Vestibular Pathologies

Question 1

Benign Paroysmal Positional Vertigo

Answer 1

Sudden onset vertgio

Duration: 30- 60 seconds

Multiple attacks

Provoke: moving head in certain directions, lying down, rolling over in bed

No auditory symptoms

Associated symptoms: nausea/ vomiting

Lesion site: SCC (usually posterior SCC)

Question 2

Benign Paroxysmal Vertigo of Childhood (BPVC)

Answer 2

Episodic vertigo

Duration: Minutes to hours

Mulitple attacks

Provoke: stress, fatigue, motion intolerance

No auditory symptoms

Associated symptoms:
-aura, phono, or photophobia
-nausea
-vomitting
-changes in vision
-anxiety

Lesion site: SCC

Question 3

Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS)

Answer 3

Unsteadiness/imbalance with standing and walking

Duration: constant with standing and walking

Multiple or constant attacks

No provocations or auditory symptoms

Associated symptoms:
-swallowing difficulties
-peripheral neuropathy

Lesion site:
-Vestibular labyrinth
-Cerebellum
-Peripheral nervous system

Question 4

Concussion/ traumatic brain injury

Answer 4

Unsteadiness; dizziness; rotational/rocking vertigo

Duration: constant or episodic

Multiple/ constant attacks

Provocations: position changes; visual stimuli

Auditory stimuli: aural fullness, otalgia, tinnitus

Symptoms:
-Headache
-cognitive changes
-mood disorders
-sleep disorders

Lesion: likely diffuse central

Question 5

Enlarged vestibular aqueduct (EVA)

Answer 5

True vertigo; feeling of unsteadiness/imbalance

Duration: minutes to hours

Multiple attacks

Provocation:
-positional
-head trauma
-pressure changes
-loud sounds

Auditory symptoms:
-hearing loss (SNHL or MHL, usually bilateral) around 3-4 years of age
-False conductive component in LF
-HL can fluctuate, be stable, or be progressive

Associated symptoms:
-Delayed motor development
-Difficulty climbing stairs, riding a bike, or moving in the dark
-often seems clumsy

Lesion site: Labyrinth

Question 6

Herpes zoster oticus (ramsay hunt syndrome)

Answer 6

True vertigo

Auditory:
-unilateral tinnitus
-unilateral hearing loss
-hyperacusis

Symptoms:
-preceded by intense ear pain and blisters in and around the tongue, face, mouth, and ear
-facial paralysis
-nausea
-vomiting

Lesion site: CN 8 and 7, CPA

Question 7

Labyrinthitis

Answer 7

True vertigo

Duration: 30 mins to an hour (possibly longer)

Single attack

Provocation:
-usually preceded by illness*****

Auditory:
-sudden unilateral SNHL
-unilateral tinnitus

Symptoms:
-possible oscillopsia

Site of lesion:
-auditory and vestibular labyrinth

Question 8

Mal de debarquement syndrome

Answer 8

Persistent rocking (no imbalance or rotational vertigo)

Duration:
-constant (over days to months);
-**relieved when in motion

Constant attacked

Provoke: preceded by prolong travel

No auditory or associated symptoms

Unknown cause

Question 9

Meniere’s disease

Answer 9

Episodic vertigo occurring during HL

Duration: minutes to hours

Multiple attacks (must have at least tow episodes for dx)

Provoke:
-changes in atmospheric pressure or weather, diet
-accompanied by an aura/knowing attack is imminent

Auditory:
-LF fluctuating HL*
-low pitch, roaring tinnitus**
-aural fullness

Symptoms:
-burnout after several years (no more dizziness but hearing loss remains)
-drop attacks (sudden, brief falls with no LOC)

Lesion of site:
Labyrinth

Question 10

Vestibular migraine

Answer 10

Episodic vertigo (multiple)

Lasting 1 minute to several days

Provok:
-headaches (at times)
-light
-sounds
-certain position
-visual stimuli

Auditory:
-Ear pain
-Aural fullness

Symptoms:
-Aura, phono, photophobia
-Sensitivity to smells
-Head pain does not necessarily accompany dizziness

Lesion site:
thought to be labyrinth and vestibular nuclei; include other areas of the midbrain and brainstem

Question 11

Nonorganic/ physiologically inconsistent

Answer 11

vague case history; inconsistent timeline

variable duration, number of attacks, provocation, auditory, assoc. symptoms,

no lesion of site

Question 12

Orthostatic hypotension

Answer 12

**True vertigo; lightheadedness; unsteadiness

Duration: a few seconds with multiple attacks

Provokes:
-standing up quickly
-changes in body posture
-antihypertensive meds

no auditory symptoms

Associated symptoms:
-blurred vision
-fatigue
-nausea
-palpitations
-headache
-weakness

Lesion of site: central

Question 13

Perilymph fistula

Answer 13

**Dizziness; imbalance; unsteadiness; vertigo

Duration:
-seconds to minutes

multiple attackers

Provocations:
pressure changes

Auditory symptoms:
-hearing loss
-tinnitus

Symptoms:
-proceded by baratrauma
-head trauma
-middle ear surgery (stapedecotmy)
-Valsalva maneuver
-n/v

Lesion site:
Labyrinth

Question 14

Persistent postural-perceptual dizziness

Answer 14

Dizziness; unsteadiness

Duration: constant for days ( more than 3 months)

Constant/ multiple attacks

Provoke:
-motion
-upright posture
-moving/ complex visual stimuli

No auditory

symptoms:
-Preceded by acute/ episodic vestibular syndromes, neurological, psychological, or other illness

no site of lession

Question 15

Superior semicircular dehisecene

Answer 15

Episodic vertigo following loud sounds

Lasting as long as the sound (30- 60 seconds) can be longer

Multiple attacks

Provoke:
-loud noise
-pressure changes

Auditory:
-LF CHL
-tinnitus
-may report amplification of sound

Symptoms:
-autophony
-sensitivie to loud sounds or pressure in ear
-oscillopsia
-drop attacks

lesion: labyrinth

Question 16

Vestibular neuritis

Answer 16

rotational vertigo

30 minutes to days

single attack

sometimes following an illness, but often no cause

no auditory (difference between b/t labrynintis)

Symptoms:
-possible oscillopssa

Site of lesion: neural/ vascular leading to labyrinthe damage