Vestibular Disorders COPY Flashcards
(52 cards)
1
Q
Benign Paroxysmal Positioning Vertigo
What is the:
- timeframe,
- hearing loss, and
- associated symptoms
A
- Seconds
- None
- Posturally evoked
2
Q
Labyrinthitis
What is the:
- timeframe,
- hearing loss, and
- associated symptoms
A
- Days
- Possible (effusion)
- URI prodrome
3
Q
Vestibular Neuronitis
What is the:
- timeframe,
- hearing loss, and
- associated symptoms
A
- Sudden, days to weeks
- None
- Slow, sometimes incomplete improvement
4
Q
What is the sensation where the patient senses they are spinning or that the world is spinning around them?
A
Vertigo
5
Q
What is the sensation where real movement causes the sensation of spinning or discomfort?
A
Dizziness
6
Q
What is the hallmark of vertigo?
A
nystagmus
7
Q
Which type of vertigo is this?
- Characterized by sudden onset
- Associated with nausea/vomitting
- Horizontal nystagmus with fast beats away from affected side
- Fixation causes suppression
A
Peripheral vertigo
(inner ear causes)
8
Q
What causes Peripheral vertigo?
A
Inner ear causes
______________
- Characterized by sudden onset
- Associated with nausea/vomitting
- Horizontal nystagmus with fast beats away from affected side
- Fixation causes suppression
9
Q
Peripheral vertigo _______ with fixation
A
suppresses
Peripheral vertigo (innear ear causes)
- Characterized by sudden onset
- Associated with nausea/vomitting
- Horizontal nystagmus with fast beats away from affected side
- Fixation causes suppression
10
Q
Which type of vertigo is this?
- Characterized by slow onset
- Vertical nystagmus
- DOES NOT suppress with fixation
A
Central vertigo (CNS involvement)
11
Q
What causes Central Vertigo?
A
Central vertigo (CNS involvement)
- Characterized by slow onset
- Vertical nystagmus
- DOES NOT suppress with fixation
12
Q
Central Vertigo _______ with fixation
A
DOES NOT suppress
Central vertigo (CNS involvement)
- Characterized by slow onset
- Vertical nystagmus
- DOES NOT suppress with fixation
13
Q
Peripheral vertigo has _______ nystagmus
A
Horizontal nystagmus with fast beats away from affected side
Peripheral vertigo (innear ear causes)
- Characterized by sudden onset
- Associated with nausea/vomitting
- Horizontal nystagmus with fast beats away from affected side
- Fixation causes suppression
14
Q
Central Vertigo has _______ nystagmus
A
Vertical nystagmus
Central vertigo (CNS involvement)
- Characterized by slow onset
- Vertical nystagmus
- DOES NOT suppress with fixation
15
Q
How do you evaluate vertigo?
A
- History/physical
- Audiometry
- Video/Electronystagmography/calorics (COWS)
- Electrocochleography
- ABR (Auditory brainstem response test)
- MRI
16
Q
What does videonystagmography test?
A
Used to test inner ear and central nervous sytem function
_____
Patient wears infrared goggles to track eye movements during positional changes and visual stimulation
17
Q
Identify the test: Patient wears infrared goggles to track eye movements during positional changes and visual stimulation
A
Videonystagmography
Used to test inner ear and central nervous sytem function
_____
18
Q
Identify the test: Cold and warm water or air is used to stimulate the inner ear
A
Caloric Testing
_________
Response is nystagmus in a specific direction: COWS
- Cold water: Eyes should move away from the cold water and slowly back
- Warm water: eyes should move toward warm water and then slowly away
19
Q
You are performing caloric testing. You are applying cold water to stimulate the inner ear. What do you expect to happen?
A
Cold water: Eyes should move away from the cold water and slowly back
_________
Response is nystagmus in a specific direction: COWS
Warm water: eyes should move toward warm water and then slowly away
20
Q
You are performing caloric testing. You are applying warm water to stimulate the inner ear. What do you expect to happen?
A
Warm water: eyes should move toward warm water and then slowly away
_________
Response is nystagmus in a specific direction: COWS
Cold water: Eyes should move away from the cold water and slowly back
21
Q
Identify the test: Measures the electric potentials in the cochlea in response to sound stimulation
A
Electrocochleography
_______
- Used to determine fluid pressure of inner ear
- Used to diagnose Meniere’s or endolymphatic hydrops
22
Q
What does Electrocochleography test?
