ENT Guidelines for EAR | Vertigo And Dizziness

Vertigo And Dizziness

The majority of dizziness in the elderly is of vascular or degenerative origin. Unsteadiness and lightheadedness are usually non-otological.

Aetiology         Medical:            Cardiovascular, metabolic and neurological conditions, anaemia, ocular disease,medications and cervical spine problems.
                                  Psychological: Anxiety and hyperventilation                                  Otological:        Benign paroxysmal positional vertigo, acute vestibular failure (labyrinthitis), Meniere’s disease, some middle ear disease and very rarely acoustic neuroma.

Symptoms: If the symptoms are from the inner ear then the patient will describe a hallucination of movement, usually rotational in nature and frequently accompanied by nausea, vomiting, and nystagmus. Meniere’s syndrome consists of a triad of episodic vertigo, associated tinnitus, and a fluctuating hearing loss. In benign paroxysmal positional vertigo (BPPV), short-lived episodes of rotational vertigo usually occur when turning over in bed. According to ENT Consultant in Lahore

Loss of consciousness is unlikely to be caused by inner ear problems.

Treatment: A general medical examination, a careful history, and blood pressure measurement may point to the cause of the dizziness.

If “the room is spinning” the patient may find it helpful to focus on a fixed object. Maintain hydration if nausea and vomiting are a feature. Vestibular sedatives such as prochlorperazine or cinnarizine are usually helpful in acute vertigo (eg. acute labyrinthitis, acute episode of Meniere’s), but long term use does not help with vestibular rehabilitation. Longer-term treatment with betahistine may be helpful in Meniere’s disease.

When to refer: Some ENT Doctor in Lahore departments run special neurotology clinics. Refer to ENT if there are ear symptoms or signs such as a discharging ear as some chronic ear disease can cause vertigo. For patients with BPPV, most can be helped by “repositioning” maneuvers, performed in the ENT/audiology department. In the absence of otological signs or symptoms accompanying the dizziness, the patient may benefit from a neurological opinion.

Wax Impaction

If the normal migration of wax out of the ear canal is inhibited in some way then a build-up can occur.  30% of people over the age of 64 years will suffer wax impaction and wax removal can improve the hearing.

Treatment: Wax can be removed by ear irrigation, aural toilet or micro-suction.  Sodium bicarbonate drops or olive oil can reduce the build-up and soften the wax.

When to refer:  Refer to the routine ENT Specialist in Lahore clinic if there is difficulty removing the wax despite olive oil. Refer if a child is uncooperative or there is uncertainty about the condition of the tympanic membrane.  The local ENT department may have a direct referral ear care clinic.  Patients will require micro-suction if contraindications to syringing exist.

Do not syringe if :

• The patient has a tympanic membrane perforation or a mucoid discharge which may suggest a perforation.
• The patient has had otitis media or acute otitis externa in the last six weeks.
• The patient has had previous ear surgery, seek advice.
• The patient has suffered complications with previous ear irrigation.
• The patient has a profound hearing loss in the other ear as it would be inadvisable to risk complications in the only hearing ear.
• The patient has had a cleft palate as he is more prone to middle ear disease.

Published By: ENT Surgeon in Lahore