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Vestibular Disorders Flashcards

Lecture 14 (104 cards)

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1
Q

the vestibular system is a somatosensory portion of the nervous system that provides?

A

awareness of the spatial position of the head and body (proprioception) and conscious awareness of active and passive limb movements and body position

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2
Q

3 components of the vestibular system

A

1) a peripheral sensory apparatus (inner ear)
2) central vestibular system (structures within the brainstem and cerebellum)
3) a motor output (connections with various motor nuclei and muscles)

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3
Q

the peripheral sensory apparatus is also called

A

vestibular labyrinth

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4
Q

the peripheral sensory apparatus is housed in the inner ear and consists of two types of motion sensors

A

three semicircular canals
two otolith organs - utricle / saccule

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5
Q

the semi circular canals are sensors for?

A

angular or rotational acceleration of the head
- detect movement in three dimensional space

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6
Q

otolith organs - utricle and saccule are sensors for?

A

Linear acceleration with respect to gravity

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7
Q

the utricle is sensitive to a change in ?

A

linear movement
sideways or up/down

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8
Q

the saccule gives information about?

A

vertical acceleration
- in a elevator

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9
Q

information regarding head movement is relayed peripheral to the central vestibular system by ?

A

vestibular portion of the vestibulocochlear nerve (Cranial nerve VIII)

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10
Q

why do disorders affecting the vestibular labyrinth often affect the cochlea to?

A

cochlea and vestibular labyrinth share blood supply

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11
Q

vestibular symptoms

A

dizziness and equilibrium

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12
Q

cochlear symptoms

A

hearing loss, tinnitus, or both

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13
Q

Central vestibular system receives input from ?

A

peripheral vestibular mechanism by vestibular division of CN VIII

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14
Q

input from vestibular labyrinth is processed in association with?

A

Visual sensory and somatosensory input

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15
Q

output from vestibular nuclei influences

A

eye movement
truncal stability
spatial orientation

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16
Q

motor output of the vestibular system is integrated into three vestibular reflexes

A

vestibulo ocular reflex (VOR) Gaze stabilizing reflex

vestibulospinal reflex (VSR)

vestibulocollic reflex (VCR)

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17
Q

when the head rotates about any axis (horizontal/vertical) distant visual images are stabilized by

A

rotating eyes about the same axis but in the opposite direction to stabilize

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18
Q

oscillopsia

A

disparity between head and eye movement is unstable gaze during head movement

illusion of unstable visual world , objects in visual field oscillate

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19
Q

vestibulospinal reflex (VSR)

A

stabilizes posture

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20
Q

vestibulocollic reflex

A

stabilizes head

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21
Q

the three components of the vestibular system work together to ?

A

Maintain balance by orienting a persons body position and motion in space

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22
Q

lesions in the cerebellum associated with?

A

nystagmus
gait ataxia

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23
Q

vestibular mechanism damaged, common manifestations are

A

sense of imbalance
dizziness/vertigo
nystagmus

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24
Q

vertigo is a type of dizziness specific to ?