A
- Used to determine fluid pressure of inner ear
- Used to diagnose Meniere’s or endolymphatic hydrops
_______
Measures the electric potentials in the cochlea in response to sound stimulation
_______
23
Q
Identify the test: Electrodes placed on the head monitor electrical activity in response to click stimulus and displays them as waves
A
Auditory Brainstem Response (ABR)
Used to determine brainstem function and to rule out an acoustic neuroma
24
Q
What does Auditory Brainstem Response (ABR) test?
A
Auditory Brainstem Response (ABR)
Used to determine brainstem function and to rule out an acoustic neuroma
__________
Electrodes placed on the head monitor electrical activity in response to click stimulus and displays them as waves
25
Treatment of Vertigo
1. Benzodiazepines (valium, xanax)
2. Meclizine/Transdermal scopolamine
3. Oral steroids
4. Salt/caffeine restriction
5. Vestibular rehabiliation
6. Interventional and surgical therapies available for persistant causes
* Intratympanic steroids
* Endolymphatic shunt
26
Causes of PERIPHERAL vertigo: identify
* Room spinning sensation with changes in head position, usually in one direction
* Peaks and resolves in seconds
* INTACT HEARING
**_Peripheral vertigo: Benign Paroxysmal Positional Vertigo_**
**_Pathophysiology_**
* crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
* Otoconia (small crystals of calcium carbonate) from utricle \> posterior semicircular canal
* May be associated with head injury, car accident, or idiopathic
**_Diagnosis_**
* Dix-hallpike maneuver
**_Treatment_**
* Epley maneuver (particle repositioning procedure)
27
Causes of PERIPHERAL vertigo: identify
* Primary cause of PERIPHERAL vertigo
**_Peripheral vertigo: Benign Paroxysmal Positional Vertigo_**
**_Presentation_**
* Room spinning sensation with changes in head position, usually in one direction
* Peaks and resolves in seconds
* INTACT HEARING
**_Pathophysiology_**
* crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
* Otoconia (small crystals of calcium carbonate) from utricle \> posterior semicircular canal
* May be associated with head injury, car accident, or idiopathic
**_Diagnosis_**
* Dix-hallpike maneuver
**_Treatment_**
* Epley maneuver (particle repositioning procedure)
28
Causes of PERIPHERAL vertigo: Benign Paroxysmal Positional Vertigo
* Presentation
**_Peripheral vertigo: Benign Paroxysmal Positional Vertigo_**
**_Presentation_**
* Room spinning sensation with changes in head position, usually in one direction
* Peaks and resolves in seconds
* INTACT HEARING
**_Pathophysiology_**
* crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
* Otoconia (small crystals of calcium carbonate) from utricle \> posterior semicircular canal
* May be associated with head injury, car accident, or idiopathic
**_Diagnosis_**
* Dix-hallpike maneuver
**_Treatment_**
* Epley maneuver (particle repositioning procedure)
29
Causes of PERIPHERAL vertigo: Benign Paroxysmal Positional Vertigo
* Pathophysiology
**_Peripheral vertigo: Benign Paroxysmal Positional Vertigo_**
**_Pathophysiology_**
* crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
* Otoconia (small crystals of calcium carbonate) from utricle \> posterior semicircular canal
* May be associated with head injury, car accident, or idiopathic
**_Diagnosis_**
* Dix-hallpike maneuver
**_Treatment_**
* Epley maneuver (particle repositioning procedure)
**_Presentation_**
* Room spinning sensation with changes in head position, usually in one direction
* Peaks and resolves in seconds
* INTACT HEARING
30
Causes of PERIPHERAL vertigo: Benign Paroxysmal Positional Vertigo
* Diagnosis and treatment
**_Peripheral vertigo: Benign Paroxysmal Positional Vertigo_**
**_Diagnosis_**
* Dix-hallpike maneuver
**_Treatment_**
* Epley maneuver (particle repositioning procedure)
