diabetes mellitus or immunodeficiency)
• patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more
Centor criteria are present • WHICH ANTIBIOTICS?
Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough
![Page 31: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/31.jpg)
Quinsy
![Page 33: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/33.jpg)
Glandular fever
![Page 34: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/34.jpg)
![Page 35: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/35.jpg)
![Page 36: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/36.jpg)
![Page 37: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/37.jpg)
Laryngology
![Page 38: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/38.jpg)
Hoarseness • Causes: URTI (Most common)Trauma(shouting/nodules).Iatrogenictumour neurological (?)functional(young women)Ask about ? Reflux symptoms , Wight loss, inhalers use, voice misuse,
stress ,swallowing, breathing• Investigations :TFT,weight ,indirect laryngoscopoy.
• Urgent Chest XRAY (IF SYMPTOMS >3 WEEKS)• If X-ray shows positive signs ..urgent referral to chest physician• If X-ray shows negative signs ..urgent referral to ENT • Early laryngeal tumours confined to vocal cords have 80-90% 5 Y
survival .
![Page 39: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/39.jpg)
2WWRed flags
Persistent hoarseness > 3 weeksPainDysphagiaHaemoptysisOtalgiaNeck lumpEspecially in - smokers- over 40yrs
![Page 40: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/40.jpg)
Croup versus epiglottitisFeatures CROUP Epiglottitis
Organism Para influanze virus H Influanza
Age < 2 years 2-6
Onset gradual rapid
Previous attack often no
Cough Parking no
Dysphagia NO +++
stridor inspiratory Insp/expiratory
Pyrexia + ++
position Lying Down Sitting forward
drooling No +++
nodes +++ +
behavior struggling Quiet
voice hoarse muffled
colour pink grey
![Page 41: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/41.jpg)
Neck lumps
• Lymphadenopathy• Branchial cyst• Thyroglossal cyst• Salivary glands• Refer urgently to ENT
![Page 42: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/42.jpg)
Urgent referral
• Mouth ulcers> 3weeks.• Lumps in mouth >3 weeks• Ubexplained sore throat>1 month• Hoarseness >3 weeks, negative
CXR.• Unexplained salivary gland
swelling>4 weeks• Unilateral unexplained ear ache
with normal otoscopy• Asymmetrical /unilateral deafness• Unilateral tinnitus
![Page 43: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/43.jpg)
![Page 44: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/44.jpg)
The ear
http://www.youtube.com/watch?feature=player_embedded&v=0kEKoQ33dB0
![Page 45: DIZZINESS History Dizziness Vertigo INNER EAR Single episode Multiple episodes Disequilibrium Presyncope Other Spinning History of 1 st episode Predisposing](https://reader037.vdocument.in/reader037/viewer/2022110304/551c14795503469e4f8b5581/html5/thumbnails/45.jpg)