Vertigo 2

Example answer


History

  • Character – true rotatory vertigo or something else e.g. unsteadiness, disequilibrium, light-headedness

  • Direction of vertigo – vertical/horizontal, clockwise/anti-clockwise

  • Onset – Sudden, gradual

  • Duration – seconds to minutes, minutes to hours, hours to days.

  • Timing – intermittent/episodic, constant

  • Exacerbating and relieving factors – directional head movements, postural change, walking, driving, previous treatments by GP/ENT specialists, any previous imaging? 

  • Associated symptoms – otorrhoea, tinnitus, otalgia, headache, photophobia, muscle weakness

  • Past Medical History – previous otological pathology, previous neuro-otological surgery, infectious disease, head injury

  • Drug History – Antibiotics, diuretics, antifungals, chemotherapy, sedative, antidepressants, anticonvulsants

  • Social History – smoking, alcohol, occupation, hobbies

  • Family History – otological conditions, brain tumours, genetic conditions, recent travel on ship/boat, scuba diving

  • Systems review

  • Elicit the patient’s ideas, concerns and expectations 


Conclusion

  • Summarise consultation

  • Thank patientOffer appropriate differential diagnosis



Differential diagnoses to consider*

Acute


  • Vestibular neuronitis

  • Acute otitis media

  • Acute vestibular failure

  • BPPV

  • Decompression sickness



Subacute


  • Postural hypotension

  • Vestibular migraine

  • Substance abuse

  • Alcohol

  • TIA

  • Mal de debarquement

Chronic


  • Meniere’s

  • Head injury

  • Vestibular schwannoma

  • Stroke

  • Multiple sclerosis



*Table not exhaustive


Management


You will be asked to suggest an appropriate management plan based on your presumed diagnosis. Ensure that you offer a complete ENT examination including microscopic examination of the ear canal and tympanic membrane in addition to cranial nerves prior to further investigations. 


Some examples are below:-



Suspected diagnosis

The following investigations/management strategies may be indicated however you must offer based on the clinical scenario you are given

Cholesteatoma

Clinical diagnosis. CT temporal bones for surgical planning. 

Consider MRI brain if any central neurological features

Skull base fracture

CT skull base


You may also mention that you would ask for a senior opinion and inform the patient of the outcome if you are unsure.

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