Vertigo 眩晕
Dept,Otolaryngology
Second Affiliated Hospital
Guangzhou Medical College
Zhang Jianguo
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,Otolaryngology
Second Affiliated Hospital
Guangzhou Medical College
Zhang 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 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
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 !
Dept,Otolaryngology
Second Affiliated Hospital
Guangzhou Medical College
Zhang Jianguo
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,Otolaryngology
Second Affiliated Hospital
Guangzhou Medical College
Zhang 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 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
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 !
