exam #2 vestibulopathies Flashcards
vestibulopathies:
- ___ vestibular dysfunction
- uni- or bilateral or both?
- may require what interventions?
- CPG applies if _____
- peripheral
- both
- adaptable, habituation, or both
- VRT is appropriate based on etiology
who are two key teammates in vestibular rehab?
audiologists
ear, nose, and throat doctors (ENTs)
vestibular neuritis:
- what is it?
- what usually happens a couple weeks beforehand?
- acute onset vertigo lasting ___ to ___
- likely have what symptom?
- hearing impaired??
- uni- or bilateral or both?
- inflammation of the balance portion of CN VIII –> could be inferior or superior portion
- viral illness (often happens in winter/spring aka flu season)
- minutes to hours
- nausea and vomiting
- no
- often unilateral, can be bilateral
diagnostic tests for vestibular neuritis:
head impulse test
caloric testing
vestibular-evoked myogenic potential (VEMP)
vestibular neuritis is typically managed by:
a dose of glucocorticoids in the first three days since symptom onset –> get inflammation down!
is vestibular neuritis responsive to vestibular rehabilitation treatment?
how long does it take for it to improve?
yes
6 weeks to 3 months
labyrinthitis:
- what is it?
- affects what?
- vertigo that lasts ___
- additional symptoms?
- uni- or bilateral or both
- bacterial or viral infection of the labyrinth (if bacterial often meningitis)
- hearing and balance
- prolonged
- n/v and tinnitus
- often unilateral, can be bilateral
diagnostic tests for labyrinthitis:
head impulse test
caloric testing
vestibular-evoked myogenic potential (VEMP)
Will also test CSF, auditory markers & MRI if bacterial
Treatment for labyrinthitis
antibiotics (bacterial)
steroids (autoimmune, viral)
is labyrinthitis responsive to vestibular rehabilitation treatment?
yes
meniere’s disease:
- what is it?
- ______ term of vestibular disorders
- vertigo lasts:
- symptoms?
- uni or bilateral?
- ischemia or fibrosis around the endolymphatic sac causing abnormalities in endolymph drainage
- catch all
- minutes to days
- n/v, fluctuating hearing loss, tinnitus that sounds like roaring, episodic
- starts unilateral, progresses to bilateral
diagnostic tests for meniere’s disease:
audiogram
may test positive on vestibular hypofunction tests
is it curable?
what helps control fluids?
do they respond to VRT?
Not curable
2g/day of sodium to control fluids
Diuretics to lower extracellular fluid
May respond to VRT at first, but need to move to habituation as it gets worse
Acoustic neuroma:
- what is it?
- presents where?
- symptoms?
- if in the IAC, what impairments are seen?
- symptom onset?
- uni or bilateral?
- benign tumor of CN VIII
- often presents in the internal auditory canal (IAC) but can be present anywhere
- dependent on tumor location
- hearing and vestibular and balance impairments
- slow onset
- unilateral
Diagnostic tests used for acoustic neuroma
CN VIII screens like Renne and Webber
MRI or CT needed
treatment for acoustic neuroma
is VRT helpful?
Surgical excision or gamma knife radiation
yes, post-op
superior canal dehiscence syndrome:
- what is it?
- symptoms:
- how do you get it?
- thinning or opening on the top of the bone overlying superior canal
- oscillopsia or vertigo induced by sound (sounds make you dizzy)
- often congenital
superior canal dehiscence syndrome:
- diagnostic tests:
- treatment:
- responsive to VRT?
- observing for eye movements caused by increased pressure or sound in the inner ear or during Valsalva
- repairing the bony deficit in surgery
- No
perilymphatic fistula:
- what is it?
- perilymph leaks into the middle ear resulting in _____ and __ that are ____
- symptoms increase with ___ and decrease with __
- perforation (usually trauma related) of the oval or round windows that disrupts biochemistry of the ear
- vertigo and hearing loss that are episodic
- increase with activity (increased pressure) and decrease with rest
perilymphatic fistula:
- diagnostic tests:
- managed with:
- hard to diagnose because similar test to other disorders, but can increase pressure in inner ear and observe for vertigo
- rest, surgery, VRT
Labyrinthine concussion:
- what is it?
- most common incidence
- symptoms:
- deficits?
- may have ___ and ____ findings
- uni or bilateral?
- respond to VRT?
- concussion of the inner ear. often co-occurs with concussion of the brain
- trauma
- balance difficulty, dizziness, concussion symptoms (cognitive changes, irritability, sleep disturbance)
- hearing and vestibular
- central (concussion) and peripheral (inner ear problem)
- can be either
- yes, with a cognitive component
Ototoxicity:
- can be _____
- uni or bilateral?
- symptoms?
- may co-occur with ___
- chemical/environmental –> gentamycin, chemotherapy agents, solvents.
no vestibular input, they look down a lot to see and feel where they’re going - bilateral
- balance dysfunction, visual dependence. not necessarily vertigo
- hearing loss
Ototoxicity:
- diagnostic tests:
- manage with:
- VEMPs, calorics, etc.
- Habituation exercises → adaptation will not work
what are the three different interventions you can use for vestibulopathies?
- adaptation: change in vestibular response to certain stimuli (neuroplastic change)
- habituation: decreased response to a stimulus with increased exposure (getting used to it)
- substitution: uptraining other systems
what is Brandt Daroff used for? Should it be used for BPPV? is it adaptation or habituation?
getting used to the motion
Not for BPPV
Habituation
According to the CPG for vestibular hypofunctions, there is HIGH evidence for ?
VRT with acute, subacute, chronic unilateral vestibular hypofunction (UVH)
VRT with bilateral hypofunction
supervised VRT
VRT improving quality of life
** age and gender do NOT influence outcomes
** saccades and smooth pursuit do NOT improve gaze stability
According to the CPG for vestibular hypofunctions, there is MODERATE evidence for ?
- modalities for balance training (virtual reality, optokinetic stimulation, platform perturbations, vibrotactile feedback)
- when to stop VR
According to the CPG for vestibular hypofunctions, there is WEAK evidence for ?
balance dosage
gaze stability HEP dosage
According to the CPG for vestibular hypofunctions, ___ _____ improves outcomes AND _____ (4) can impact outcomes
- early intervention
- anxiety, vision disturbance, migraine, long term use of vestibular suppressants
what should you work on for gaze stability?
VOR retraining (metronome start at 60 bpm –> 120 bpm, diagonal, vertical, horizontal)
VOR 1/2 (one thing moving / two things moving)
