Vestibular Presentation

Question 1

MAV

Answer 1

• migraine associated vertigo
• 2nd most frequent cause of recurrent vertigo
• misaligned vertebrae messes with blood flow to brain, surrounding nerves vasodilate other arteries which irritates brain/vestibular structures

Question 2

MAV Causes/Risk Factors

Answer 2

• hormonal fluctuations
• foods
• weather changes
• stress
• meds
• sleep disturbances

Question 3

MAV S/Sx

Answer 3

• dizziness
• motion intolerance
• spontaneous vertigo attacks
• diminished eye focus
• photosensitivity
• sound sensitivity/tinnitus
• balance loss and ataxia
• neck pain with associated muscle spasms
• confusion, altered cognition
• spatial disorientation
• anxiety/panic

Question 4

MAV Tests/measures

Answer 4

• audiologists
• vestibular rehab specialists
• computerized audiological/dynamic visual acuity testing
• horizontal canal testing
• functional balance/gait measures
• Jacobsen Dizziness Inventory
• Dynamic Gait Index
• ABC
• TUG

Question 5

MAV Interventions

Answer 5

• Meds
• Vestibular Rehab
• Lifestyle mods

Question 6

MAV Interventions

Answer 6

• Meds
• Vestibular Rehab
• Lifestyle mods

Question 7

PPPD

Answer 7

• peripheral postural-persistant disorder

- comes with behavioral aspects (OCD, depression, Anxiety)

Question 8

PPPD Cause/Risk Factors

Answer 8

• Environments (Crowds, stores, motion)
• medical illness
• previous/concurrent vestib disorder
• upright posture
• head/body motion
• after vertigo causing event
• drug reactions

Question 9

PPPD S/Sx

Answer 9

3 or more months of:

• postural dizziness (no vertigo)
• unsteadiness that fluctuates
• rocking/swaying feeling
• more symptomatic days than not
• Sx with no particular movement
• behavioral attributes (anxiety etc)

Question 10

PPPD Intervention

Answer 10

• meds
• vestibular balance rehab therapy
• counseling

Question 11

Vestibular/Labyrinthitis Neuritis

Answer 11

-infection that inflames CN

VIII

Question 12

Vestibular Neuritis S/Sx

Answer 12

• loss of balance

- affects vestibular branch of CN VIII

Question 13

Labyrinthitis

Answer 13

• vestib and cochlear branches of CN VIII

- loss of hearing and balance

Question 14

Risk Factors of labyrinthitis, vestib neuritis

Answer 14

• all age groups
• kids less
• viral infection (less likely bacterial)

Question 15

S/Sx Labyrinthitis/Vestibular Neuritis

Answer 15

• vertigo
• dizziness
• disequilibrium
• imbalance
• nausea
• hearing loss (vestib)
• not painful

Question 16

Labyrinthitis/Vestibular Neuritis:

Dizziness

Answer 16

• Acute: constant, sudden severe

- chronic: fast movement, persistent feeling of haziness/uneasiness

Question 17

Acute Labyrinthitis/Vestibular Neuritis Treatment:

Answer 17

-meds to kill virus/bacteria

Question 18

Chronic Labyrinthitis/Vestibular Neuritis:

Answer 18

• BPPV can develop (epley)

- vestibular rehab exercises

Question 19

Perilymphatic Fistula

Answer 19

• membrane tear between middle ear and inner ear

- perilymph fluid from inner ear flows into middle ear

Question 20

Perilymphatic Fistula

Answer 20

• membrane tear between middle ear and inner ear

- perilymph fluid from inner ear flows into middle ear

Question 21

Causes of Perilymphatic Fistula

Answer 21

• head trauma
• whiplash
• ear trauma
• scuba diving
• rapid incr in ICP

Question 22

Perilymphatic Fistula S/Sx

Answer 22

• ear feels full
• sensitive hearing
• dizziness (w/ or w/o vertigo)
• sudden hearing loss
• symptoms increase with change in altitude
• Sx with increased CSF pressure

Question 23

Perilymphatic Fistula S/Sx

Answer 23

• ear feels full
• sensitive hearing
• dizziness (w/ or w/o vertigo)
• sudden hearing loss
• symptoms increase with change in altitude
• Sx with increased CSF pressure

Question 24

Perilymphatic Fistula Treatment

Answer 24

• surgery

- post surgery: don’t perform activities that incr CSF

Question 25

Meniere's Disease

Answer 25

-Fluctuating vestibular condition that presents with acute episodes involving a variety of inner ear S/Sx following by mostly Sx free period between attacks

Question 26

Causes of Meniere's Disease

Answer 26

-endolymphatic hydrops

Question 27

S/Sx Meniere's Disease

Answer 27

- rotational vertigo attacks - hearing loss - tinnitus - sensation of fullness or pressure --imbalance, nystagmus, otolithic crisis of Tumarkin (falls) during attacks

Question 28

Diagnosis of Meniere's Disease

Answer 28

- hearing tests - blood tests - MRI - Rule out other Dx

Question 29

Treatment Meniere's Disease

Answer 29

- no cure - medications - hydrops diet (maintain constant sodium levels) - no PT during attacks

Question 30

Tumors of Vestibular System

Answer 30

- most common is: vestibular schwannoma or acoustic neuroma - men=women - age 30-60

Question 31

Causes of Vestibular Schwannoma

Answer 31

-over production of myelin from Schwann Cells of the Vestibulocochlear nerve

Question 32

S/Sx of Vestibular Schwannoma

Answer 32

- unilateral hearing loss - tinnitus - dizziness - loss of balance

Question 33

S/Sx of Vestibular Schwannoma

Answer 33

- unilateral hearing loss - tinnitus - dizziness - loss of balance

Question 34

Dx of Vestibular Schwannoma

Answer 34

- audiogram - CT - MRI

Question 35

Treatment of Vestibular Schwannoma

Answer 35

- surgical removal - radiation - careful monitoring of symptoms