Vestibular Disorders

Question 1

Labyrinthitis & Vestibular Neuritis

Answer 1

Vestibular labyrinthitis is the inflammation of the inner ear labyrinth
Vestibular neuritis is the inflammation of the vestibular nerve
Both conditions can be caused by infections such as OM, Cold/Influenza, Measles/mumps, meningitis, etc (typically upper respiratory infection)
Symptoms will include both cochlear and vestibular for labyrinthitis, and only vestibular for vestibular neuritis.
S/S include:
- aural fullness
- tinnitus
- HF SNHL
- Acute vertigo
- Nausea
- Nystagmus
Differential Dx:
- OME
- Perilymphatic fistula
- BPPV

Question 2

Vascular Occlusion of the Labyrinthine Artery

Answer 2

Occlusion of the labyrinthine artery (primary arterial supply to the cochlea) can lead to sudden and profound SNHL with vestibular dysfunction
Vestibular symptoms may subside from compensation but HL is permanent
More common in older adults with atherosclerotic vascular diseases or hyper-coagulation disorders.
Can suspect TIA or even stroke if patient complains of episodic vertigo (prior to occlusion)

Question 3

Migraine-Associated Vertigo (MAV)/Vestibular Migraine

Answer 3

Migraine:
May involve the pain pathways of the trigeminal and cervical nerves as well as the brainstem and thalamic nuclei and can include sensory auras.
About 1/3 to 1/2 of migraine sufferers report episodic vertigo
MAV:
dizziness and vertigo can be the aura of a migraine
Can be accompanied by photophobia, nausea, motion and noise intolerance, ataxia and weakness of extremities
MAV should have migraine symptoms in at least 50% of vertigo episodes
Important to treat the migraine and avoid triggers instead of treating the vertigo