A

vestibualr system disorders

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25
self
subjective vertigo
26
environment
objective vertigo
27
true vertigo is almost always caused by deficits within the ?
peripheral labyrinth or its connections to the cental vestibular system
28
vertigo can be
peripheral or central origin
29
True vertigo it is
associated with an illusory sense of motion or rotation over which individuals have no control
30
major conditions that produce episodic vertigo include
menieres reccurrent vestibular neuritis benign paroxysmal positional vertigo migraine associated vertigo SSCD posttraumatic vertigo - labyrinthine fracture
31
nystagmus refers to
disturbance of ocular movement characterized by rhythmic oscillations or rapid jerky movements of one or both eyes
32
what forms basis of detection, nature of nystagmus in response to eye gaze. positional changes, and vestibular stimulation
electronystagmography (VNG) tests
33
vestibular compensation involves changes in the
central vestibular nuclei that leads to partial restoration of lost neural activity within affected nuclei which reduces the asymmetry and rebalances vestibular activity
34
symptoms occur with acute unilateral peripheral vestibular injury because of?
asymmetry input between right and left central vestibular nuclei
35
bilateral peripheral deficits generally
DO NOT show vestibular compensation
36
central vestibular pathology
DOES NOT show vestibular compensation
37
what is vestibular labyrinthitis
inflammation of inner ear labyrinth
38
vestibular neuritis is?
inflammation of vestibular nerve
39
labyrinthitis and vestibular neuritis often preced by infections
cold/flu/otitis media measles/mumps meningititis
40
what is single most common complication of acute or chronic OME?
serous labyrinthitis
41
Cochlear symptoms are present in vestibular labyrinthitis or vestibular neuritis?
Vestibular labyrinthitis
42
Cochlear symptoms of in vestibular labyrinthitis
aural fullness tinnitus high frequency SNHL
43
Vestibular symptoms of vestibular labyrinthitis and neuritits?
actue vertigo nausa/vommitting nystagmus
44
electronystagmography (ENG) or videonystagmography (VNG) results indicate
peripheral vestibular anomalies
45
treatment of labyrinthitis and vestibular neuritis
antibiotic/antiviral drugs vestibular suppressant drugs steroids for HL
46
labyrinthitis and vestibular neuritis differential diagnosis
otitis media with effusion perilymphatic fistula benign paroxysmal positional vertigo - no HL
47
what is the primary arterial supply to cochlea?
Labyrinthine
48
vascular occlusion of labyrinthine artery
occlusion causes sudden and profound SNHL and vestibular dysfunction
49
migraine headaches is
severe, episodic, and disabling neurological condition
50
migrane charactersized by
unilateral head throbbing fatigue auditory/visual inputs nausea/ vomitting
51
Migraine associated vertigo should have migraine symptoms in at least
50% of vertigo episodes
52
Benign paroxysmal Positional Vertigo is
most common cause of vertigo if peripheral origin
53
benign
not life threatening
54
Paroxysmal
sudden; brief spells
55
Positional
triggered by certain head movements or positions
56
Vertigo
false sense of rotational movement
57
BBPV etiology
55 average idiopathic head trauma vestibular neurititis menieres migrane diabetes osteoporosis
58
Clinical presentation of BBPV
mild intense diziness getting out of bed, HEAD POSITIONING worse in morning and evening
59
what does BBPV involve?
posterior semicircular canal
60
BBPV takes one of three forms:
1) acute; resolves over 3 months 2) intermittent ; active and inactive 3) Chronic; continous
61
BBPV pathophysiology
otolith organs contain otoconia or otoliths, sensitive to gravity otoliths become dislodged and migrate into fluid filled semicircular canals otoliths move with gravity while fluid in semi circular canals do not, fluid moves when it is normally still when particles accumulate in canals they interfere with normal fluid movement that canals use to sense head motion inner ear sends false signals to brain that head is moving, resulting in diziness
62
BBPV evaluation
audiogram/MRI normal DIX HALLPIKE TEST
63
BBPV management
Epley maneuver surgery in cases to stop vertigo
64
Menieres Syndrome
idiopathic syndrome characterized by endolymphatic hydrops
65
Menieres pathophysiology
result of overproduction or under absorption of endolymph
66
Menieres epidemiology
peak age 30-60 unilateral but can become bi lateral
67
Menieres clinical presentation
intermittent episodes of vertigo fluctuating SNHL tinnitus aural fullness
68
