bilateral vestibular dysfunction

Question 1

symptoms of bilateral vestibular disorder

Answer 1

• oscillopsia - vision bounces, blindness with head movement
• postural instability, imbalance
• impaired spatial learning, spatial disorientation/navigation, wayfinding
• loss is permanent
• possible hearing loss

Question 2

most common cause of bilateral vestibular disorder

Answer 2

aminoglycoside antibiotic - especially gentamicin

Question 3

antibiotics linked to bilateral vestibular disorder

Answer 3

gentamicin
streptomycin
tobramycin
less commonly linked: neomycin, amikacin, netilmicin, vancomycin

Question 4

antiarrhythmic drug linked to bilateral vestibular disorder

Answer 4

amiodarone

Question 5

neurodegenerative disorder linked to bilateral vestibular disorder

Answer 5

CANVAS - cerebellar ataxia, neuropathy, vestibular areflexia syndrome

Question 6

deficiency in what amino acid is linked to bilateral vestibular disorder

Answer 6

thiamine vitamin B1 (wernicke encephalopathy)

Question 7

what chemotherapy agent is linked to bilateral vestibular disorder

Answer 7

cis-platinum is ototoxic (affecting hearing and balance)

Question 8

labs are used to identify what diseases linked to bilateral vestibular disorder

Answer 8

• syphilis
• lyme disease
• autoimmune disease

Question 9

MRI/CT focused on internal auditory canal are linked to bilateral vestibular disorder

Answer 9

• meningitis

- NF2 neurofibromatosis type 2 (schwannoma)

Question 10

cause majority of cases of bilateral vestibular disorder is

Answer 10

idiopathic

Question 11

why is aging related to bilateral vestibular disorder

Answer 11

by age 80 lose 50% of vestibular hair cells

Question 12

what disorders are linked to bilateral vestibular disorder

Answer 12

• autoimmune disorders

- CANVAS

Question 13

what drugs are linked to linked to bilateral vestibular disorder

Answer 13

• aminoglycoside antibiotics - gentamicin
• amiodarone antiarrhythmic drug
• cis-platinum chemotherapy drug

Question 14

tests for bilateral vestibular disorder?

Answer 14

• head impulse
• caloric test
• VEMP
• dynamic visual acuity
• romberg - eyes closed on cushion
• MRI/CT - internal auditory canal
• labs - lyme titer, syphilis, autoimmune markers

Question 15

treatment for bilateral vestibular disorder

Answer 15

vestibular compensation exercises

Question 16

what treatment should NOT be used for bilateral vestibular disorder

Answer 16

vestibular suppressant medications - not helpful, only issue during dynamic movement

Question 17

why does bilateral vestibular disorder cause Head-motion-induced oscillopsia

Answer 17

loss of VOR vestibulo-ocular reflex activity

- which promotes gaze stabilization during dynamic activities

Question 18

PPPD

Answer 18

persistent postural-perceptual dizziness

Question 19

criterial for

Answer 19

• dizziness type symptom >50% of time for >3 months (swaying, nonvertiginous)
• typically after acute vestibular symptoms or impaired postural control
• symptoms exacerbated by upright posture, motion, visual stimular or complex visual patterns
• symptoms cause significant distress, functional impairment
• no biomarkers or better explained by other disorder

Question 20

PPPD - are highly reliant on what for balance?

Answer 20

vision

Question 21

PPPD - commonly present with what psychological issues?

Answer 21

anxiety, depression, panic

Question 22

PPPD - what should you tell patient

Answer 22

• symptoms are real
• not fatal and can improve
• recommend counseling/psychotherapy

Question 23

PPPD - interventions

Answer 23

• habituation - graded exposure to provocative enviro to desensitive
• make exercise task specific eg. going to grocery store; progress duration, crowd, reduce supportive device
• balance stance drills to decrease reliance on vision, improve proprioceptive cues
• tai chi, relaxation, controlled deep breathing
• antianxiety medication
• counseling, psychological treatment