**_Presentation_**
* Room spinning sensation with changes in head position, usually in one direction
* Peaks and resolves in seconds
* INTACT HEARING
**_Pathophysiology_**
* crystalline structures have disengaged from hair cells in the semicircular canals, move throughout the canal with position change, and cause conflicting signals to the brain
* Otoconia (small crystals of calcium carbonate) from utricle \> posterior semicircular canal
* May be associated with head injury, car accident, or idiopathic
31
Causes of PERIPHERAL vertigo: identify
* Distinct episodic attacks
* Prolonged vertigo
* Fluctuating hearing loss-low frequency tilt is common
* Tinnitus
* Aural fullness
**_Meniere's Disease_**
**_Etiology_**
* Etiology unknown--maybe allergic, AI, migraine variant
**_Treatment_**
* Salt/caffeine restriction
* Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
* Benzodiazepines (acute phase)
* Oral steroids (acute phase)
* Intratympanic steroid injections
**_Types_**
1. Classical Meniere's
2. Cochlear Meniere's (not dizzy)
3. Vestibular Meniere's (no auditory symptoms)
4. Bilateral Meniere's (autoimmune IED)
5. Subclinical endolymphatic hydrops (aural fullness)
6. Post traumatic (SNHL and years later get symptoms of Meniere's)
32
Causes of PERIPHERAL vertigo: identify
* What disease is hallmarked by tinnitus, vertigo, and hearing loss?
**_Meniere's Disease_**
**_Presentation_**
* Distinct episodic attacks
* Prolonged vertigo
* Fluctuating hearing loss-low frequency tilt is common
* Tinnitus
* Aural fullness
**_Etiology_**
* Etiology unknown--maybe allergic, AI, migraine variant
**_Treatment_**
* Salt/caffeine restriction
* Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
* Benzodiazepines (acute phase)
* Oral steroids (acute phase)
* Intratympanic steroid injections
**_Types_**
1. Classical Meniere's
2. Cochlear Meniere's (not dizzy)
3. Vestibular Meniere's (no auditory symptoms)
4. Bilateral Meniere's (autoimmune IED)
5. Subclinical endolymphatic hydrops (aural fullness)
6. Post traumatic (SNHL and years later get symptoms of Meniere's)
33
Causes of PERIPHERAL vertigo: Meniere's Disease
* Presentation
**_Meniere's Disease_**
**_Presentation_**
* Distinct episodic attacks
* Prolonged vertigo
* Fluctuating hearing loss-low frequency tilt is common
* Tinnitus
* Aural fullness
**_Etiology_**
* Etiology unknown--maybe allergic, AI, migraine variant
**_Treatment_**
* Salt/caffeine restriction
* Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
* Benzodiazepines (acute phase)
* Oral steroids (acute phase)
* Intratympanic steroid injections
**_Types_**
1. Classical Meniere's
2. Cochlear Meniere's (not dizzy)
3. Vestibular Meniere's (no auditory symptoms)
4. Bilateral Meniere's (autoimmune IED)
5. Subclinical endolymphatic hydrops (aural fullness)
6. Post traumatic (SNHL and years later get symptoms of Meniere's)
34
Causes of PERIPHERAL vertigo: Meniere's Disease
* Etiology
**_Meniere's Disease_**
**_Etiology_**
* Etiology unknown--maybe allergic, AI, migraine variant
**_Treatment_**
* Salt/caffeine restriction
* Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
* Benzodiazepines (acute phase)
* Oral steroids (acute phase)
* Intratympanic steroid injections
**_Types_**
1. Classical Meniere's
2. Cochlear Meniere's (not dizzy)
3. Vestibular Meniere's (no auditory symptoms)
4. Bilateral Meniere's (autoimmune IED)
5. Subclinical endolymphatic hydrops (aural fullness)
6. Post traumatic (SNHL and years later get symptoms of Meniere's)
**_Presentation_**
* Distinct episodic attacks
* Prolonged vertigo
* Fluctuating hearing loss-low frequency tilt is common
* Tinnitus
* Aural fullness
35
Causes of PERIPHERAL vertigo: Meniere's Disease
* Treatment
**_Meniere's Disease_**
**_Treatment_**
* Salt/caffeine restriction
* Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
* Benzodiazepines (acute phase)
* Oral steroids (acute phase)
