Vestibular disorders and interventions

Question 1

causes of BPPV

Answer 1

infection
head trauma
vestibular weakness
advancing age - most common cause of dizziness in older people

Question 2

mechanism of BPPV causing dizzienss

Answer 2

otoconia are displaced in the macula of the utricle
they can ossify as people age and then chunks break off and move around/get displaced

Question 3

BPPV symptoms

Answer 3

vertigo with changing head positions
nausea w/ or w/o vomiting
nystagmus - most important, required for diagnosis

Question 4

types of BPPv

Answer 4

cupulolithiasis
canalithiasis

Question 5

cupulolithiasis characteristics

Answer 5

immediate onset
persistent duration
no change in nystagmus intensity
otoconia are stuck in the cupula

Question 6

canalithiasis characteristics

Answer 6

latency within 1-40s
short duration < 1 min
nystagmus fluctuates in intensity
otoconia stuck in canal
once movement of otoconia stops, symptoms stop

Question 7

direction of nystagmus indicates which affected canal

Answer 7

torsion/rotational: vertical canal anterior or posterior
horizontal - horizontal canals

Question 8

vertical nystagmus

Answer 8

indicates central disorder like concussion, not BPPV

Question 9

which assessment is for vertical canals?

Answer 9

loaded dix hallpike test

Question 10

loaded dix hallpike test steps

Answer 10

pt head turned 45 towards affected side
flex head 30 degrees for 30 seconds
move pt into supine with head extended 20-30 degrees off table maintaining 45 degree rotation

Question 11

results of loaded dix hallpike

Answer 11

up beating torsional nystagmus: posterior canal
down beating torsional nystagmus: anterior canal
they beat “towards” canal! in supine anterior is up and posterior is down

Question 12

common complaints of anterior canalithiasis

Answer 12

vertigo w bending over, emptying dishwasher, weeding

Question 13

treatment for vertical canal

Answer 13

modified eply maneuver/canalith repositioning maneuver

Question 14

steps of epley

Answer 14

1. turn head 45 degrees towards affected side
2. pt lies supine w 20-30 degrees extension over edge of table maintaining 45 degree rotation
3. hold until nystagmus subsides
4. rotate head opposite direction 45 degrees maintaining extension, hold until nystagmus subsides
5. roll onto same side maintaining 45 degrees relative to body, tuck chin to shoulder
6. help pt sit up keeping chin tucked, sit and watch for eye movement

Question 15

assessment of horizontal canal

Answer 15

supine roll test

Question 16

supine roll test steps

Answer 16

pt supine, roll head to one side, assess, then roll head to other side

Question 17

positive supine roll test

Answer 17

horizontal nystagmus without torsion

Question 18

geotropic nystagmus

Answer 18

canalithiasis
geo - towards ground on both sides
stronger beating on affected side

Question 19

ageotropic nystagmus

Answer 19

cupulolithiasis
ageo - away from ground
beats weaker on affected side
cupid is weak?

Question 20

treatment for horizontal canal BPPV

Answer 20

barbecue roll/lempert/baloh maneuver

Question 21

steps of barbecue roll

Answer 21

1. pt turned towards involved ear w 20 degrees cervical flexion
2. head turned straight up, hold 15s or until nystagmus resolves
3. head turned towards uninvolved side, 15s
4. roll onto side w head down towards table

Question 22

treat cupulolithiasis

Answer 22

liberatory/semont maneuver

Question 23

steps of semont maneuver

Answer 23

rotate head 45 degrees to unaffected side
move pt from seated to sidelying on affected side
hold 1 min
rapidly move to left sidelying so nose is down
hold 1 min
return to sitting

Question 24

HEP for posterior SCC BPPV

Answer 24

keep switching sides like in semont, holding 30 s each side or until vertigo stops
10-20 times
repeat until without vertigo 2 consectutive days

Question 25

most common BPPV

Answer 25

posterior SCC canalithiasis

Question 26

features of central vestibular pathology

Answer 26

ataxia abn smooth pursuit/saccades no hearing loss diplopia altered cx acute vertigo not suppressed by visual fixation nystagmus pure vertical, long persist

Question 27

features of peripheral vestibular disorder

Answer 27

mild ataxia normal smooth pursuit/saccades hearing loss/tiniitus/fullness acute vertigo suppressed by visual fixation intense symptoms up/dpwn beating torsional nystagmus or horizontal

Question 28

oculomotor exam for a pt with vertigo should include

Answer 28

smooth pursuit saccades abn here would indicate central assess nystagmus

Question 29

VOR

Answer 29

maintains stable gaze while we move or world moves around us maintains eye movement velocity the same as head movement velocity

Question 30

impaired VOR will result in:

Answer 30

retinal slip: eyes lag beind, blurring vision w head/eye movement decreasing vision and posture control

Question 31

CTSIB assesses:

Answer 31

systems needed for balance vestibular sensory vision

Question 32

CTSIB conditions

Answer 32

1: eyes open/fixed surface - tests none (all 3 affected if issues here) 2: eyes closed/fixed - tests sensory mainly 3: moving visual/fixed surface - sensory and vestibular with incorrect vision 4: eyes open/unstable surface - vision mainly 5: eyes closed/unstable surface - vestibular only 6: moving visual/unstable surface - vestibular only w incorrect vision

Question 33

UVH

Answer 33

unilateral vestibular hypofunction impaired balance due to impaitment in one ear dizzy/vertigo w head turns, blurred vision nausea trouble walking/veer to side

Question 34

BVH causes and symptoms

Answer 34

bilateral vestibular hypofunction caused by ototoxicity, meningitis, autoimmune, head trauma, 8th cranial neuroma, neuronitis oscillopsia - visual blurring with head movement disequilibrium no nausea gait ataxia

Question 35

principles of vestibular intervention

Answer 35

brief duration but high frequency throughout the day exercises may increase symptoms can include general conditioning

Question 36

VOR adaptation exercises

Answer 36

heads movements up/down, L/R maintain visual gaze on target change base of support with increasing balance challenge to challenge vestibular system start w stable target, then move it in opposite direction of head movement

Question 37

BVH interventions

Answer 37

alternate looking between two targets in seated progress to wider distance, busy background, standing add vertical head turns focus on target, close eyes and move head trying to keep eyes centered on targte, open and compare

Question 38

meniere's disease

Answer 38

recurrent, progressive vestibular disease tinnitus, deaf, fullness in ears, vertigo

Question 39

acoustic neuroma

Answer 39

vestibular nerve tumor hearing loss one side tinnitus, unsteady, loss of balance, dizziness, facial numbness