Vertigo 眩晕

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

1. 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

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

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

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 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

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

In Atlanta Olympic Games in 1996

Vertebral-basilar artery insufficiency

Last shooting Vertigo attack

Only 0.1 loss Silver Medal

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

Dept. OtolaryngologySecond Affiliated HospitalGuangzhou Medical CollegeZhang Jianguo

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

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

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

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

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

Where: Zhanjiang,Guangdong

When: in 1998What: 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

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

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

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 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 !