1. By D. Nichelle Cashe

2.  A 20 yo female came into the Minute Clinic with c/o feeling poorly, ear fullness and dizziness.  Objects seem to be in motion when she tries to focus  Symptoms had begun 1 week previous  She works as a childcare provider  Symptoms had not prevented her from going to work, but had now gotten untolerable.  Has taken dayquil and nyquil to help improve symptoms with minimal success.  H/o tumor behind the R ear and previous DX of cholesteoma and murmur.

3.  Afebrile, VSS.  Normocephalic, EOM intact, PERRLA.  Bilat TMs are red ; Fluid present behind R TM.  Nares patent; turbinated pink and moist.  Oropharynx moist, pink with PND noted in posterior pharynx.  Cardio: RRR, S1 S2. Previous h/o innocent murmur(I/VI)

4.  Acute Otitis Media: 2 caps BID x 10days.  Vertigo (due to her h/o R ear tumor, we are unable to treat her at the Minute Clinic for this dx.)  Advised to f/u with ENT if symptoms do not improve or worsen within 3 days.

5.  BPPV (Benign paroxysmal positional vertigo) ◦ Disorder of the inner ear that is characterized by episodes of a spinning sensation.  Subjective vertigo- you feel that you are spinninig  Objective vertigo- the sensation that the room is spinning ◦ Accounts for 42% of cases of vertigo ◦ Rate of recurrence is 50% or higher ◦ Average age of onset is 51 years old ◦ Commonly caused by calcium carbonate and protein crystals (otoconia) that collect in posterior semicircular canal.

6.  Complete health history  Medications  Assess for head trauma, ear disease, or sx.  Thorough P.E. important ◦ HEENT ◦ Neuro exam (coordination, gait, sensation)

7.  Dix-Hallpike Maneuver (The gold standard) ◦ The goal of the exam is duplicate the symptoms ◦ This will determine if the cause of vertigo is benign. ◦ Use caution in patients with head, neck and back issues. ◦ https://www.youtube.com/watch?v=59EIKztATiw https://www.youtube.com/watch?v=59EIKztATiw (3 min video showing Dix Hallpike & Epley’s Maneuver)  Positive response shows (tortional upbeating nystagmus)  If positive begin canalith repositioning (Epley’s Manuever) These maneuvers have a 90% success rate Meclizine-12.5mg, 25mg or 50mg q4hrs prn on a short term basis. Most helpful with Labyrinth Vertigo.

8.  Meniere’s disease  Vestibular Neuritis  Labyrinthitis  Vestibular Schwannoma  Trauma  Presyncope  Lightheadedness  Disequilibrium  Migraine