Evaluation of Vestibular System

Question 1

What are the structures for hearing and balance?

Answer 1

1. Cochlea
2. Semicircular Canals
3. 8th Nerve

Question 2

For vestibular dysfunction, what are the common concerns?

Answer 2

1. Disequilibrium & Vertigo
2. Can be acute/chronic
3. Ranges from mild-severe
4. Most recover spontaneously

Question 3

For Vestibular Dysfunction, who’s at a greater risk?

Answer 3

Elders

Question 4

What causes of Vestibular Dysfunction should an audiologist care about? and what of vestibular dysfunction are they?

Answer 4

1. Meniere’s Disease
2. Perilymph Fistula
3. Vestibular Neuritis
4. Benign Paroxysmal Positional Vertigo

They are Peripheral Vestibular Dysfunction

Question 5

What are the symptoms for Meniere’s Disease?

Answer 5

1. Fluctuating low frequency SNHL
2. Typical unilateral
3. Roaring (low frequency sound) tinnitus

Question 6

What is the cause for Meniere’s disease?

Answer 6

An increase in endolymphatic fluid pressure

Question 7

What are the symptoms for Vestibular Neuritis?

Answer 7

1. Sudden onset of vertigo
2. Nausea
3. Vomiting
4. Usually w/o auditory symptoms

Question 8

What is the cause for Vestibular Neuritis?

Answer 8

Thought to be a viral infection of vestibular portion of VIIIth nerve

Question 9

What are the symptoms for Perilymph Fistula?

Answer 9

1. Fluctuating and typically unilateral but not limited to low frequencies
2. Tinnitus
3. Vertigo

Question 10

What causes Perilymph Fistula and what is?

Answer 10

a. It’s caused by abnormal communication between ME and IE

b. It’s essentially an extra opening in the cochlea

Question 11

Why can a Perilymph Fistula occur?

Answer 11

1. Trauma
2. Surgery
3. Congenital Anomalies

Question 12

What’s the main different between Perilymph Fistula & Meniere’s Disease?

Answer 12

Meniere’s Disease only pertains to low frequencies while Perilymph Fistula does not

Question 13

For BPPV, what are most cases?

Answer 13

Idiopathic

Question 14

What is the most frequent cause of vertigo?

Answer 14

BPPV

Question 15

What test do we use to assess the Peripheral Vestibular Dysfunctions?

Answer 15

Nystagmus

Question 16

What is Nystagmus?

Answer 16

It’s a rocking motion of the eyes

Question 17

When does nystagmus occur?

Answer 17

Always with true vertigo

Question 18

Can nystagmus occur spontaneously? What is it called?

Answer 18

Yes, Congenital Nystagmus

Question 19

For the many tests used for vestibular function to look at nystagmus, what do we analyze?

Answer 19

1. Presence
2. Degree
3. Type in comparison to norms

Question 20

For Nystagmus, which assessment is commonly used?

Answer 20

Electronystagmography (ENG)

Question 21

For Nystagmus, what is VNG or ENG?

Answer 21

It analyzes eye movement through an electrical response since our cornea has a positive charge and the retina has a negative charge

Question 22

For VNG or ENG, what does the difference in the electrical potential tells us?

Answer 22

As our eyes moves the ENG will obtain an objective measurement of nystagmus to determine if the patient really have nystagmus

Question 23

While we’re doing an ENG or VNG, what are we doing?

Answer 23

A caloric test

Question 24

What is the purpose of a caloric test?

Answer 24

To get them dizzy and see if they truly have vertigo

Question 25

For caloric testing, what do you do to make the patient have vertigo?

Answer 25

Irrigate the ear canal with warm or cold water or air to stimulate the vestibular system

Question 26

For caloric testing, what does irrigate the EAC do?

Answer 26

Stimulate the vestibular system. The warm temperature would stimulate the vestibular system in one way while the cold temperature would stimulate the vestibular system in another way

Question 27

For caloric testing, what’s the rule for direction of nystagmus?

Answer 27

COWS: Cold opposite, Warm Same

Question 28

For caloric testing. how can the response be classified?

Answer 28

1. Normal
2. Absent
3. Hyperactive
4. Hypoactive

Question 29

Define Rotary Chair

Answer 29

Mechanized chair that rotates at varying velocity in both clockwise and counterclockwise directions

Question 30

The purpose of the Rotary Chair is to…?

Answer 30

View nystagmus during movement since we’re trying to make our client have a vertiginous reaction

Question 31

What two tests does not use nystagmus?

Answer 31

1. Computerized Dynamic Posturography

2. Vestibular-Evoked Myogenic Potential (VEMP)

Question 32

What does the Computerized Dynamic Posturography assess?

Answer 32

1. The ability to coordinate movement by measuring vestibulospinal reflexes

Question 33

What does the Computerized Dynamic Posturography measure?

Answer 33

The patient’s ability to compensate for various disruptions in balance

Question 34

What is VEMP?

Answer 34

A test that measures the sound-evoked muscular reflex of our sternocleidomastoid muscle by placing electrodes on the sternocleidomastoid muscle

Question 35

What’s the purpose of the sternocleidomastoid muscle?

Answer 35

Purpose of reflex is thought to stabilize the head in response to unpredictable movements

Question 36

What causes the sternocleidomastoid muscle to contract?

Answer 36

The saccule, which is responsible for linear acceleration sends a message to this muscle

Question 37

When we identify that the patient has difficulty, what do we do about it?

Answer 37

1. Balance Rehabilitation
2. Medical
3. Surgical

Question 38

For medical treatment for Peripheral Vestibular Dysfunction, what are the factors and what do we treat?

Answer 38

1. Depends on cause
2. Typically provide symptomatic treatment

The medication would treat: Nausea and Vestibular Suppressant

Question 39

For surgical treatment for Peripheral Vestibular Dysfunction, what are the factors and what do we treat?

Answer 39

1. Depends on cause
2. Most invasive treatment
3. Two types of procedures: Preservation & Ablation