* Intratympanic steroid injections
**_Types_**
1. Classical Meniere's
2. Cochlear Meniere's (not dizzy)
3. Vestibular Meniere's (no auditory symptoms)
4. Bilateral Meniere's (autoimmune IED)
5. Subclinical endolymphatic hydrops (aural fullness)
6. Post traumatic (SNHL and years later get symptoms of Meniere's)
**_Presentation_**
* Distinct episodic attacks
* Prolonged vertigo
* Fluctuating hearing loss-low frequency tilt is common
* Tinnitus
* Aural fullness
**_Etiology_**
* Etiology unknown--maybe allergic, AI, migraine variant
36
Causes of PERIPHERAL vertigo: Meniere's Disease
* 6 subtypes
**_Meniere's Disease_**
**_Types_**
1. Classical Meniere's
2. Cochlear Meniere's (not dizzy)
3. Vestibular Meniere's (no auditory symptoms)
4. Bilateral Meniere's (autoimmune IED)
5. Subclinical endolymphatic hydrops (aural fullness)
6. Post traumatic (SNHL and years later get symptoms of Meniere's)
**_Presentation_**
* Distinct episodic attacks
* Prolonged vertigo
* Fluctuating hearing loss-low frequency tilt is common
* Tinnitus
* Aural fullness
**_Etiology_**
* Etiology unknown--maybe allergic, AI, migraine variant
**_Treatment_**
* Salt/caffeine restriction
* Diuretics-Triamterene/hydrochlorothiazide (HCTZ)
* Benzodiazepines (acute phase)
* Oral steroids (acute phase)
* Intratympanic steroid injections
37
Causes of PERIPHERAL vertigo:
* What is the pathophysiologic link between migraines and meniere's that leads to vertigo?
* Vasospasm of the internal auditory artery causes ischemia to the labyrinth
* This leads to isolated infarction of the inner ear (probably through vasospasm of small arteries)
* Migraine may cause vasospastic microvascular ischemic damage to inner ear resulting in hearing loss and susceptibility to developing endolymphatic hydrops (ELH)
38
Causes of PERIPHERAL vertigo: identify
* Sudden, violent vertigo
* Commonly associated with nausea and intense vomiting
* Last for hours to days
* may, may not have hearing loss
* Usually preceded by viral URI
**_Vestibular Neuritis/Labyrinthitis_**
**_Treatment_**
* Steroids
* Benzodiazepines
* Meclizine
* Vestibular rehab (some)
39
Causes of PERIPHERAL vertigo: **_Vestibular Neuritis/Labyrinthitis_**
* Characteristics
**_Vestibular Neuritis/Labyrinthitis_**
**_Characteristics_**
* Sudden, violent vertigo
* Commonly associated with nausea and intense vomiting
* Last for hours to days
* may, may not have hearing loss
* Usually preceded by viral URI
**_Treatment_**
* Steroids
* Benzodiazepines
* Meclizine
* Vestibular rehab (some)
40
Causes of PERIPHERAL vertigo: **_Vestibular Neuritis/Labyrinthitis_**
* treatment
**_Vestibular Neuritis/Labyrinthitis_**
**_Treatment_**
* Steroids
* Benzodiazepines
* Meclizine
* Vestibular rehab (some)
**_Characteristics_**
* Sudden, violent vertigo
* Commonly associated with nausea and intense vomiting
* Last for hours to days
* may, may not have hearing loss
* Usually preceded by viral URI
41
Causes of PERIPHERAL vertigo: Identify
* Dizziness
* Tinnitus
* Hearing loss
* Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity
**_Perilymphatic fistula_**
**_Pathophysiology_**
* Defect in one or both of the windows separating the middle and inner ear
* Perilymph fluid leaks into middle ear
* Usually caused by head trauma
**_Treatment_**
* Some self-healing, others surgical
42
Causes of PERIPHERAL vertigo: **_Perilymphatic fistula_**
* Presentation
**_Perilymphatic fistula_**
**_Presentation_**
* Dizziness
* Tinnitus
* Hearing loss
* Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity
**_Pathophysiology_**
* Defect in one or both of the windows separating the middle and inner ear
* Perilymph fluid leaks into middle ear
* Usually caused by head trauma
**_Treatment_**
* Some self-healing, others surgical
43
Causes of PERIPHERAL vertigo: **_Perilymphatic fistula_**
* When do symptoms worsen?
