ENT Hearing and Balance Disorders 2

Question 1

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?

Accepted Answer

Epley canalith repositioning maneuver

Answer

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.

Question 2

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

Accepted Answer

Right horizontal canal canalithiasis

Answer

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

Question 3

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

Accepted Answer

Abnormally low cVEMP thresholds with large amplitudes

Answer

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.

Question 4

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

Accepted Answer

A normal head impulse test

Answer

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

Question 5

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

Accepted Answer

20 minutes to 12 hours

Answer

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.

ENT - Ear, Nose, and Throat Specialist Certification Practice Test

ENT - Ear, Nose, and Throat Specialist Certification Practice Test

ENT Hearing and Balance Disorders 2