Vestibular Rehab 1

Question 1

What are the 3 semi circular canals and what type of acceleration do they detect?

Answer 1

• Horizontal
• Posterior
• Anterior
• Detect angular acceleration

Question 2

What are the 2 otolith organs and what do each of them detect?

Answer 2

• Saccule: Vertical acceleration
• Utricle: Linear acceleration & head tilt

Question 3

What fluid are the semi circular canals filled with?

Answer 3

Endolymph

Question 4

What is the ampulla?

Answer 4

Widened end of semicircular canal

Question 5

What does the ampulla contain?

Answer 5

Gelatinous cupula - flexible membrane

Question 6

What does the cupula contain?

Answer 6

Sensory hair cells: stereo cilia & kinocilia

Question 7

Where do the sensory hair cells in the ampulla sit?

Answer 7

Crista ampullaris

Question 8

What occurs when the stereocilia are deflected toward kinocilia?

Answer 8

Excitation (depolarization)

Question 9

What occurs when the stereocilia are deflected away from the kinocilia?

Answer 9

Inhibition

Question 10

What is the healthy vestibular system resting firing rate?

Answer 10

70-100 spikes/sec

Question 11

What are inside the otolith organs?

Answer 11

Maculae and otoconia that sits on top

Question 12

With head tilt or acceleration, gravity/other acceleration pull on crystal which activates what?

Answer 12

Hair cells

Question 13

What structures contain hair cells that deflect with head movements?

Answer 13

Cupula and maculae

Question 14

What structures contain otoconia?

Answer 14

Utricle or saccule

Question 15

What structures sense rotational head movements?

Answer 15

Semicircular canals

Question 16

When you turn your head to the left, what occurs in an intact vestibular system?

Answer 16

• Left Vestibular Apparatus is Excited and Right Inhibited
• Eye go right

Question 17

What is oscillopsia?

Answer 17

• Stationary objects in the environment appear to be in motion when the patient is in motion
• Cause blurred vision

Question 18

What is disequilibrium ?

Answer 18

Sensation of being off balance

Question 19

What might a patient report if they have vertigo?

Answer 19

Room is spinning

Question 20

What is the pathophysiology of BPPV?

Answer 20

• Otoconia is dislodged from the otolith organs (usually utricle)
• It float in the semi-circular canal disrupting the vestibular signals to the brain

Question 21

What does: Benign Paroxysmal Position Vertigo mean?

Answer 21

• Benign: not life threatening with overall favorable prognosis
• Paroxysmal: Rapid and sudden onset, short spell
• Positional: Only occurs with certain head movements
• Vertigo: Feels like you are spinning or the world around you is spinning

Question 22

What is canalithiasis?

Answer 22

• Otoconia are free floating in the semicircular canal
• Vertigo lasts 30-90 seconds then fatigues

Question 23

What is cupulothiasis?

Answer 23

• Otoconia are adhered to the cupula
• Vertigo greater than 90 seconds and does not fatigue

Question 24

During pathophysiology of BPPV: The particles in the canal affect the flow of endolymph as the head is turned. What series of events does this cause?

Answer 24

• Disruption of the cupula deflection when the head is turned
• Inaccurate signals are sent down CN VIII that are different than what the head is actually doing (some hair cells excite while others inhibit and it is not consistent with the head movement)
• Discrepancy of sensory information between ears causes vertigo and nystagmus

Question 25

What symptoms are seen with BPPV?

Answer 25

- Nystagmus & Vertigo with change in head position (lasts <15 sec) - Occasional nausea with or without vomiting - Disequilibrium

Question 26

What is nystagmus?

Answer 26

involuntary eye movement

Question 27

What is normal/typical nystagmus?

Answer 27

- Following lots of spinning - Optokinetic reflex

Question 28

What is atypical nystagmus?

Answer 28

- CNS Pathology, vestibular pathology, drug toxicity - BPPV: the movement of the cupula or crystals causes alteration in firing rate

Question 29

What tests and measures test the posterior or anterior canal?

Answer 29

- Dix-Hallpike Test - Sidelying Test

Question 30

What test examines the horizontal canal?

Answer 30

Roll test

Question 31

What is vertebrobasilar insufficiency?

Answer 31

Occlusion of the vertebral artery resulting in loss of blood flow to the brain

Question 32

Dix-Hallpike Maneuver examines posterior canal of (BLANK) ear and anterior canal of (BLANK) ear

Answer 32

Dix-Hallpike examines posterior canal of downward ear and anterior canal of upward ear

Question 33

During Dix-Hallpike maneuver if the posterior canal is involved what type of nystagmus is seen?

Answer 33

Torsional upbeating nystagmus

Question 34

During Dix-Hallpike maneuver if the anterior canal is involved what type of nystagmus is seen?

Answer 34

Torsional downbeating nystagmus

Question 35

During Dix-Hallpike maneuver if canalithiasis is present how long will nystagmus last?

Answer 35

Transient nystagmus <30-90 seconds

Question 36

During Dix-Hallpike maneuver if cupulolithiasis is present how long will nystagmus last?

Answer 36

prolonged nystagmus >90 seconds, does not fatigue

Question 37

What geotropic nystagmus?

Answer 37

- Fast phase is toward the earth - Otoconia are in canal - Side with strongest nystagmus is the affected ear

Question 38

What is ageotropic nystagmus?

Answer 38

- Fast phase is away from the ear - Otoconia are in cupula - Side opposite strongest nystagmus is affected ear