Chp 24 vestibular disorders Flashcards
How many people vestibular disorders in a year
Most Common reason to see a physician and 3 primary functions of the vestibular system
15 million, dizziness
Maintain a central image on the fovea of the retina
Maintaining Postural stability
Providing information used for spatial orientation
What 3 types of semicirular ear canals do we have and what is there purpose..
What is endolymph and cupula
Descride the Kinocilia and the Stereocilia realtionship
Anterior, Posterior, horizontal. and work in sync and produce angular accerleration
The endolymph has a density a little bit more so than water and moves when the semicicular ear canals move. However at the end of each semi circle ear canal is a cupula which is a barricade from the utricle and the saccule (otolith organs)
So inside the cupula is a crista ampularis and in it sits two hair types the stereocillia and kinocillia. Now if the head turns to the right lets say it going to excite or (depolarize) the stereocillia cells and inhbits the left kinocillia cells (hyperpolarization and that is how the head knows if its to the right or to the left and vice versa would happen if he or she turnced to the left.
What are the otolith organs
Which one is responsible for Horizontal Linear accerleration and which one is responsible for Vertical accerleration
Saccule and the Utricle located at the base of the semicircular ear canals and they operate the same as the except there hair cells move carbonate crystals to stimulate nerves instead of endolymph
Saccule- vertical linear acceleration
Uticle - static head postion and horizontal linear accerleration
Whats Tonic firing Rate?
Vestibulo-occular reflex - What happens when the head turns right, superior,and right or inferior and right
Tonic Firing Rate - is usally between 70 to 100 milispikes per second when head is rotated. It is the ipislateral excitation while contralateral side is inhibited
Vestibulo-occular reflex is responsible for maintaing the image on the retina so this done through a process
If Lateral or (horizontal) semicircular ear canal is stimulated by turning the head to the right it sends an message to the medial vestibular nucleus then this sends a message right occulomotor nucleus and then left abduncens nucleus- then to the direct muscle itself right medial rectus and left lateral rectus.
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Muscle moves eye opposite its “titled” in certain cases.
Anterior would be stimulated if head moved superiorly (lateral vestibular nuclues) left oculomotors left inferior oblique and right superior rectus
Down and right Stimulate posterior ear canal- medial vestibular nucleus- left trochlear nucleus and left oculomotor nucleus right superior oblique and left inferior rectus
Describe the following
Push-pull mechanism
Inhbitory cutoff
Velocity storage system
Push-pull - is the whole idea that when the right side is activated the left side is inhibited via the semicircular ear canals. vice versa can happens as well
Inhibitory cutoff- when when shutoffs to 0 and is hyperppolarized and the resting is 70-100 degrees per second.
Velocity Storage system- After the cupula sends a signal to the brain it remains on for an additional 10 seconds to compensate for any minor head movements
“dizziness” is usually a general term to describe
Vertigo, Dysequilbrium, and Oscilliopsia.
Describe each one of these terms and somethings that can cause them
Vertigo- is the illusion of movement. Usually you feel like you are moving but, you are truly not at all. Unilateral Central Lesion, BPPV, use only in episodes
Dysequllibrium- sensation of being off balance and usally not due to vestibular disorder- weakness in the LE’s unilateral vestibular hypofunction somatosenstaion
Oscilliopsia- sense that an object is in motion when it is stationary. BVH, unilateral vestibular hypofunction, upper brainstem/ vestibular cortex lesion.
Just a few exams for patients with dizziness
Dizziness Handicap Inventory, VAS FIM
Head Thrust test (headed rotated in unpredictable patterns) Head Shaking induced nystagumus - (Patient closes eyes and head is rotated 20 cycles and then eyes are open check for nystagmus). dynamic visual acutiy test-
Gait and Balance testing
Vestibular - function test SCC test- put cold water or blow cool air into ear canal and this causes a shift in the endolymph and patient if postive will result in a nystagmus
BBPV vs UVL vs BVL vs Central lesion
Beningn Paroxysmal Postional Vertigo- Usally caused by a sudden change in position of the head and usually doesn’t progress into anything really that serious.
