Vestibular Rehab

Question 1

1-24 hours (acute) Fullness of ear, hearing loss, tinnitus, vomiting. (+) nystagmus. Pt wakes up in the morning, an have to crawl to the bed (can’t go to work)

Answer 1

Ménière’s Disease

Question 2

What are the key points to examine (to know) in vestibular patients?

Answer 2

Is it coming from the brain or from ear?

Is it one side or both?

Question 3

Oscillopsia

Answer 3

decreased gaze stability

Question 4

as I walk towards a subject, I am not able to stabilize gaze and it becomes blurry (oscillopsia)

Answer 4

Bilateral Vestibular Hypofunction

Question 5

classic vestibular bilateral symptom?

Answer 5

oscillopsia

Question 6

classic unilateral vestibular symptom

Answer 6

motion sensitivity

Question 7

vertigo with strain ex. a pt blow their nose or strain in the toilet, they get vertigo

Answer 7

fistula

Question 8

Vertical NYSTAGMUS

Answer 8

CENTRAL Finding until proved otherwise

Question 9

Direction changing nystagmus; Look to the right, right beating nystagmus – look to the left, left beating:

Answer 9

This is a CENTRAL SIGN

Question 10

Saccades:

Answer 10

Look from target to target

• Significant Overshooting is a Central Sign
• Multiple movements is a Central Sign
• Undershoot is considered normal

Question 12

Ask patient to focus on your nose, slowly move head side to side, observing for visual fixation

What is the name of this test? What does it test?

Answer 12

VOR, HEAD THRUST

• Left - Right discrimination test
• Decrease in fixation with forced LEFT ROTATION = LEFT DYSFUNCTION, + L Head Thrust test

Question 13

Left to Right discrimination tests:

Answer 13

1. head thrust
2. Singleton’s test

Question 14

Test for BPPV

Answer 14

• HALLPIKE TEST
• Patient starts in long sit, with head rotated 30 degrees towards the side to test. Ask the patient to keep their eyes open as you quickly bring them into a supine position with their head extended 10 degrees.
• Classically pt will experience vertigo when placed in the hallpike position (affected ear 30 degrees below horizontal) and should demonstrate a torsional nystagmus. Vertigo is caused by excitation of the posterior semi-circular canal (which has now become gravity sensitive.) BPPV of anterior or horizontal SSC is rare. Patient may report episodes of vertigo over past months or years.

Question 15

• Initial episode can be with rolling for the snooze alarm or retrieving object from shelf.
• complaints of vertigo (room spinning) with static positioning
• Pt usually knows which positions are involved and avoids them!
• Symptoms usually abate quickly with movement out of provoking positions.

Answer 15

BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

Question 17

Otoconia dislodge into the semicircular canals (usually posterior) and become free floating in the endolymph of the canal. When the head is moved into provoking positions endolymph is moved by debris which pulls cupula out of position. In the hallpike expect latency and fatigue nystagmus. Almost all cases of BPPV:

Answer 17

CANALITHIASIS

free floating = latency nystagmus

Question 18

Otoconia become adhered to the cupula (end organ in the ampulla) making it gravity sensitive. Expect immediate nystagmus which may not fatigue.

Answer 18

CUPULOLITHIASIS

(could be a stroke)

Question 19

which canal is affected in upgoing, rotary nystagmus to the affected ear

Answer 19

Posterior Canal

Question 20

which maneuver would work best for immediate horizontal nystagmus (Cupulolithiasis)?

Answer 20

Liberatory maneuver

Question 21

which canal is affected in horizontal nystagmus?

Answer 21

horizontal canal

Question 22

which canal is affected in downgoing, rotary nystagmus to the affected ear

Answer 22

Anterior Canal

Question 24

which maneuver would work best for latency horizontal nystagmus (Canalithiasis)?

Answer 24

BARBEQUE ROLL