class 4: vestibular Flashcards
what is central vest issues 2/2
damage to the central vestibular ocular pathway, brain – cerebellum, BS, vestibular nuclei
what are peri vest issues 2/2
an issue of the SCC (posterior and horizontal) or otolith organs, debris moving in the SSC
Peripheral: Labyrinth related conditions
- BPPV
- Vestibular neuritis
- Labyrinthitis
- Acoustic neuroma
Central: Brain-related related conditions
- CVA
- Cerebellar disorder
- MS
Central - nys
o Does not change with fixation
o Changes in direction
o Unable to suppress nys
o Types
Down beating nys – almost always a central issue
Gaze evoked
Non-fixation nys
Peri - nys
Decreases with fixation
Does not change direction
The nys presentation decreases – fatigable
Abnormal Smooth Pursuits and Saccades indicates peri or central
central disorder
what makes up the Labyrinth of the inner ear
Semicircular canal + otolith organs
what makes up the SCC
- Anterior
- Posterior
- Horizontal
what make up the Otolith Organs
- Saccule
- Utricle
what are the two types of BPPV can we fix
posterior and horizontal
what are some causes of BPPV
- Infection
- Head trauma
- Vestibular weakness
- Advancing age
what mech causes BPPV at the physiological level
Mechanical disorder caused
by otoconia displaced from
the macula of the utricle
Types of BPPV
Canalithiasis
Cupulolithiasis
what is Canalithiasis
a condition where particles become loose and float in a semicircular canal of the inner ear, causing vertigo.
< 1 min
what is Cupulolithiasis
a type of benign paroxysmal positional vertigo (BPPV) that occurs when otolith crystals become detached from the utricle and stick to the cupula of the inner ear’s semicircular canals.
> 1 min
BPPV – Signs and Symptoms
Vertigo: with change in head position, such as when turning over in bed, getting into or out of bed, or when bending over/coming up
Nystagmus: (involuntary, rapid and repetitive movement of the eyes) – Most important symptom
Posterior Canal BPPV - canal or cupulo
CANALITHIASIS
update: either depending on time
canal < 60 secs
cupulo >60 secs
what is the test for posterior canal BPPV
dix hall pike
what is the treatment for posterior canal BPPV
Modified Epley (first choice)
Li maneuver for the posterior canal
Semont plus (from Strupp RCT)
Posterior canal - nys
nys upbeating and torsional toward the tested side
what is the testing that we do for horzontal canal BPPV
bow and lean
roll test
what is the procedure for bow and lean
bow
- geo: nys will beat towards the affected ear
-ageo: nys will beat towards the healthy ear
lean
- geo: nys will beat towards the Good ear.
-ageo: nys will beat towards the affected ear
what is the name for the two type of horzontal canal BPPV
geotrophic and ageotrophic
what is the procedure for the roll test
- pt head flexed 20‐30 degrees
- PT lowers patient to supine - with head still flexed
- PT quickly moves head to right and holds for 30 sec
o Look for nys - Move head back to midline – 30 secs
- PT quickly moves head to left and holding for 30 sec.
o Look for nys
roll test geo
nys towards the ground (canal)
roll test ageo
nys towards the ceiling (cuplo)
what are the choices for posterior canal repositioning
Modified Epley (first choice)
Li maneuver for the posterior canal
Semont plus (from Strupp RCT)
what are the choices for horizontal canal repositioning - geo
Gufoni maneuver
Li quick repositioning maneuver
what are the choices for horizontal canal repositioning - ageo
Kim maneuver
Gufoni maneuver for ageotropic
what is Labyrinthitis
Inflammation of labyrinth
what are the sym of Labyrinthitis
Sudden onset of vertigo, nausea, vomiting
Positive head-impulse test
HEARING LOSS, TINNITUS
HIT is positive with central or peri disorder
peri disorder
what side is the HIT testing
Turn to the left the left ear is affected
do we see axtai with central of peri disorders
central - cere
how long does Labyrinthitis normally last
Days to weeks
what is Vestibular Neuritis
condition that causes inflammation of the vestibular nerve in the inner ear, which can lead to vertigo, dizziness, and imbalance
what are the sym of Vestibular Neuritis
- Sudden onset of vertigo, nausea, vomiting
- Positive head-impulse test
do we normally have hearing loss with central disorders
no - this is a peri issue
dipolpia a central or per issue normally
central
durtion of Vestibular Neuritis
Days to weeks
what is the Vestibulo-Ocular Reflex (VOR)
Responsible for maintaining focus on an image during rapid head
movements.
VOR must generate rapid compensatory eye movements in the
direction opposite the head rotation.
Menière’s Disease
Overproduction of fluid within the inner ear > Increase in pressure > Vertigo
what are the sym of Menière’s Disease
- Vertigo
- Hearing loss
- Tinnitus
- Aural fullness
- drop attacks
duration of meniere’s diase attacks
min to hours
what is Acoustic Neuroma/
Vestibular Schwannoma:
Slow-growing tumor that
develops from the balance
and hearing nerves supplying
the inner ear
Acoustic Neuroma/
Vestibular Schwannoma: symptoms
- Hearing loss
- Tinnitus
- Loss of balance
- Vertigo
- Facial numbness and
weakness or loss of muscle
movement
Unilateral Vestibular Hypofunction - treatment
- Gaze stability: Improves VOR e.g., VOR x 1, VOR x 2
- Postural stability and balance
- Habituation
what is habituation
Thought is repeated exposure to a provocative stimulus (e.g. head movements) will lead to a reduction of the motion-provoked symptoms.
Reduction of symptoms after repeated stimulus.
EX: turing head in grocery store cause symptoms then do this or something like this
Bilateral Vestibular Hypofunction - treatment
- Gaze stability: x1 yes; x2 no (unless asymmetrical involvement)
- Imaginary targets - subsition
- Walking
do we ahve hearing loss with BPPV
no
what is a another name for the semount plus
liberatory
what is the brandt daroff exercise
HEP for BPPV
is geo canal or cupulo
canal
is ageo canal or cupulo
cupulo
for the roll test how do we know what ear is effected
geo: ear with the worst symptoms
ageo: ear with the better symss
would labrinthitis or vestibular neuritis present with hearing loss
labryrinthitis
why do we do the HIT
check the VOR
do we see a postive HIT test with vestibular neuritis
yes
is the HIT positive for BPPV
no
if we see downbeating and torsional BPPV during dix hall pike testing what does this indicate
anterior canal BPPV
modified epley is for canal or cupulo
canal
is liberatory manuver for canal or cupulo
cupulo
how many time can we do brandt daroff exercises
up to x5 times
roll test and geo - how do we know what side
side effected has stronger more intense symtoms
rol test ageo - how do we know what side
side effected has less intense sym
which part of the bow and lean do we memorize
the lean part
- geo: nys will beat towards the Good ear.
-ageo: nys will beat towards the affected ear
what is the one treatment we do for all horizontal for the NPTE
horizontal canal reposiotioning manuever - BBQ roll
turn to side effected to start
what is pendular nys
the eye oscillate as equal soeeds
pendular nys is seen with what kind of disorders
central
what medications are helpful for meinere’s disease
diuretic’s
getting rid of the fluid
meinere’s disease - diet changes
less salt
