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Eyes, ears, nose, and throat
Conductive hearing loss
Eustachian tube dysfunction
Tympanic membrane perforation
Age-related macular degeneration
Retinopathy of prematurity
Temporomandibular joint dysfunction
Gastroesophageal reflux disease (GERD)
Retropharyngeal and peritonsillar abscesses
Thyroglossal duct cyst
Acoustic neuroma (schwannoma)
Eye conditions: Inflammation, infections and trauma: Pathology review
Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review
Eye conditions: Retinal disorders: Pathology review
Nasal, oral and pharyngeal diseases: Pathology review
Parathyroid disorders and calcium imbalance: Pathology review
Thyroid nodules and thyroid cancer: Pathology review
Vertigo: Pathology review
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At the family medicine center, there’s a 55 year old female, named Juliette, who came to visit the doctor because she has had some episodes where she felt like “everything around her was moving”.
These episodes start abruptly and usually last a few hours.
She also complains of ringing in her left ear and feels that she can’t hear very well from that ear.
Her medical history is otherwise insignificant.
Clinical examination reveals horizontal nystagmus.
Next to Juliette, there’s a 70 year old male, named Alasdair, who is brought in by his son because an hour ago he felt that “the room around him was moving” and had difficulty in speaking.
He also complains of “seeing double”.
Alasdair has hyperlipidemia and hypertension.
Clinical examination reveals vertical nystagmus.
Alright, so both Juliette and Alasdair have vertigo.
People with vertigo will often say they get “dizzy,” which is an imprecise term.
What they are experiencing is either vertigo, syncope or presyncope, also known as lightheadedness, or disequilibrium.
The difference is vertigo can be thought of as having an illusion of self-motion, or movement of the surrounding environment; syncope is the feeling of blacking out or fainting; and disequilibrium causes a sensation of being off balance without the sensation of the environment moving.
Vertigo arises when there’s a mismatch between other sensory systems, like sight and proprioception, and the vestibular system.
The vestibular system is made of the vestibular apparatus; including the three semicircular canals, the utricle and saccule, the vestibular nerve, and the vestibular structures in the brainstem and cerebellum.
Vertigo can be broken down into peripheral vertigo, which is due to damage to the vestibular apparatus, or damage to the vestibular nerve, and central vertigo, which is due to damage to the vestibular structures in the brainstem or cerebellum.
Vertigo is defined as an illusion of movement that's either self-movement or movement of the surrounding environment. Vertigo is classified into peripheral and central vertigo. Peripheral vertigo is caused by disorders like benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, and an acoustic neuroma. Causes of central vertigo include posterior circulation stroke, brainstem or cerebellar tumors or lesions.
Diagnosis is made based on clinical presentation and the patient's history, but sometimes imaging studies are required to rule out central causes like a posterior circulation stroke. Treatment depends on the underlying causes and may include medications like antiemetics and benzodiazepines, or even surgery.
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