Lecture 43: Balance assessment

Question 1

What are the non-laboratory methods for assessing balance?

Answer 1

• History
• Ear exam
• Eye movements
• HEAD THRUST
• FUKUDA stepping test
• FISTULA test
• DIX HALLPIKE

Question 2

What are the lab methods of testing balance?

Answer 2

• Audiogram
• Optokinetics
• Calorics
• Computerized head thrust
• vEMP

Question 3

What is the purpose of a history?

Answer 3

• Precipitating factors i.e head movement, loud noising, diving, migraine
• Episodic nature
• Duration of vertigo
• Associated factors, migraine, tinnitus, hearing loss, aural fullness

Question 4

Whats of note when it comes to the orientation of the semicircular canals?

Answer 4

• Semicircular canals are orthoganal to each other
• Lateral canal inclined to 30 degrees
• Sup/post are 45 degrees off sagital plane

Question 5

Whats of note when it comes to the otolithic organs?

Answer 5

• Utricle is in horizontal plane

- Saccule is in vertical plane

Question 6

Write some notes on semicircular canals:

Answer 6

Ampulla is dilated end
Cristae ampularis is the structure containing the sensory cells and their support cells
Capula is the gelatinous mass extending across it at a right angle

Question 7

How is nyastigmus described?

Answer 7

Described in direction of the fast phase i.e left nystagmus is fast phase to the left = left beating nystagmus

This means there is a relative hyperactivity in the left ear or hypofunction in the right (most of the time vestibular physiology is hypofunctional)

Question 8

What is the HEAD THRUST?

Answer 8

• Gently grasp and tilt patients head down 30 degrees
• Get them to look at target i.e nose
• Rapidly (but gently) rotate the head head 15-0 degrees one side and then the other
  = Eyes should remain on nose
• Watch for catch up saccade to refixate after movement is complete
  = Vestibular occular reflex compromised

Question 9

What is calorics?

Answer 9

• Pt lying down with LSCC oriented up
• Cold water causes endolymph to become dense and fall
• Deflection capula away (inhib right side)
  = Nystagmus fast phase beat away

COWS

Cold Oppose Warm Same

• Warm water causes endolymph to become less dense, rise and cause deflection capula towards (Excitation)
• Increased firing right ear, so nystagmus fast phase beats towards stimulation

This test will differentiate between central and peripheral vertigo causes, it also will cause vertigo onset.

Question 10

What is the implication also of calorics?

Answer 10

• Cold ear drops
• Suctioning
• Ear syringing
• Mastoid cavity clean

Can all cause this because LSCC is close to the mastoid cavity, bone is very thin here

Question 11

What is the fistula test?

Answer 11

TO assess if their is an abnormal connection between the middle and inner ear.

Ellicits nystagmus and vertigo when pressure applied

Question 12

What is the FUKUDA (unterberger) stepping test?

Answer 12

Remove proprioception and visual stimulation i.e box over head, hands remain oustretched not swinging, and see if the patient naturally turns to one side, might indicate WEAKNESS with the vestibular system

Question 13

What is the dix hallpike assessment of balance?

Answer 13

• Used in the assessment of benign paroxysmal positional vertigo
• Sitting, turn the patients head 45 degrees and lie them down so their head is over the edge of the bed, This rapid movement may cause loose otogonia to trigger vertigo.
• Turn the head 90 degrees left
• Turn the head and body 90 degree left (lying on their side now) and then sit back up
• EXAMINE FOR NYSTAGMUS and ask about symptoms of vertigo

Can also repeat these head movements to get the crystals out of the semicircular canals (Now called EPLY)

Question 14

What is the VEMP lab test?

Answer 14

Measuring electro signals from the vestibular nuclei