Session 9: vestib management Flashcards
(41 cards)
What are the three main management options for vestibular disorders?
*Medication:
- Treats acute symptoms (e.g., labyrinthitis attack).
- Can also manage chronic symptoms (e.g., Ménière’s disease).
*Vestibular Rehabilitation:
- Treats chronic or recurrent symptoms (e.g., uncompensated labyrinthitis).
*Surgery:
- Used for severe, disabling dizziness when other treatments fail.
- Example: Disabling symptoms of Ménière’s disease.
When is each management option typically used?
- Medication: For acute and chronic symptom relief.
- Vestibular Rehabilitation: For persistent, recurrent, or uncompensated vestibular dysfunction.
- Surgery: As a last resort for disabling dizziness not resolved by other treatments.
At what levels of care is medication used to manage vestibular disorders?
- Primary care (GP): For initial symptom management.
- Secondary care (ENT): For more specialized treatment.
- Tertiary care (specialist balance clinics): For complex or refractory cases.
What symptoms are medications typically used to treat?
- Acute symptoms: Example: An attack of labyrinthitis.
- Chronic symptoms: Example: Ongoing symptoms in Ménière’s disease.
What are vestibular suppressants, and how do they work?
*Definition: Medications that reduce nystagmus and symptoms of vestibular dysfunction.
-Types and Examples:
- Anticholinergics (e.g., amitryptiline):
- Prevent motion intolerance.
- Must be taken before symptoms occur.
- May delay vestibular compensation.
- Antihistamines (e.g., betahistine):
- Reduce motion sickness.
- Can be taken after symptoms occur.
- Benzodiazepines (e.g., lorazepam):
- Prevent motion intolerance.
- Act as central suppressants.
- Can cause sedation and delay compensation.
What are anti-emetics, and when are they used?
- Purpose: Control nausea and vomiting during acute vestibular episodes.
- Side Effects:
- Sedation or movement disorders (e.g., acute dystonia, pseudoparkinsonism).
- Use should be short-term to avoid withdrawal effects.
What are some other medications used for vestibular disorders?
- Diuretics (e.g., bendroflumethiazide):
Manage fluid balance in Ménière’s disease. - Calcium Channel Blockers:
Potential future treatment for Ménière’s disease. - Antidepressants:
- Treat depression associated with vestibular conditions.
- May prevent future symptoms.
- Steroids:
- Treat acute phases of Ménière’s disease and vestibular neuritis.
- Long-term use may prevent compensation in some cases (e.g., labyrinthitis) but is necessary for others (e.g., Ménière’s).
What are the challenges in using medications for vestibular disorders?
- The mechanism of action for many drugs is unknown.
- Varying levels of research exist on their effectiveness.
- Future research is exploring potential new drug options.
When is surgery considered for vestibular conditions?
- Surgery is performed rarely and only for extremely disabling symptoms.
- Risks include hearing loss, as most procedures are destructive rather than corrective.
What is a labyrinthectomy, and when is it used?
- The vestibular end organ is destroyed (chemical or surgical).
- Used for fluctuating disorders with significant hearing loss, such as severe Ménière’s disease.
What is chemical labyrinthectomy (Gentamycin treatment), and how does it work?
- A grommet is inserted into the tympanic membrane.
- Gentamycin is injected into the middle ear cavity.
- The drug passes through the round window and destroys hair cells in the labyrinth and cochlea.
- It often causes hearing loss but reduces vestibular function.
*Advantages:
- Less invasive than surgical labyrinthectomy.
Can be repeated if necessary.
What is vestibular neurectomy, and what are its limitations?
- The vestibular nerve (and sometimes the auditory nerve) is severed.
- Performed for fluctuating disorders with significant hearing loss, such as severe Ménière’s disease.
- Limitations:
- Not always successful; the nerve may regrow.
What is perilymph fistula repair, and when is it used?
- A leak in the inner ear is repaired using tissue from elsewhere in the body.
- Outcomes:
- Success rates are variable.
In some cases, inserting a grommet into the tympanic membrane is helpful.
What is an endolymphatic shunt, and why is it rarely performed?
- A drain is inserted to remove excess endolymph.
- Used in severe Ménière’s disease.
- Limitations:
- Research has questioned its value, so it is rarely performed today.
What is superior semicircular canal dehiscence (SSCD) repair?
- A plate is placed over the hole in the bony labyrinth.
- Limitations:
- Can cause significant hearing loss.
What is canal plugging, and when is it used?
- The affected semicircular canal is sealed off to reduce/remove symptoms.
- Uses:
- Treats BPPV or SSCD when other methods fail.
- Limitations:
- Rarely needed, as repositioning maneuvers suffice for most BPPV cases.
What is Vestibular Rehabilitation?
Treatment of vestibular disorders designed to:
– Reduce symptoms
– Improve balance function
– Reduce disability
– Improve general activity levels
Who is suitable for VR?
VR can be used to treat patients with:
– Benign Paroxysmal Positioning Vertigo (BPPV)
– Unilateral vestibular lesion
– e.g - Labyrinthitis/vestibular neuritis
- Acoustic neuroma
– Bilateral vestibular lesions
– e.g - Caused by ototoxic drugs
– “Quiescent” Ménière’s Disease
what does vestibular rehab usually consist of?
- a balance excercise programme
*Advice regarding:
* The cause of balance problems
* How the cause relates to the patient’s symptoms
* Strategies for managing day-to-day problems
* Other methods of reducing effects of dizziness
– Counselling for the psychosocial effects of the
balance disorder may also be offered
what is vestibular rehabilitation less useful for?
- Patients without a vestibular problem
- Fluctuating vestibular problems
e.g - Active Ménière’s Disease - Perilymph Fistula
what are the aims of vestibular rehab?
- Patient education
- Improve balance
- Reduce motion provoked symptoms
- Improve general conditioning
- Decrease disability
what are the components of vestibular rehab?
- Information provision
- Exercise therapy
- Practical advice
- Counselling
what is information provision?
- Explanation of:
– The condition causing the balance
disorder/dizziness
– Relationship between patients’ symptoms and the
condition
– The treatment
– Likely outcome and factors affecting outcome
What types of exercises are included in exercise therapy for vestibular disorders?
- Habituation exercises
- Adaptation exercises
- Gaze stabilization exercises
- Postural stability exercises
- Gait exercises
