Lecture 43: clinical evaluation of balance

Question 1

When you turn your head to the left which lateral canal is excited

Answer 1

1. Moving head to left
2. The fluid motion is in the opposite direction (to the right).
3. As the axis of the hair cells for firing is in the direction of the eyes
   a) in the left canal the fluid will go anteriorly in same direction of hair axis
   b) right canal, fluid goes posteriorly in opposite direction of hair axis
4. Left canal is excited while Right canal has decreased firing

Question 2

Which canals does Ampulopetal flow (toward the ampulla due to movement of the head in the opposite ) excite and inhibit

as well as Ampullofugal flow

Answer 2

Ampullopetal: excitatory in lateral canals;
inhibitory in superior/post canal

but lateral is the one we can test

Ampullofugal: opposite

Question 3

What 5 things we need to know when asking history of dizziness/chronic imbalance

Answer 3

1. Have spinning? True vertigo.
   (Disequilibrium: boat feeling )
2. Episodic or constant? How many?
3. Duration of vertigo: min, hr, days
4. Precipitating factors:
   eg. Head movement, Loud noise, Diving/Valsalva, Migraine.
5. Associated factors (menieres disease signs) - tinnitus, migraines, hearing loss, aural fullness)

Question 4

What are 6 examinations you can do about clinical balance

Answer 4

• Ear examination
• Eye movements
• Head thrust test
• Fukuda stepping test
• Fistula test
• Dix hall pike

Question 5

hsf

Answer 5

1. Moving head to left
2. The fluid motion is in the opposite direction (to the right).
3. As the axis of the hair cells for firing is in the direction of the eyes
   a) in the left canal the fluid will go anteriorly in same direction of hair axis
   b) right canal, fluid goes posteriorly in opposite direction of hair axis
4. Left canal is excited while Right canal has decreased firing

Question 6

COWS??????????????

20min

Answer 6

cold opposite warm same

Cold water/ air: nystagmus goes to the opposite side of the water

Warm water/air: nystagmus goes to the same side of the water

Question 7

sudden reduction

Answer 7

Eyes drift because stimulate, the fast phase.

Nystagmus

Question 8

Acute vestibular neuronitis

Answer 8

acute onset then: allow cerebellar clamp. get them out of bed. no more than a few days of anti nausea pills

Question 9

What is the nystagmus

Answer 9

Named in direction of the fast corrective movement

eg. right ear bad nystagmus left

Question 10

What is the head thrust test

Answer 10

1. Hold head at 30.
2. Rapidly
   Delay in moving the eyes to follow the head turn

This

Question 11

Calorics explained

Answer 11

COWS ? maybe

Question 12

Fistula test

Answer 12

Small area where the vestibular system isn’t covered with bone. Therefore there is
choelsystoma

Question 13

Fukuda stepping test

Answer 13

box on head

Arms out straight. Will turn toward the ear not good.

Question 14

Dix hallpike test

Answer 14

There is a slight delay, then Geonystagmus towards the offending side. Then p

Question 15

BPPV

Answer 15

VErtigo is self limiting lasting less than 1 minute. Not associated with tinnitus/ hearing loss.
Crystals of utricle will fall into post semicircular canal- looking up.

Question 16

Goal of management

Answer 16

1.Treat the condition and vertigo
2. Maximise other systems: eyes open, contact with environment: walking sticks.
Normal glasses- not bifocals

3. brainstem stroke - vertigo