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VESTIBULAR NEURONITIS Detail presentation
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- 2. Scenario A 50 yearsold male presents with sudden, severe vertigo 02 days after the upper respiratory tract infection. There is no tinnitus or hearing loss. On caloric testing there is reduced vestibular senstivity on right side. 1. What is the most probable clinical diagnosis? 2. What is the differential diagnosis? 3. What is you treatmant plan?
- 3. Synonym Vestibular neuritis It ischaracterized by •Sudden severe episode of vertigo •Nausea and •Vomiting •without hearing loss and tinnitus.
- 4. Etiopathology •Exact etiology isunknown. •Inflammation of vestibular ganglion by various factors like viruses. •Preceding history of upper respiratory tract infection (URTI). •Self limiting disease and settles within 2-3 weeks . •Affected age group is between 30 to 50 years
- 5. Clinical features: 1. Suddensevere episode of vertigo is the commonest presentation. 2. No hearing loss or tinnitus.
- 6. On examination 1. Tuningfork tests are unremarkable. 2. Nystagmus is positive. There is no sign of neurological involvement. 3. On caloric testing, there is reduced vestibular sensitivity (canal paresis) on the affected site. (Clinical features are those of acute vestibular failure
- 7. Treatment •Treatment is directedtowards relief of symptoms •Vestibular sedatives •Dimenlydrinate (Dramamine), prochlorperazine (Stemitil, Stabil) chlorpromazine (Largectil) are given orally or parenterally to relieve vertigo and vomiting •Vasodilators •Inhalation of carbogen i.e. 5% carbon dioxide with 95% oxygen. It act as a vasodilator and increases labyrinthine circculation •Betahistines •Thiazide diuretics
- 8. Scenario A 50 yearsold male presents with sudden, severe vertigo 02 days after the upper respiratory tract infection. There is no tinnitus or hearing loss. On caloric testing there is reduced vestibular senstivity on right side. 1. What is the most probable clinical diagnosis? 2. What is the differential diagnosis? 3. What is you treatmant plan?
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- 10. Etiopathology • Usually occursduring the course of herpes, measles, mumps or as a part of influenza type illness.
- 11. Clinical features •Vertigo • tinnitus •hearing loss are the commonest presentations. •It is differentiated from vestibular neuronitis where there is absence of tinnitus and hearing loss
- 12. Treatment a. Strict bedrest is advised and head is immobilized with affected ear above. b. Parenteral systemic antibiotics c. Labyrinthine sedatives are given for relief of vertigo. d. Treatment of the underlying cause:
- 13. SELF ASSESSMENT • Q.1.Vertigo, sensorineural hearing loss and tinnitus are seen in all except: • a. Hypothyroidism • b. Meniere’s disease • c. Perilymh fistula • d. Syphilitic labyrinthititis • e. Viral labyrinthititis
- 14. • Q.2. Allare true about viral labyrinthitis except: • a. Managed conservatively • b. There may be hearing loss • c. There may be tinnitus • d. There may be vertigo • e. Usually occur during course of viral infection