Vertigo is a subtype of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system.
Vertigo is a subtype of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system.
Please find the power point on Benign Paroxysmal Positional Vertigo (BPPV). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Vestibular function tests are essential tests in otorhinolaryngology examination, especially examination of ear.
This presentation explains about all the important vestibular function tests.
Please find the power point on Labyrinthitis and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Benign Paroxysmal Positional Vertigo (BPPV). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Vestibular function tests are essential tests in otorhinolaryngology examination, especially examination of ear.
This presentation explains about all the important vestibular function tests.
Please find the power point on Labyrinthitis and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
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Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
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Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
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A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
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The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
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students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
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The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2. Questions
• Define vertigo. Classify vertigo according to its
duration.
• Write down the characteristics of peripheral vertigo.
• How will you investigate peripheral vertigo?
• How do you differentiate BPPV from central vertigo?
3. Introduction
• Illusion of motion of self or the surrounding
• Mostly a symptom of vestibular lesion
• Vertigo
– Rotatory : Vestibular lesion
– Tilt / Drop : Otolith dysfunction
– Unsteadiness : Miscellaneous
4. •Types of vertigo
–Objective : the patient has the sensation
that objects in the environment are moving
–Subjective : the patient feels as if he or she
is moving
–Pseudovertigo : an intensive sensation of
rotation inside the patient's head
5. • Vertigo must not be confused with
– Dizziness
– Light Headedness
– Blackouts
– Fainting xzcvbn,m
– BGiddiness
– Disequilibrium
• Dizziness occurs due to CNS, CVS , ANS, GIT ,
Psychiatric disorders etc.
6. Main Categories of Dizziness
Category Description %of patients
Vertigo False sense of motion,
possibly spinning sensation
45 to 54
Disequilibrium Off-balance Up to 16
Presyncope Feeling of losing
consciousness or black out
Up to 14
Lightheadedness Vague symptoms, possibly
feeling disconnected with the
environment
~10
7. Etiology of vertigo
Vest. end organ Vest . Nerve Central
Peripheral (Account for 85% of cases) Accounts for 15% cases
Erosion Inflammation Inflammation
Irritation Degeneration Degeneration
Vascular Vascular Vascular
Degeneration Trauma
Trauma Neoplasm
Inflammation
Neoplasm
Metabolic
Autoimmune
9. History
• The most important clue to diagnosis
• Most important points
– Duration : seconds, minutes, hours
– Associated hearing loss
– Episodic/ continuous
– Association to head movement
16. Vestibular function tests
• Spontaneous nystagmus / Gaze nystagmus
• Head thrust test
• Head shake test
• Positional test /Positioning test- Dix Hallpike
• Fistula test
• Valsalva / hyperventilation / loud noise
• Romberg's test – normal / sharpened
• Tandem walk test
17. Features Peripheral Central
1. Nystagmus character
a. Direction Fixed Changes
b. Duration Short (days) Long (weeks)
c. Effect of optic fixation Inhibited Unchanged
d. Latency Present Absent
2. Imbalance Mild Severe
3. Nausea & vomiting Severe Variable
4. Deafness & tinnitus Common Rare
5. Neurological deficit Rare Common
18. Provoking factor Causes
Change in head position B.P.P.V., labyrinthitis, multiple
sclerosis
Sudden standing up from
sitting position
Orthostatic hypotension
Sudden neck movement Cervical spondylosis, VBI
Recent URTI Vestibular neuronitis
Stress Psychogenic, migraine
Change in ear pressure Perilymph fistula
21. Investigations
1. Vestibular
– Caloric Test
•Fitzgerald Hallpike Bithermal Caloric Test
•Modified Kobrak’s Test
•Dundas Grant Test
– Electronystagmography
– Rotation Chair Testing
– Dynamic Posturography
22. Investigations
2. Audiological
– PTA, Glycerol Dehydration Test
– ECoG
– BERA
3. Radiological
– X Ray Cervical Spine
– Doppler USG Carotico -Vertebral System
– HRCT Temporal Bone
– MRI Brain
4. Serological : TPHA, Autoantibodies
23. Caloric test
• Basic Vestibular function test
• Principle:
– On irrigation of EAC with warm/cold water
temperature changes in labyrinth which causes
convection current formation in inner ear fluids
– Endolymph moves under convection current
influence and stimulates the labyrinth
– Nystagmus is seen
24.
25. Fitzgerald - Hallpike
• Bithermal Caloric Test
• Patient kept supine with head elevated 30o (Makes
HSCC vertical & more sensitive)
• Each ear is irrigated with both warm & cold water
(Warm water : 44o C, Cold water : 30o C)
• Rate of Irrigation : 500ml/ min
• Duration of Irrigation : 60-90 sec or when nystagmus
occurs whichever is early.
• Amount of Irrigation usually: 300- 350 ml.
26. •Wait 10 minutes before changing ear or water to allow
temperature to get normal
•Note Nystagmus Direction & Duration
28. • Direction Nystagmus “COWS”
– Cold : Opposite Side
– Warm :Same Side
• Duration of Nystagmus is calculated from start of
irrigation to end of Nystagmus (Normal 90-140 Sec)
• Calculation of results : The nystagmus elicited in 2
ears using warm / cold stimulus is compared
mathematically using Jonkee’s formula