9.21 Vestibular Review 2 Flashcards
What are some of the available tools to help us hone in on the problem?
- VAS
- disability scale
- activities-specific confidence scale
- multidimensional dizziness inventory
- screen for anxiety and depression
The VOR is the only visual vestibular interaction test that assesses
peripheral vestibular function
saccades: will see nystagmus at
periphery of visual field
saccades are a (central/peripheral) issue
CNS
3 sensory systems offering info for balance
- vision
- vestibular
- somatosensory
2 major theories behind pathology of BPPV
- free floating (canalithiasis)
- adhered to cupula (cupulolithiasis)
Most common cause of vertigo
BPPV
Where are the otoconia located?
- utricle
- saccule
What is the function of scarpa’s ganglion?
point on vestibular nerve that allows it to have a resting firing rate
What rate does Scarpa’s ganglion fire?
causes firing of about 100 spikes/second at rest
Fastes reflex we have
VOR (3-neuron arc)
What allows the VOR to be so fast?
close arrangement to extra ocular muscles
Most common cause of ototoxia
gentamycin
What is neuritis?
sudden-onset vestibular hypofunction
neuritis: first 3 days
- nausea, vomiting, dizziness
- nystagmus
neuritis: characteristics of the nystagmus
- spontaneous (only initially)
- static defect
neuritis: after 3 days
If they can visually fixate, they will have a VOR deficit
can visually fixate =
no nystagmus
Which disorder has periods of exacerbation and remission?
Meniere’s disease
There is never communication between these
- endolymph
- perilymph
Would you expect loss of hearing or aural fullness with a BPPV pt?
no
With horizontal, right-beating nystagmus, what is the vestibular system doing?
producing leftward eye movement
If the slow phase is to the left, the CNS thinks your head is turning….
right
A slow phase to the left indicates hypofunction of the (right/left) side
left
What is indicative of a posterior canal BPPV?
upbeat and torsional nystagmus
How would you tell if the BPPV was due to cupulolithiasis?
- less latency (immediately deflects the cupula)
- longer duration of nystagmus (over 60s)
How would you tell if the BPPV was due to canalithiasis?
comes on slowly because the otoconia tumble through the endolymph
purpose of Brandt Daroff habituation exercises?
- repeatedly provoke the aggravating position
- idea is that you become desensitized to the stimulus
Another name for the Semont maneuver
liberatory maneuver
Torsional nystagmus will be present with which of the SCC?
- anterior
- posterior
What will be used to treat BPPV for anterior and posterior canals?
Epley maneuver
What are the 5 techniques to know
- Dix-Hallpike
- Semont/liberatory maneuver
- Canalith repositioning maneuver/Epley
- Brandt Daroff
Dix-Hallpike position: If nystagmus subsides within 60s, how do you treat?
perform carnalith repositioning (Employ)
Dix-Hallpike position: If nystagmus subsides after 60s, how do you treat?
liberatory maneuver (Semont)
The Semont/liberatory maneuver is for
adherent otoconia
The Epley maneuver is for
free floating otoconia
horizontal nystagmus is tested in
sidelying
beats toward the ground in both positions (will be worse on one side than the other)
geotropic
beats upward
ageotropic
Which side will be worse with geotropic nystagmus?
On the side with the most pronounced nystagmus
