Internal Medicine

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

Inner Ear Disorders Producing Vertigo 839

■Auditory Brainstem Response (ABR) testing to exclude retrocochlear

pathology when asymmetric SNHL is present

■Laboratory test including CBC, Platelets, ESR, ANA, RF, TSH, Choles-

terol, glucose, FTA, BUN, Creatinine, UA for evaluation of progressive

or premature SNHL

■Electronystagmography to test for nystagmus and peripheral

labyrinth function

■CT scan of the temporal bone (1.0 mm fine cuts, axial and direct

coronal images) to evaluate for inner ear malformation and superior

semicircular canal dehiscence syndrome

■MRI of the internal auditory canal and brain with gadolinium

contrast enhancement to exclude cerebellopontine angle or brain

tumors and multiple sclerosis

differential diagnosis

■Goal is to establish the tissue/organ responsible for vestibular

symptoms: peripheral labyrinth, visual system, proprioception or

cerebellar/central nervous system.

management

■Initially, supportive care to control acute vertigo is crucial – usually

with valium and compazine

■Vestibular physical therapy for persistent imbalance or disequilib-

rium

■Meniere’s Disease:

➣low salt diet (2 gram Na/day), diuretics, intratympanic gentam-

icin if medical therapy fails

■Labyrinthitis:

➣antibiotics

■BPPV:

➣Epley maneuver

■Positional vertigo:

➣Cawthorne head exercises

■Superior semicircular canal dehiscence syndrome: observation or

surgery

specific therapy

n/a

follow-up

■Vestibular physical therapy for persistent imbalance or disequilib-

rium