Vestibular Disorders Flashcards
(31 cards)
Balance System involves
Visual, proprioceptive and vestibular system
helps orient the body and head in space to maintain upright posture and maintain visual focus
feedback to a central system
vertigo
spinning or whirling of self or environment –
different than just lightheadedness, unsteadiness, loss of consciousness
Perilymph fistula
abnormal communication between air filled space of ME and perilymphatic space of inner ear
can occur at otic capsule, oval window or round window
Causes of Perilymph Fistula
stapedectomy, head trauma, barotrauma, chronic ear surgery, congenital anomalies, chronic OME, spontaneous rupture
Auditory symptoms of Perilymph fistula
sudden onset of HL, unilateral to a varying degree
SNHL, possibly mixed, LF HL
aural fullness and tinnitus
Perilymph Fistula vestibular symptoms
mild unsteadiness, motion induced vertigo, tullio’s sign: vertigo & nystagmus induced by loud sound
Perilymph Fistula treatment
bedrest 7-10 days, reduced activity, vestibular suppressants and perilymph fistula repair
Perilymph fistula prognosis
relieves vestibular symptoms more than it improves hearing, resolution of major symptoms for ~50% of patients (more so in individuals with an observed fistula)
Vestibular Neuritis/Labyrinthitis
Infection of inner ear/vestibular nerve resulting in sudden spontaneous vestibular loss
if there is only one vestibular nerve involved, vertigo results
Vestibular Neuritis/labyrinthitis symptoms
auditory: neuritis=no aud symptoms
labyrinthitis=HF SNHL
vestib: imbalance, disequilibrium, possibly vertigo, occasionally positional, horizontal beating nystagmus with torsional component, symptoms occur over a period of days-weeks
Vestibular neuritis/labyrinthitis ENG results
spontaneous horizontal nystagmus, gaze evoked nystagmus in horizontal plane, unilateral weakness on caloric test
VN/L treatment
symptom based medication
vestib rehab therapy to build up central compensation
VN/L prognosis
symptoms subside after a few weeks, once infection clears up symptoms should decrease significantly
Superior Canal dehiscence (SCD)
roof of superior semicircular canal is missing
SCD symptoms
tllio phenomenon, dizziness, pressure induced nystagmus, LF conductive HL, tinnitus, autophony
SCD differential diagnosis with otosclerosis
reflexes (present in SCD but not otosclerosis) and VEMPs, audio may have enhanced BC, CT scan
SCD causes & trauma
slow erosion of bone, congenital, trauma
treated by resurfacing area, plugging superior canal
Benign Paroxysmal Positional Vertigo (BPPV)
most inner ear disorder that causes dizziness
VIOLENT WHIRLING VERTIGO LASTING SECONDS TO MINUTES BROUGHT ON BY POSITIONAL CHANGE
~20% of all dizziness is due to BPPV, ~50% of all dizziness in older individuals is due to BPPV
BPPV Cupuloithiasis & canalithiasis
particles adhere to cupula of SCC, indicated more in horizontal canal movement – vertigo is intense and persists while head is in provocative position
canalithiasis: free floating particles within SCC, sludge through canal and gravitate toward posterior canal
BPPV Posterior SCC–Classic 4 signs
- Mixed torsional and vertical nystagmus with upper pole of eye beating toward affected ear and vertical nystagmus beating toward forehead
- Onset after maneuver-nystagmus typically appears after 1-2 sec latency, lasts only up to 30 sec
- Reversal of nystagmus direction upon return to sitting
- fatigue of response with repetition of maneuver
BPPV Horizontal SCC
much less common than posterior, pt lies supine and head & body are quickly turned toward side being tested
purely horizontal nystagmus-generally beats toward undermost ear but in some cases can beat towards uppermost ear
Possible causes of BPPV
idiopathic: 50-70%
secondary: 30-50% (head trauma, viral labyrinthitis, meniere’s disease, migranes, inner ear surgery)
no auditory symptoms
BPPV Treatment/Rehab
spontaneous recovery without treatment, maneuevers, repositioning
surgical treatment: section posterior ampullary nerve, posterior SCC occlusion fixes cupula in place rendering it unresponsive to normal angular acceleration or to stimulation from free floating particles or those stuck in cupula
Presyncope
“about to faint” feeling
