Lecture 35: Clinical evaluation of balance

Question 1

How do we detect acceleration and gravity?

Answer 1

Using our utricle (horizontal) and saccule (verticle)

These have calcium carbonate crystals that move and are effected by gravity.

Question 2

Ampullopetal and ampullofugal flow?

Answer 2

Ampullopetal is towards the ampulla and is excitatory in lateral canals and inhibitory in superor and posterior canals

Ampullofugal flow is away from the ampulla and has opposit effect as above.

Question 3

COWS?

Answer 3

Cold

Opposite

Warm

Sameside

Question 4

When the right hand side is taken out what is the concequence?

Answer 4

It’s like you are turning to the left in a circle. The fast phase nystagmus is in the opposite direction.

Question 5

What is a nystagmus?

Answer 5

• A rhythmic oscillation of the eye with a fast phase and slow phase
• Is described in the direction of the fast phase
• Usually due to relative hypoactivity but can also be a hyperactive system.

Question 6

Tests that can be done?

Answer 6

1. Head thrust (world feels like its catching up when you turn towards the damaged side)
2. Caloric test (warm or cold and causes nystagmus)
3. Fistula test (pushing on ears to cause nystagmus)
4. Unterberger stepping test (eyes closed = spin to the damaged side)
5. Dix Hallpike (pull back and down with head towards side you are testing, and allow time for latency) Epley’s used for confined bed space using pillow

Question 7

What is BPPV?

Associations?

symptoms?

Answer 7

Benign Paroxysmal positional vertigo

• 30% of 70 year olds have it
• Vertigo that is self-limiting lasting less than 1 min
• Associated with positions: rolling in bed, looking up, bending over, turning quickly
• NOT associated with tinnitus, hearing loss or migranes
• Use Dix Hallpike
• Geotropic nystagmus usually into the ground