Hearing and Balance Disorders Flashcards

A patient has brief vertigo when rolling over in bed. On right Dix-Hallpike testing, upbeating torsional nystagmus starts after a short delay and fades within 30 seconds. What is the best next step?

Answer: Epley canalith repositioning maneuver

Upbeating torsional nystagmus that starts after a delay and fades on Dix-Hallpike points to posterior canal BPPV, which is treated with the Epley maneuver.

Supine roll testing gives geotropic horizontal nystagmus to both sides, stronger with the head turned right. What is the most likely diagnosis?

Answer: Right horizontal canal canalithiasis

In geotropic horizontal canal BPPV, the stronger nystagmus is on the affected side, and geotropic nystagmus suggests free-floating debris (canalithiasis).

Which vestibular evoked myogenic potential (VEMP) finding is typical of superior semicircular canal dehiscence?

Answer: Abnormally low cVEMP thresholds with large amplitudes

A dehiscence acts as a third mobile window, which makes the vestibular end organ more sensitive to sound and produces low VEMP thresholds with large amplitudes.

In a patient with acute continuous vertigo and spontaneous nystagmus, which HINTS exam finding is most worrying for a stroke?

Answer: A normal head impulse test

In acute vestibular syndrome, a normal head impulse test suggests a central cause such as a posterior circulation stroke.

Under the 2015 Bárány/AAO-HNS criteria, how long must vertigo episodes last for a diagnosis of definite Ménière's disease?

Answer: 20 minutes to 12 hours

Definite Ménière's disease requires two or more spontaneous vertigo episodes lasting 20 minutes to 12 hours, plus audiometrically documented low- to mid-frequency sensorineural hearing loss.

A patient has recurrent vertigo episodes lasting 4 to 24 hours with photophobia, a history of migraine, and normal hearing on audiometry. What is the most likely diagnosis?

Answer: Vestibular migraine

Vestibular migraine causes episodes of 5 minutes to 72 hours with migraine features, and hearing stays stable.

What is the main risk to counsel patients about before intratympanic gentamicin for intractable unilateral Ménière's disease?

Answer: Sensorineural hearing loss in the treated ear

Gentamicin is mainly vestibulotoxic, but it can also cause cochlear damage and hearing loss in the treated ear.