07/04/2022
(Continued from before)
History taking and clinical signs are most important for diagnosis of different disorders in ENT. Most of the patients report to the emergency with acute vertigo.First duty of the physician is to exclude acute cardiac and neurological disorders. If diagnosed, patient should be treated accordingly. But majority of the patients belong to acute vestibular system disorders. Benign Paroxysmal Pisitional Vertigo is the commonest of such disorders. Patient gets sharp rotatory feeling associated with nausea and vomiting when the patient turned the head one side or other or stoops down or looks up to pickup something from a height. Usually there is no hearing problem. If not treated, the problem continues and may become chronic and recurrent. A simple manoeuvre called Epley’s manoeuvre can cure it. Other disorders are Vestibular migraine, vestibular neuronitis, Mineires’ disease are next few common disorders having specific symptoms and signs which help in diagnosis.A few medicines are ototoxic I.e. toxic to the inner ear. These may cause vertigo with or without deafness. Streptomycin, Quinine, certain diuretics etc are a few examples. There are few other disorders like perilymph leakage, # footplate of stapes, head injury etc which also may cause damage to the inner ear. Central disorders are comparatively rare. Ischaemic changes, haemorrhage and thrombosis of blood vessels supplying brain stem or cerebellum may cause vertigo. Rarer disorders are medications like contraceptives, cancer chemo therapeutic agents , Diaseminnated Sclerosis, tumours and Even disorders like glaucoma may result vertigo. Psychological disorders also may cause this disorder. One also must remember that inspite of taking a good history and doing all types of investigations, some cases of vertigo are of unknown or idiopathic origin. One also must remember there may be several causes combined together and a very careful history taking and clinical examinations are required for diagnosis.
(To be continued)
