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OT6 Otolaryngology
True nystagmus and vertigo caused by a peripheral lesion will never last longer than
a few weeks, due to compensation from
the cerebellum (unless there is a history of cerebellar ischemia/stroke). Central lesions do not compensate, therefore nystagmus and vertigo will persist
5 “D”s of Vertebrobasilar Insufficiency Drop attacks
Diplopia
Dysarthria
Dizziness Dysphagia
Differential Diagnoses of Common Presentations Toronto Notes 2019 Differential Diagnoses of Common Presentations
Dizziness
Dizziness
True Vertigo
Non-Vertiginous
Peripheral (Vestibular)
Benign paroxysmal positional vertigo (BPPV)
Labyrinthitis
Menière’s disease
Vestibular neuronitis
Autoimmune inner ear disease Cholesteatoma
Ototoxic drug exposure Perilymph fistula
Recurrent vestibulopathy
Superior semicircular canal dehiscence Temporal bone fracture
Common causes in bold
Figure 11. Differential diagnosis of dizziness
Otalgia
External Ear
Infection
Auricular cellulitis
External canal abscess Herpes simplex/zoster Otitis externa
Trauma
Burns
Frostbite
Hematoma
Lacerations
Other
Cerumen impaction Foreign body
Neoplasm of external canal
Figure 12. Differential diagnosis of otalgia
Central
Cerebrovascular disorders
Vertebrobasiliar insufficiency Transient ischemic attacks Wallenberg’s syndrome Cerebellar infarction
Migrainous vertigo Multiple sclerosis Inflammation
Meningitis
Cerebellar abscess
Trauma: cerebellar contusion Toxic: alcohol, hypnotics, drugs Tumours
CPA tumours
Posterior fossa tumours Glomus tumours
Otalgia
Middle/Inner Ear
Infection
AOM
Mastoiditis
Myringitis
Otitis media with effusion Skull base infections Trauma
Barotrauma
Traumatic perforation Other
Cholesteatoma
Neoplasm
Wegener's granulomatosis
Organic Diseases
Cardiac Arrhythmias Aortic stenosis
Vasovagal
Orthostatic hypotension Anemia
Peripheral neuropathy Visual impairment
Functional
Depression
Anxiety
Panic disorder (hyperventilation) Personality disorder Phobic dizziness
Referred Pain
Infection
Ramsay Hunt syndrome Tonsillitis
Tracheitis
Trauma
Cervical arthritis Thyroiditis
Other
Glossopharyngeal neuralgia Neoplasm of oral cavity, larynx, pharynx
Teeth
TMJ syndrome Trismus