Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

840 Inner Ear Disorders Producing Vertigo Insomnia

■Surgery should be considered for persistent vertigo. Labyrithectomy

is curative but results in complete hearing loss. Vestibular neurec-

tomy is curative when patients have hearing

complications and prognosis

■Most patients improve with little or no balance dysfunction.

Insomnia..........................................

CHAD CHRISTINE, MD

history & physical

■Difficulty initiating sleep

■Difficulty maintaining sleep

■Early awakening

■May be notable for anxiety or depression

tests

■Lab tests unremarkable

■Brain imaging unremarkable

■Sleep lab studies helpful if sleep apnea or restless legs syndrome sus-

pected

differential diagnosis

■Meds: steroids, beta-blockers, excessive thyroid hormone, decon-

gestants, herbs, stimulants (pemoline, methylphenidate, etc), diure-

tics causing nocturia

■Stimulants (caffeine, nicotine, alcohol, cocaine, amphetamine) ex-

cluded clinically

■Periodic limb movements in sleep (often described as limb discom-

fort by pt & observed as rhythmic flexion movement of one or both

legs) is excluded by history & sleep study (see “Restless Legs Syn-

drome” for treatment)

■Medical disorders such as hyperthyroidism, gastroesophageal reflux,

congestive heart failure (orthopnea), nocturia excluded clinically

■Anxiety disorders & depression excluded clinically

■Neurodegenerative disorders (Parkinson’s disease, Alzheimer’s dis-

ease/sundowning, etc) excluded clinically

management

■Depends on cause

■General measures