Vestibular Review

Question 1

what 2 systems make up spatial awareness?

Answer 1

vision
somatosensory

Question 2

spatial awareness provides ___ & ____

Answer 2

balance and gaze-stability

Question 3

list the order of structures for hearing

Answer 3

outer ear
external auditory canal
tympanic membrane
ossicles
middle ear
inner ear
endolymph
cochlea
hair cells
auditory/cochlear nerve

Question 4

list the order of structures for vestibular input (movement)

Answer 4

semicircular canals
endolymph
ampulla
cupula
saccule and utricle
otoconia
vestibular nerve
CN 8
vestibular nuclei
cerebellum

Question 5

how are the semicircular canals paired?

Answer 5

R anterior w/ L posterior
L anterior w/ R posterior
L & R horizontal

Question 6

how is the vestibular system activated with a head turn?

Answer 6

endolymph moves over cupula and excites the side to which the head was turned and inhibits the other side

Question 7

saccule detects ____ movement and utricle detects ______ movement

Answer 7

saccule - vertical
utricle - horizontal

Question 8

brain areas for the vestibulo-spinal reflex

Answer 8

cerebellum
vestibulospinal tract

Question 9

brain areas for the vestibular-occular reflex

Answer 9

oculomotor nerve (CN III) nucleus
trochlear nerve (CN IV) motor nucleus
abducens nerve (CN V) motor nucleus

Question 10

reflex that signals head position to body and maintains GAZE STABILITY via proprioception secondary to VOR

Answer 10

vestibulo-cervical reflex

Question 11

reflex that controls horizontal and vertical eye movements via LINEAR VOR

Answer 11

otolith-ocular reflex

Question 12

higher cortical connections for vestibular system

Answer 12

thalamus
visual cortex
hippocampus
amygdala

Question 13

diagnosis?
sudden onset of vertigo
lasting days (3-7)
single event
residual balance and dizziness lasting 1-2 weeks

Answer 13

vestibular neuritis or labyrinthitis

Question 14

diagnosis?
short spells/episodic
lasting seconds per episode
recurring

Answer 14

BPPV

Question 15

diagnosis?
gradual onset over months or years
constant

Answer 15

bilateral hypofunction

Question 16

diagnosis?
sudden onset of vertigo
recurring spells
lasts hours to days
initial vertigo lasts 1-3 days and improves over 1-2 weeks
low frequency hearing loss

Answer 16

Meniere’s disease

Question 17

diagnosis?
constant
fluctuating severity

Answer 17

MDD or PPPD

Question 18

neuritis vs labyrinthitis

Answer 18

neuritis - no hearing loss
labyrinthitis - hearing loss

Question 19

neuritis & labyrinthitis commonly caused by ____ infection

Answer 19

viral

Question 20

symptoms of vestibular hypofunction

Answer 20

affects VOR and VSR
postural instability
gaze-instability
movement-related dizziness
motion-sensitivity
foggy-headedness
kinesiophobia
oscillopsia

Question 21

causes of vestibular hypofunction

Answer 21

neuritis
labyrinthitis
Meniere’s disease
acoustic neuroma
ototoxic meds
gentamicin (aminoglycosides)
meningitis
ear surgeries

Question 22

acoustic neuroma affects ____ cells

Answer 22

Schwann

Question 23

symptoms of acoustic neuroma

Answer 23

gradual onset of hearing loss, tinnitus, imbalance, motion-sensitivity, facial numbness/weakness

Question 24

Meniere’s disease/endolymphatic hydrops

Answer 24

build-up of endolymphatic fluid within the inner ear causes pressure on inner ear membranes and hair cells that can cause inflammation and damage over time

Question 25

what electrolyte imbalance can cause Meniere's?

Answer 25

sodium/potassium

Question 26

what vestibular conditions can cause hearing loss?

Answer 26

labyrinthitis Meniere's

Question 27

what is a inner ear fistula/dehiscence?

Answer 27

structural "hole" that makes inner ear unable to regulate pressure and flow of endolymph

Question 28

what are central vestibular issues?

Answer 28

stroke brain tumor MS lesions vestibular migraine PPPD MDDS

Question 29

vestibular migraine is a ____ ____ disorder

Answer 29

sensory perceptual

Question 30

diagnosis? recurring episodes of vertigo lasting 1-5 days photophobia, phonophobia, brain fog

Answer 30

vestibular headache

Question 31

which electrolyte deficiency could trigger vestibular headache?

Answer 31

magnesium

Question 32

what is persistent postural positional dizziness (PPPD)?

Answer 32

autonomic (SNS) and emotional hyper-responsiveness to vestibular stimuli. (AKA chronic functional dizziness) abnormal adaptation following trauma

Question 33

symptoms of PPPD

Answer 33

constant visual motion-sensitivity and imbalance coupled with anxiety, kinesiophobia, visual vertigo, space motion discomfort persists for >3 months

Question 34

what is Mal de Debarquement (MDDS)?

Answer 34

mal-adaptation following disembarking moving vehicle

Question 35

symptoms of MDDS

Answer 35

PERSISTENT sesnsation of rocking or swaying that lasts beyond expected period of adaptation worse when still

Question 36

self-reported outcome measures for vestibular issues

Answer 36

dizziness handicap inventory activity-specific balance confidence scale vestibular disorders ADLs vestibular activities and participation questionnaire

Question 37

vertigo symptom quality

Answer 37

illusion of movement spinning, rocking, swaying, falling

Question 38

disequilibrium symptom quality

Answer 38

sense of being off balance unsteady, wobbly, drunk, tilited

Question 39

gaze-instability symptom quality

Answer 39

foggy-headed, heavy-headed, light-headed, motion-sickness

Question 40

cardiovascular symptom quality

Answer 40

light-headed, pre-syncope, tunnel vision

Question 41

anxiety symptom quality

Answer 41

floating, swimming, rocking

Question 42

visual involvement symptom quality

Answer 42

diplopia, oscillopsia

Question 43

nystagmus is named for the ____ phase

Answer 43

fast

Question 44

nystagmus slow phased caused by ____ and fast phase by _____

Answer 44

slow - VOR fast - corrective saccades

Question 45

CNS nystagmus sources

Answer 45

cerebellum and brainstem

Question 46

peripheral vestibular nystagmus charcteristics

Answer 46

direction is fixed horizontal decrease intensity with fixation gaze towards fast phase increased intensity

Question 47

Alexander's Law

Answer 47

gaze towards fast phase of nystagmus increased intensity (peripheral)

Question 48

BPPV nystagmus

Answer 48

transient (changes) positional direction depends on canal involved not constant

Question 49

CNS nystagmus characteristics

Answer 49

direction-changing vertical or pendular not affected by fixation

Question 50

gold standard for IDing unilateral vestibular hypofunction

Answer 50

VNG/ENG

Question 51

gold standard for IDing bilateral vestibular hypofunction

Answer 51

rotary chair

Question 52

canalithiasis vs. cupulolithiasis

Answer 52

canal - vertigo <1 min cup - vertigo as long as head in position