Published on April 17, 2008
Vertigo 眩晕: Vertigo 眩晕 Dept. Otolaryngology Second Affiliated Hospital Guangzhou Medical College Zhang Jianguo Define 定义: Define 定义 Vertigo is defined as a hallucination幻觉of movement. This may be a sensation of turning, spinning, falling, rocking, etc. Dizziness头昏, although commonly used by the patient as a term to describe the above sensations, refers to less severe and distinct sensations of giddiness眼花, faintness衰弱, confusion混乱, blankness空虚, or unsteadiness摇摆. This differentiation is important, since vertigo arises from disturbance of the vestibular end-organ, vestibular nerve, or vestibular nucleus. Dizziness may arise from mild disturbance of the vestibular apparatus but usually indicates disturbance in other regions. Evaluating Vertigo : Evaluating Vertigo Whether the symptom experienced is true vertigo. If the complaint does consist of a sensation of motion or turning, the origin lies in the vestibular apparatus前庭器; otherwise, other regions must be subjected to examination and evaluation Evaluating Vertigo: Evaluating Vertigo 2.The pattern of the vertigo. It is important to note whether the attacks are spontaneous or precipitated突如其来的 by movement. The presence of paroxysmal突发性的 attacks separated by periods of relative freedom from symptoms indicates a different pathologic condition than more or less continuous dizziness. Evaluating Vertigo: Evaluating Vertigo 3. The degree of vertigo. Vertigo arising in the labyrinth迷路 is usually accompanied by nausea and often vomiting. Less specific forms may be milder and may arise from any part of the body. Evaluating Vertigo: Evaluating Vertigo 4. The association of hearing loss or tinnitus with dizziness is a definite aid to localization. Complete audiometric听力测定 evaluation is essential to the examination of the dizzy patient, since these diseases may affect the vestibular apparatus alone, the cochlear apparatus alone, or both together. Examination : Examination Examination of the patient with labyrinthine symptoms (vertigo, hearing loss, and tinnitus) should include caloric examination前庭功能检查之冷热水试验 and hearing evaluation. Diagnosis: Diagnosis The main causes of vertiginous labyrinthine disturbance are: 1. Acute toxic labyrinthitis 2. Meniere's disease 3. Paroxysmal positional vertigo (postural位置性vertigo) 4. Vestibular neuronitis前庭神经元炎 5. Vertebral-basilar artery insufficiency椎基底动脉供血不足 6. Trauma 7. Tumor (Acoustic neurinoma听神经瘤) Wang Yifu -Silver Medal: Wang Yifu -Silver Medal In Atlanta Olympic Games in 1996 Vertebral-basilar artery insufficiency Last shooting Vertigo attack Only 0.1 loss Silver Medal Differential Diagnosis: Differential Diagnosis 1.Disease of the cerebellum, vascular disease and tumors 2. Disease of the proprioceptive本体感受的system 3.Cerebral anoxemia脑缺氧, arteriosclerosis动脉硬化, postural hypotension位置性低血压, and anemia 4.Endocrine disease, hypothyroidism甲状腺功能低下; and female hormonal disturbance 5. Epilepsy癫痫 Meniere’s Disease: Meniere’s Disease Dept. Otolaryngology Second Affiliated Hospital Guangzhou Medical College Zhang Jianguo Define: Define Meniere’s disease is characterized by deafness and tinnitus as well as by vertigo, loss of balance, nausea and vomiting, and thus involves both the cochlear and vestibular components of the inner ear. Pathology: Pathology The earliest findings are dilatation of the scala media(中阶) of the cochlea and the saccule(球囊). This dilatation in the cochlea is evidenced by stretching of Reissner's membrane rather than of the basilar membrane. Etiology : Etiology Although it is clear that this is a disease affecting the fluid physiology of the endolymphatic内淋巴 system, the origin of this disturbance has not been defined. It is not as yet known whether the primary disturbance is one of hypersecretion高分泌, hypoabsorption低吸收, or a disturbance of balance between both secretion and absorption. Etiology main causes: Etiology main causes 1. Local disturbance of salt and water balance. 2. Disturbance endolymphatic system. 3. Local allergy of the inner ear. 4. Vascular disturbance of the inner ear. 5.Local labyrinthine manifestation of systemic metabolic disease. 6. Anatomic alterations in both the endolymphatic duct（内淋巴管） and, the cochlear aqueduct（耳蜗导水管）. 7. Disturbance of the endolymphatic duct or sac, causing interference with absorption of endolymph. Symptoms : Symptoms There is usually a period of intra-aural fullness or pressure which the patient may experience for weeks, days, or hours prior to the attack. The spontaneous, sudden onset of severe vertigo accompanied by nausea and vomiting. There is an almost unnoticed depression of hearing in the involved ear due to loud roaring tinnitus occurring with the onset of vertigo. Model Court示范庭-True story: Model Court示范庭-True story Where: Zhanjiang,Guangdong When: in 1998 What: A woman be killed by her husband. The husband be jailed监禁20 years. Why: The relative of wife think her husband should be death . The relative of husband think 20 years is too long, Because his wife had Meniere’s Disease. When the husband hit his wife, the wife’s disease break out发作. Lawyer of the husband interview me. I tell the Meniere’s Disease to them. A patient with Meniere’s Disease didn’t damage herself. The consciousness was clear. Result: After one week, I get the news from Guangzhou Daily. The husband has been sentenced to death. Specific symptoms : Specific symptoms 1. Fluctuating 波动hearing loss. 2. Diplacusis复听(the perception of a different pitch音调 in the involved ear than in the normal ear) (指用同一音频刺激时两耳的音调感受能力有差别). 3. Intolerance to loud sounds （tinnitus）. Treatment : Treatment Medical treatment. Many cases can be controlled by Antihistamine 抗组胺药 Tranquillizers镇定剂 Vasodilators 扩血管药 Diuretics 利尿剂 Medical treatment controls the condition in over two –thirds of patients. Surgical treatment: Surgical treatment 1、Decompression of the endolymphatic sac 内淋巴囊减压 2、Vestibular neurectomy前庭神经切除 3、Stellate ganglionetomy星状神经节切除 4、Labyrinthectomy 迷路切除术 Surgical treatment: Surgical treatment This is surgical to treatment Meniere’s disease by US navy hospital. They connect a canal to round window. From the canal they can gate perilymph liquid and adjust that balance. Thank you !: Thank you !