0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40
838 Inner Ear Disorders Producing Vertigo(feeling of faintness with change in position); dizzy (often used for
vertigo, imbalance, disequilibrium or lightheadedness)
■Duration of vertigo important in differential diagnosis
■Association of auditory symptoms, such as hearing loss, tinnitus and
aural fullness, usually implicates peripheral ear dysfunction
■Neurological symptoms suggest central pathology
■History of prior trauma, viral infection, ototoxic exposure, otologic
surgery may provide important clues to the underlying pathology
■Physical examination should include a complete otologic, neuroto-
logic, cerebellar, gait and cranial nerve examinationSigns & Symptoms
■Rotatory vertigo or sensation of environmental movement lasting
seconds, minutes, hours, or days
■Hearing loss may be present and may increase in severity with
episodes
■Tinnitus is often present, and in absence of hearing loss, may provide
a clue to which ear is affected
■Aural pressure that does not clear with opening of the Eustachian
tube could be a clue to the diagnosis of Meniere’s disease
■Meniere’s Disease: episodic vertigo lasting several hours, fluctuate
hearing loss, tinnitus, aural fullness
■Labyrinthitis: acute vertigo for hour to days, hearing loss, fever, nau-
sea, vomiting
■Vestibular neuronitis: vertigo lasting days, severe nausea and vom-
iting, antecedent viral infection, and absence of hearing loss
■Ototoxic vestibulopathy: usually associated with imbalance or dise-
quilibrium, oscillopsia in sever cases, high frequency hearing loss
■Benign Paroxysmal Positioning Vertigo (BPPV): vertigo lasting min-
utes with turning of head to side, fatigable, no hearing loss, history
of past trauma, vestibular neuronitis, or otologic surgery
■Positional Vertigo: persistent vertigo that comes on with specific
position
■Superior semicircular canal dehiscence syndrome: vertigo with pos-
itive pressure on the ear, loud noise, running or valsalva
■Migraine associated vertigo: unilateral headache, visual symptoms
■Multiple sclerosis: muscle weakness, neurologic symptomstests
■Audiological Evaluation to rule out hearing loss: pure tone audiom-
etry, speech audiometry, immittance testing, acoustic reflexes