**_Perilymphatic fistula_**
Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**_Presentation_**
* Dizziness
* Tinnitus
* Hearing loss
* Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity
**_Pathophysiology_**
* Defect in one or both of the windows separating the middle and inner ear
* Perilymph fluid leaks into middle ear
* Usually caused by head trauma
**_Treatment_**
* Some self-healing, others surgical
44
Causes of PERIPHERAL vertigo: **_Perilymphatic fistula_**
* Pathophysiology and usual cause
**_Perilymphatic fistul_**
**_Pathophysiology_**
* Defect in one or both of the windows separating the middle and inner ear
* Perilymph fluid leaks into middle ear
* Usually caused by head trauma
**_Treatment_**
* Some self-healing, others surgical
**_Presentation_**
* Dizziness
* Tinnitus
* Hearing loss
* Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity
45
Causes of PERIPHERAL vertigo: **_Perilymphatic fistula_**
* treatment
**_Perilymphatic fistula_**
**_Treatment_**
* Some self-healing, others surgical
**_Presentation_**
* Dizziness
* Tinnitus
* Hearing loss
* Symptoms get worse with changes in altitude (elevators, airplanes, travel over mountain passes) or air pressure (weather changes), as well as with exertion or activity
**_Pathophysiology_**
* Defect in one or both of the windows separating the middle and inner ear
* Perilymph fluid leaks into middle ear
* Usually caused by head trauma
46
Causes of CENTRAL vertigo: Identify
* unilateral SNHL
* tinnitus (if progression)
* dizziness (if progression)
* Romberg/Tandem romberg towards affected side
**_Acoustic Neuroma_**
**_Pathophysiology_**
* Benign slow growing tumor of the acoustic nerve
**_Diagnosis_**
* MRI
**_Treatment_**
1. Surgery
2. Stereotactic radiation
47
Causes of CENTRAL vertigo: **_Acoustic Neuroma_**
* Presentation
**_Acoustic Neuroma_**
**_Presentation_**
* unilateral SNHL
* tinnitus (if progression)
* dizziness (if progression)
* Romberg/Tandem romberg towards affected side
**_Pathophysiology_**
* Benign slow growing tumor of the acoustic nerve
**_Diagnosis_**
* MRI
**_Treatment_**
1. Surgery
2. Stereotactic radiation
48
Causes of CENTRAL vertigo: **_Acoustic Neuroma_**
* Pathophysiology
**_Acoustic Neuroma_**
**_Pathophysiology_**
* Benign slow growing tumor of the acoustic nerve
**_Diagnosis_**
* MRI
**_Treatment_**
1. Surgery
2. Stereotactic radiation
**_Presentation_**
* unilateral SNHL
* tinnitus (if progression)
* dizziness (if progression)
* Romberg/Tandem romberg towards affected side
49
Causes of CENTRAL vertigo: **_Acoustic Neuroma_**
* Diagnosis
**_Acoustic Neuroma_**
**_Diagnosis_**
* MRI
**_Treatment_**
1. Surgery
2. Stereotactic radiation
**_Presentation_**
* unilateral SNHL
* tinnitus (if progression)
* dizziness (if progression)
* Romberg/Tandem romberg towards affected side
**_Pathophysiology_**
* Benign slow growing tumor of the acoustic nerve
50
Causes of CENTRAL vertigo: **_Acoustic Neuroma_**
* Treatment
**_Acoustic Neuroma_**
**_Treatment_**
1. Surgery
2. Stereotactic radiation
**_Presentation_**
* unilateral SNHL
* tinnitus (if progression)
* dizziness (if progression)
* Romberg/Tandem romberg towards affected side
**_Pathophysiology_**
* Benign slow growing tumor of the acoustic nerve
**_Diagnosis_**
* MRI
51
List 7 causes (other than acoustic neuroma) of central vertigo
1. Lyme disease
2. Demyelinating disease
3. CVA (especially basilar or cerebellar)
4. Psychogenic
5. CNS infection
6. CNS tumors
7. Drugs (polypharmacy for elderly/street drugs in teens/young adults)
52
Identify the audiogram
Classic Meniere's Audiogram
