5. Vestibular disorders. Examination of the Vestibular System. Meniere's Disease, Labyrinthitis. Vestibular Neuritis.

Question 1

What is a VESTIBULAR SYSTEM?

Answer 1

• Sensory System
• Contributes to SPATIAL Orientation = Movement AND Sense of Balance

Question 2

Describe the VESTIBULE

Answer 2

• Central Part of the BONY LABYRINTH of INNER Ear, that’s found in PETROUS PART of Temporal Bone, and it houses the ORGANS of Hearing / Balance
• Organs of Hearing / Balance = Vestibule, Semi-Circular Canal AND Cochlea

0 Vestibule Contains 2 OTOLITHS = Work together to PERCEIVE LINEAR Acceleration AND Gravity
a) Utricle
b) Saccule

0 Semi-Circular Canals Contain 3 CANALS = Detect ROTATIONAL Movement on 3D Plane, and are found at RIGHT ANGLES to each other, FILLED WITH Endolymph
a) Superior
b) Posterior
c) Horizontal

0 Cochlea is the SPIRAL PART of Inner Ear, that PERCEIVES Sound, which is USEFUL for SPAITAL Orientation

Question 3

What is a VESTIBULAR DISORDER?

Answer 3

• Temporary / Permanent Damage to Vestibular System, leading to DYSFUNCTION
• DUE TO:
  a) XS FLUID in Inner Ear
  b) DISPLACEMENT of Inner Ear CRYSTALS
  c) MALFORMATION of Inner Ear STRUCTURE
  d) Disease / Infx / Toxic Chemicals
  e) Immunological Response
  f) MEMBRANE TEAR / TUMOR GROWTH

Question 4

What are the COMMON Vestibular Disorders?

Answer 4

• Benign Paroxysmal Positional Vertigo (BPPV)
• Labyrinthitis
• Vestibular Neuritis
• Meniere’s Disease
• Peri-lymph Fistula

Question 5

What are the SYMPTOMS of VESTIBULAR DISORDERS?

Answer 5

• DIFFICULTY in Balance, Equilibrium AND Orientation = DUE to DAMAGE to Semi-Circular Canals OR Otoliths (Vestibule)
• Nausea
• Fullness of Ear
• Loss of Hearing
• Vertigo

Question 6

What is the TREATMENT for VESTIBULAR DISORDERS?

Answer 6

• Medication
• Head-Repositioning Maneouvers
• Surgery
• Vestibular Rehab Therapy
• Dietary Changes = LOW Salt Diet
• REDUCING Stress

Question 7

What is the EXAMINATION of VESTIBULAR DISORDERS?

Answer 7

• A COMBINATION of Tests = Measuring Hearing / Eye Movement / Balance

1) Hearing Tests = Auditory Testing / Tympanometry / Otoacoustic Emissions (OAE) / Electrocochleography (ECoG)

2) Eye Movements = Electronystagmography (ENG) / Videonystagmography (VNG) / Rotary-Chair Testing

3) Balance = Computerised-Dynamic Posturography (CDP)

Question 8

Describe the HEARING TESTS for VESTIBULAR DISORDERS

Answer 8

a) AUDITORY TESTING = Measures Px ABILITY to HEAR sounds / RECOGNISE words at VARIOUS FREQUENCIES (f) and VOLUMES

b) TYMPANOMETRY = Measures EARDRUM Fx // Acoustic-Reflex Test to measure MUSCLE REFLEX in ear WITH LOUD Sounds

c) OTOACOUSTIC EMISSIONS (OAE) = Measures RESPONSIVENESS of HAIR CELLS in the COCHLEA

d) ELECTROCOCHLEAGRAPHY (ECoG) = Measures SOUND SIGNAL TRANSMISSION from ear ALONG BEGINNING of Hearing NERVE

Question 9

Describe the EYE MOVEMENT TESTS for VESTIBULAR DISORDERS

Answer 9

• Measuring ABILITY of EYE TO FOCUS on Objects, DURING HEAD MOVEMENT

VIA
a) Electronystagmography (ENG)
b) Videonystagmography ( VNG)
c) Rotary-Chair Testing

Question 10

Describe the BALANCE TESTS for VESTIBULAR DISORDERS

Answer 10

• Vestibular Organs provide Sensory info to do with Equilibrium, Movement AND Acceleration
• VO Disorders will have NEGATIVE impact on Balance, Posture AND Movement
• Recorded via Computerised Dynamic Posturography (CDP)

Question 11

Describe MENIERE’s DISEASE

{Symptoms, Etiology, Diagnosis, Tx)

Answer 11

• DYSFUNCTION of ENDOLYMPHATIC SAC (In Semi-Circular Canals AKA LABYRINTH)
• Symptoms = Vertigo / Tinnitus / Hearing Loss
• ## DUE TO, ABNORMALITY in COMPOSITION / AMOUNT of Endolymph in Inner Ear
• DIAGNOSIS
  a) Audiogram = For Hearing Loss

b) Electronystagmography = Eye Movement FOR Balance Fx

• TREATMENT
  0 Meds for Vertigo = CYCLIZINE / DIAZEPAM
  0 Meds for Nausea = PROCHLORPERAZINE
  0 Diuretics = REDUCE Body Fluid retained

0 Surgery = IF SEVERE
a) Endolymphatic Sac DECOMPRESSION = SMALL PORTION of Bone is REMOVED OVER ELS

b) LABYRINTHECTOMY = PORTION of INNER EAR is SURGICALLY Removed

c) VESTIBULAR NERVE RESECTION = Vestibular Nerve is Cut

Question 12

Describe LABYRINTHITIS

{Symptoms, Etiology, Diagnosis, Tx)

Answer 12

• Inner Ear disorder DUE to Infection of the LABYRINTH and the VESTIBULAR NERVES connecting the Inner Ear to Brain
• SYMPTOMS = Over Several Weeks; Chronic Dizziness (Vertigo) / Tinnitus / Hearing Loss of Affected Ear
• DUE TO Viruses (Inner Ear, Stomach, Resp.T) E.g. Herpes
• DUE TO Bacteria E.g. Lyme Disease
• TREATMENT = Goes away on its own within few weeks
  0 Antibiotics = Bacterial Infection
  0 Antihistamines
  0 Medication for Nausea / Vomiting
  0 Steroids AND Anti-viral = Viral Infection
  0 Physical Therapy = TO CHALLENGE Vestibular System

Question 13

Describe VESTIBULAR NEURITIS

{Symptoms, Etiology, Diagnosis, Tx)

Answer 13

• INFLAMMATION of VESTIBULAR PORTION of VESTIBULOCOCHLEAR NERVE (Relays Messages from VO to brain)
• SYMPTOMS = Vertigo / Nausea n Vomiting / Impaired Concentration
• DUE TO SYSTEMIC Viral Infections = Herpes / Measles / Influenza
• DIAGNOSIS = Horizontal Nystagmus / Rapid-Eye Movement (REM); Carry our Hearing / Balance Tests
• TREATMENT
  0 Meds for Nausea / Dizziness
  0 Steroids AND Anti-viral Drugs
  0 Antibiotics = Bacterial Infection
  0 IV Fluids = DEHYDRATION from Vomiting