what is required for a definitive diagnosis of menieres
- two or more definitive episodes lasting 20 minutes or longer - a least two of the four characteristic symptoms should be present
69
acute cases of menieres
vertigo lasts from 2-4 hours but can last up to 12 to 24 - vertigo of long duration with other smyptoms is indicative of menieres - hearing can return to normal
70
as menieres progresses,
attacks more frequent HL does not return to normal WRS continues to deteriorate recruitment becomes permanent
71
menieres disease and hearing loss
acoustic distortion at first, affecting speech understanding - loudness recruitment
72
change in hearing that is considered significant is
shift of >15 dB HL for average threshold of 0.5, 1, 2,3 khz shift in word rec scores of 15to 20% or greater
73
early state of menieres, audiometric configuration
- low frequency rising SNHL *worse from 250 to 1000 with normal hearing from 2000 and up* - flat configuration ; moderate to moderately severe SNHL W/ bi laterla disease an asymmetery of >25 dB HL reported
74
Middle stage, audiometric configuration
hearing sensitivity is reduced at all frequencies but worse at high and low frequencies - reverse cookie bite configuration
75
Late (burn out stage) audiometric configuration
flat severe sensorineural hearing loss - peaks at 1000 and 2000
76
menieres disease immittance
normal tymps reflexes present at lower sensation levels
77
diplacusis
same tone presented to both ears sounds different and or distorted in menieres ear
78
79
loudness recruitment
abnormal growth of loudness for signals at suprathresholds itensities -ARTs obtained at lower SL
80
electrocochleography
test that reflects elevation of inner ear pressure, distention of the basilar membrane of the inner ear
81
what is considered significant/positive for Menieres disease
>0.42 0r 42%
82
menieres management during an acute attack
sedatives and tranquilizers to control vertigo and nausea
83
long term management of menieres
decreasing the endolymph - low sodium diet increasing vascualr circulation of the inner ear
84
Are cochlear implants useful for menieres?
YESSS excellent option
85
menieres differential diagnosis
acoustic neuroma labyrinthine viral infections idiopathic vertigo perilymphatic fistula cogan syndrome
86
Superior Semicircular Canal Dehiscence
sscd creates a third mobile window into the inner ear that alters the normal fluid mechanics of vestibulocochlear system
87
Etiology of SSCD
developmental anomaly of temporal bone (congenital) - head trauma such as skull fractures idiopathic
88
SSCD signs and symptoms
vestibular symptoms alone or auditory systems alone both symptoms no symptoms
89
SSCD can mimic several auditory and vestibular systems (differential diagnosis)
Patulous (open) eustachian tube
90
SSCD vestibular symptoms can be evoked by loud noises or maneuvers that change middle ear intracranial pressure
S/S caused by excessive movement of perilymph - vertigo/diziness - nystagmus - tullios phenomenon - Oscillopsia
91
Conductive and/or fluctuating HL can occur with SSCD mimicking
otosclerosis or menieres
92
for SSCD patients show what kind of audiometric configuration 70%
low frequency air bone gap (worse at 250 through 1000 hz)
93
what is an important test for differential diagnosis of otosclerosis and SSCD
ARTS otoslcerosis is abnormal SSCD SSCD ARTS remain normal
94
diagnosis of SSCD
vestibular treatment high resolution temporal bone CT scans EcochG
95
Treatment of SSCD mild to moderate
conservative treatment for mild to moderate symptoms - ear plugs to avoid loud sounds
96
Treatment of SSCD debilitating symptoms
surgical repair with bony cement or soft tissue plugging
97
Mal de debarquement
illusion of movement felt after long travel on water by boat | sickness of disembarkment
98
Etiology of mal de debarquement
middle aged women
99
symptoms of mal de debarquement
rocking, swaying, and disequilibrium after return to land anxiety and depression worse in enclosed spaces when motion less
100
Diagnosis of mal de debarquement
no specific tests subjective history objective diagnostic such as vestibular testing and radiologic imaging
101
Treatment of mal de devarquement
no treatment standard drugs for motion sicknees vestibular rehabilitation
102
vestibular dysfunction in children is often accompanied by
hearing loss
103
genetic conditions with HL that affect vestibular system
CHARGE EVA BOR Bilateral waardenburg Usher
104
if a child has a hearing loss of >60 dB HL and has not walked by 14.5 months
suspect vestibular dysfunction

Acquired Auditory Vestibular Disorders (3 decks)

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