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neuromuscular II > exam #2 vestibulopathies > Flashcards

exam #2 vestibulopathies Flashcards

1
Q

vestibulopathies:
- ___ vestibular dysfunction
- uni- or bilateral or both?
- may require what interventions?
- CPG applies if _____

A
  • peripheral
  • both
  • adaptable, habituation, or both
  • VRT is appropriate based on etiology
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2
Q

who are two key teammates in vestibular rehab?

A

audiologists
ear, nose, and throat doctors (ENTs)

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3
Q

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?

A
  • 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
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4
Q

diagnostic tests for vestibular neuritis:

A

head impulse test
caloric testing
vestibular-evoked myogenic potential (VEMP)

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5
Q

vestibular neuritis is typically managed by:

A

a dose of glucocorticoids in the first three days since symptom onset –> get inflammation down!

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6
Q

is vestibular neuritis responsive to vestibular rehabilitation treatment?
how long does it take for it to improve?

A

yes
6 weeks to 3 months

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7
Q

labyrinthitis:
- what is it?
- affects what?
- vertigo that lasts ___
- additional symptoms?
- uni- or bilateral or both

A
  • bacterial or viral infection of the labyrinth (if bacterial often meningitis)
  • hearing and balance
  • prolonged
  • n/v and tinnitus
  • often unilateral, can be bilateral
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8
Q

diagnostic tests for labyrinthitis:

A

head impulse test
caloric testing
vestibular-evoked myogenic potential (VEMP)
Will also test CSF, auditory markers & MRI if bacterial

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9
Q

Treatment for labyrinthitis

A

antibiotics (bacterial)
steroids (autoimmune, viral)

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10
Q

is labyrinthitis responsive to vestibular rehabilitation treatment?

A

yes

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11
Q

meniere’s disease:
- what is it?
- ______ term of vestibular disorders
- vertigo lasts:
- symptoms?
- uni or bilateral?

A
  • 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
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12
Q

diagnostic tests for meniere’s disease:

A

audiogram
may test positive on vestibular hypofunction tests

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13
Q

is it curable?
what helps control fluids?
do they respond to VRT?

A

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

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14
Q

Acoustic neuroma:
- what is it?
- presents where?
- symptoms?
- if in the IAC, what impairments are seen?
- symptom onset?
- uni or bilateral?

A
  • 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
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15
Q

Diagnostic tests used for acoustic neuroma

A

CN VIII screens like Renne and Webber
MRI or CT needed

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16
Q

treatment for acoustic neuroma
is VRT helpful?

A

Surgical excision or gamma knife radiation
yes, post-op

17
Q

superior canal dehiscence syndrome:
- what is it?
- symptoms:
- how do you get it?

A
  • thinning or opening on the top of the bone overlying superior canal
  • oscillopsia or vertigo induced by sound (sounds make you dizzy)
  • often congenital
18
Q

superior canal dehiscence syndrome:
- diagnostic tests:
- treatment:
- responsive to VRT?

A
  • observing for eye movements caused by increased pressure or sound in the inner ear or during Valsalva
  • repairing the bony deficit in surgery
  • No
19
Q

perilymphatic fistula:
- what is it?
- perilymph leaks into the middle ear resulting in _____ and __ that are ____
- symptoms increase with ___ and decrease with __

A
  • 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
20
Q

perilymphatic fistula:
- diagnostic tests:
- managed with:

A
  • hard to diagnose because similar test to other disorders, but can increase pressure in inner ear and observe for vertigo
  • rest, surgery, VRT
21
Q

Labyrinthine concussion:
- what is it?
- most common incidence
- symptoms:
- deficits?
- may have ___ and ____ findings
- uni or bilateral?
- respond to VRT?

A
  • 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
22
Q

Ototoxicity:
- can be _____
- uni or bilateral?
- symptoms?
- may co-occur with ___

A
  • 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
23
Q

Ototoxicity:
- diagnostic tests:
- manage with:

A
  • VEMPs, calorics, etc.
  • Habituation exercises → adaptation will not work
24
Q

what are the three different interventions you can use for vestibulopathies?

A
  1. adaptation: change in vestibular response to certain stimuli (neuroplastic change)
  2. habituation: decreased response to a stimulus with increased exposure (getting used to it)
  3. substitution: uptraining other systems
25
Q

what is Brandt Daroff used for? Should it be used for BPPV? is it adaptation or habituation?

A

getting used to the motion
Not for BPPV
Habituation

26
Q

According to the CPG for vestibular hypofunctions, there is HIGH evidence for ?

A

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

27
Q

According to the CPG for vestibular hypofunctions, there is MODERATE evidence for ?

A
  • modalities for balance training (virtual reality, optokinetic stimulation, platform perturbations, vibrotactile feedback)
  • when to stop VR
28
Q

According to the CPG for vestibular hypofunctions, there is WEAK evidence for ?

A

balance dosage
gaze stability HEP dosage

29
Q

According to the CPG for vestibular hypofunctions, ___ _____ improves outcomes AND _____ (4) can impact outcomes

A
  • early intervention
  • anxiety, vision disturbance, migraine, long term use of vestibular suppressants
30
Q

what should you work on for gaze stability?

A

VOR retraining (metronome start at 60 bpm –> 120 bpm, diagonal, vertical, horizontal)
VOR 1/2 (one thing moving / two things moving)

31
Q
A

neuromuscular II (18 decks)

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