NON-TRAUMATIC CONDITIONS OF THE EAR400 ENT emergencies
Vertigo
DIAGNOSIS
1 Tw o m a i n g r o u p s o c c u r :
(i) Peripheral vertigo (85%)
This is due to lesions in the vestibular nerve and inner ear, such as acute
labyrinthitis, vestibular neuronitis, Ménière’s disease with accompany-
ing sensorineural deafness and tinnitus, benign paroxysmal positional
vertigo (BPPV), otosclerosis, cholesteatoma, ototoxic drugs such as
gentamicin and rapid, high-dose frusemide (furosemide), or trauma.
(ii) Central vertigo (15%)
This is due to lesions in the CNS, such as a vertebrobasilar transient
ischaemic attack (TIA), a cerebellar or brainstem stroke, cerebello-
pontine angle tumour, demyelination, vertebrobasilar migraine, or
alcohol and drug toxicity.
2 Peripheral vertigo is usually acute, intermittent, positional and associated
with nystagmus, deafness, nausea, vomiting and sweating.
3 Central vertigo is more gradual in onset, constant and dominated by the
associated neurological signs such as headache, weakness, ataxia and/or
dysarthria.MANAGEMENT1 Give patients with incapacitating vertigo midazolam 0.05–0.1 mg/kg i.v. or
diazepam 0.1 mg/kg i.v. as symptomatic treatment, with bed rest until the
vertigo has gone.
(i) Alternatively, give prochlorperazine 12.5 mg i.m., but beware that
it may cause extrapyramidal side effects including akathisia – an
unpleasant ‘intolerable sense of restlessness’ in up to one-third of
patients.
2 Refer patients with peripheral causes of vertigo that do not settle to the ENT
team, and with central causes of vertigo to the medical team.
(i) A computed tomography (CT) scan or magnetic resonance
imaging (MRI) is indicated for focal neurological signs.Facial nerve palsy
DIAGNOSIS
1 Lower motor neurone paralysis
(i) There is weakness of the whole side of the face, including the
forehead muscles.
(ii) Causes include:
(a) Bell’s palsy with an abrupt onset sometimes associated with
postauricular pain, hyperacusis and abnormal taste in the
anterior two-thirds of the tongue