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Year 2: Neuromuscular II > Test 2: vestibulopathies > Flashcards

Test 2: vestibulopathies Flashcards

1
Q

describe vestibulopathies

A

peripheral vestibular dysfunction

can be unilateral or bilateral

may require habituation or adaptation or both

CPG applies if VRT is appropriate based on etiology

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2
Q

types of vestibulopathies

A

vestibular neuritis

labyrinthitis

meniere’s disease

acoustic neuroma

superior canal dehiscence syndrome

perilymphatic fistula

labryinthine concussion

ototoxicity

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3
Q

what is a videonystamography

A

video goggles used to track for nystagmus with various conditions

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4
Q

what is a electronystagmography

A

electrodes used around the eye to record electric activity

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5
Q

what is a rotary chair

A

sit in a chair in a dark room that spins around

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6
Q

what is video head impulse test

A

studies VOR at high frequency

more sensitive than clinical head impulse test

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7
Q

what is vestibular evoked myogenic potential

A

applying a repetitive sound stimulus to one ear and then averaging the reaction of the muscle activity in response to each sound click or pulse

CVEMP (cervical mm)

OVEMP (ocular mm)

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8
Q

what is computerized dynamic posturography

A

detects postural sway by measuring shifts in the center of gravity (COG) as a person moves within their limits of stability

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9
Q

what is caloric testing

A

water or air in ear to see electrical activity

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10
Q

describe vestibular neuritis

A

inflammation of balance portion of CN VIII (can be inferior or superior portion)

precipitated by viral illness (usually a few weeks prior)

acute onset vertigo

lasts min to hours

likely have N&V

usually no hearing impact

often unilateral but can be bilateral

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11
Q

diagnosis of vestibular neuritis

A

head impulse test, caloric testing, VEMP

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12
Q

management of vestibular neuritis

A

glucocorticoids in first 3 days since symptom onset

want to reduce the inflammation

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13
Q

is vestibular neuritis responsive to vestibular rehabilitation treatment (VRT)

A

yes

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14
Q

how long until vestibular neuritits improves

A

6 weeks to 3 months

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15
Q

what is labyrinthitis

A

bacterial or viral infection of labryrinth

if bacterial it is generally meningitis

will affect hearing and balance

prolonged vertigo

N&V

will have tinnitis

often unilateral but can be bilateral

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16
Q

diagnosis of labyrinthitis

A

head impulse test

caloric testing

vestibular evoked myogenic potential

will also test CSF, auditory markers, and MRI in case of bacterial

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17
Q

treatment of labyrinthitis

A

bacteria = antibiotics

autoimmune/viral = steroids

18
Q

is labyrinthitis responsive to VRT

A

yes

19
Q

describe meniere’s disease

A

aka endolymphatic hydrops

ischemia or fibrosis of endolymphatic sac causing abnormalities in endolymph drainage

often the catch all term for vestibular disorders

may have N&V

may have fluctuating hearing loss

may have tinnitus that sounds like roaring

starts unilateral and progresses to bilateral

episodic

20
Q

diagnosis of menieres

A

audiogram is important; will show low frequency hearing loss

may test positive on vestibular hypofunction tests

21
Q

treatment for menieres

A

not curable

2g/day of sodium to control fluids

diuretics to lower extracellular fluid

22
Q

does menieres respond to VRT

A

may respond to VRT at first but need to move to habituation as it gets worse

23
Q

what is an acoustic neuroma

A

aka vestibular schwannoma

benign tumor CN VIII

often presents in the internal auditory canal but can present other places as well

symptoms dependent on tumor location

if in IAC - will have hearing and balance impairment

tumors are slow growing so symptom onset can be slow

typically unilateral

24
Q

diagnosis of acoustic neuroma

A

may be positive on other CN VIII screens like Renne and Webber

MRI and CT needed

25
Q

treatment for acoustic neuroma

A

sx excision or gamma knife radiation

VRT may be helpful post op

26
Q

what is superior canal dehiscence syndrome

A

thinning or opening on the top of the bone overlying the superior canal

symptoms are oscillopsia or vertigo induced by sound

often congenital

27
Q

diagnosis of superior canal dehiscence

A

observing eye movements caused by increased pressure or sound in inner ear or during valsalva

28
Q

treatment for superior canal dehiscence

A

repair of bony deficit in sx

not responsive to VRT

29
Q

what is a perilymphatic fistula

A

perforation (usually trauma related) of the oval or round windows that disrupts the biochemistry of the ear

perilymph leaks into the middle ear resulting in vertigo and hearing loss that are episodic

symptoms increase with activity (increase pressure) and decrease with rest

hard to diagnose because similar test to other disorders but can increase pressure in inner ear and observe for vertigo

30
Q

medical management of perilymphatic fistula

A

rest, sx, and VRT

31
Q

describe labyrinthine concussion

A

concussion of inner ear

often cooccurs with brain concussion

most common incidence is trauma

symptoms = balance problems, dizziness, concussive symptoms, cognitive changes, irritability, and sleep disturbances

may have central and peripheral findings

can be unilateral or bilateral

32
Q

does labyrinthine concussion respond to VRT

A

yes

with a cognitive component

33
Q

what is ototoxicity

A

can be chemical or environmental

typically bilateral

gentamycin (powerful antibiotic), chemo, solvents all can cause

symptoms = balance dysfunction and visual dependence

won’t necessarily have vertigo

may co-occur with hearing loss

adaptation WILL NOT WORK

34
Q

screen for ototoxicity

A

VEMPs, calorics, etc

35
Q

adaptation vs habituation vs substitution

A

adaptation = change in vestibular response to certain stimuli (neuroplastic change where there is a physiological balance of signaling)

habituation = decreased response to a stimulus with increased exposure (get used to it)

substitution = uptrain other systems

36
Q

CPG for vestibular function high evidence

A

VRT with acute/subacute/chronic unilateral vestibular hypofunction

VRT with bilateral hypofunction

supervised VRT

VRT to improve quality of life

age and gender DO NOT influence outcomes

37
Q

CPG for VRT is against what

A

saccades and smooth pursuit to improve gaze stability

this DOES NOT work

38
Q

CPG for VRT has moderate evidence for what

A

modalities based training
- virtual reality
- optokinetic stimulation
- platform perturbations
- vibrotactile feedback

when to stop CR (i.e. plateau)

39
Q

CPG for VRT has weak evidence for

A

balance dosage

gaze stability HEP

40
Q

other notable things that may impact outcomes according to the CPG

A

early intervention improves outcomes

anxiety, vision disturbances, migraines, long term use of vestibular suppressants can also impacy outcomes (i.e. meclazine damages inner ear over time)

41
Q
A

Year 2: Neuromuscular II (18 decks)

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