Unilateral Vestibular Lesion - caused by an infection in the vestibular nerve eighth cranial nerve. Postiive for rombergs gait is usally wide base and decreased arm swing usally turn head while walking to compensate
Bilateral Vestibular Lesion - ditto as above
Central lesion- Romberg negative Tandem stance romberg usally positive usally positive for single leg stance gait = ataxia head during walking may not keep balance
Most common cause of UVH - unilateral ventricular hypofunction what about BVH basically decreased receptor input
UVH - tramua, viral infection or vascular events.
BVH - caused by ototoxicty - posion that gets into receptors preticurally from antibiotics.
Central Vestibular Pathology vs. Peripheral Vestibular pathology
Central Vestibular Pathology- Ataxia often serve abnormal eye movements including diplopia, altered consciousness nystagmus pure presistent vertical
Peripheral Vestibular Pathology - ataxia mild smooth prusuit fullness in ears, tinnitus, acute vertigo jerky nystagmus, eye problems not as serve as the central lesions, spontanesous horizontal nystagumus
Describe each treatment BBPV most common vertigo
The canalith repositioning maneuver
The Liberatory manuever
Brandt-Daroff exercises
Whats some other good exercises
Canalith - The head is first upright next is titled off table supine neck turns head to the side still supine next prone with head off table this will remove debris from the SCC to the vestibule- (utricle and saccule) just a common name used to described both. Also instruct patient to sleep upright at night. canalithasis- stones in the canal
Libreratory - Same pretty much as canalith but more radicule and for posterior ear canal issues and cuplalithasis- stones in the cupula
Brandt-daroff - other random head movements for presistent or mild vertigo for patient who may not tolerate the canalith procedure less extreme of the two 5-10 times 3 times daily
Other exercises- Gaze stabiltiy, postural stability, motion senstivity - perform repeated motions over and over again until no more instability with the motion.
Patient Education - dont drink to much, keep head upright and avoid unesscary head movements, whack it regularly, sleep upright, minimize driiving to fast, always participate in no pants work day, and stay away from vegetables and fruits, eat doughnuts and drink pepsi by the caseload, and don’t exercise and run at night in all black into oncoming traffic and don’t stop at redlights, no brakes bro, drive in reverse whenever possible, skip work at least once a week, urinate where ever you please, womanize, do drugs, participate in local KKK seminars on occasion, do sketchy work whenever money is low, don’t try to hard to do legal work the man will only bring you down. Rally Rally Rally, convince others to not work and join deathsquaders do this and it should decrease your chances of vertigo
Describe each of the following
Menieres disease -
Perilymphatic Fistula
Acoustic neuroma
Motion sickness
Can MS cause vertigo
Multiple system atrophy
Cervical vertigo
What is PT not good for and what to look out for.
Meineres diseease- low hearing frequency and veritgo and fullness in ears 1 to 2 hours per episode probadly an increase endolymph- Medically treated toward fluid buildup. Diuretic to control amount of water in the body surgery to ethier prevent the fluid buildup in the inner ear or to stop vestibular signal. PT can do gaze and postural stablity exercises to help prevent episodes from occuring
Perilymphatic Fistula- Puncture of the oval window a part that seperates middle ear from the inner ear. leakage of perilymph into the middle ear and results in hearing loss and vertigo usally caused by head trauma or deep sea diving due to the increased pressure
Acoustic Neuroma- vestibular schwannomma is a benign located on cranial nerve VIII results in hearing loss, tinnitus, and dysequilibrium, treatment usally invovles surgical excsision of the tumor
Motion sickness- the idea of motion sickness is caused by the vestibular, proception, and visual scenarios experienced on a boat or where have you don’ match the normal neural patterns.
MS can cause issues with cranial nerve eight where it enters the skull.
Multiple system atrophy- invovles CNS and four clinical domains- cerebellar, ataxia, autnomic
Cervical Vertigo- dizziness by impaired vestibular nucleus due generally to a CVA and second cause can be vertibrobasilar artery insuffiency
PT not good for Meinieres disease and look out for sudden hearing loss, a fullness in the ear filling, clear liquid discharge from ears or nose could CSF indication of a possible serious issue
