Pathophysiology Common Vestibular Disorders

Question 1

Vestibular Neuritis Pathophysiology?

Answer 1

Viral infection - Usually preceded by viral infection affecting upper respiratory system or GI tract

Question 2

What part of ear does Vestibular Neuritis typically affect?

Answer 2

Superior vestibular nerve (horizontal semicircular canal paresis)

Question 3

What disorder?
Patient compliants
- Acute/abrupt onset of vertigo
Worse at onset, gets better over time
- Nausea/vomiting
- Imbalance that lasts 1-3 days

Answer 3

Vestibular Neuritis - Acute

Question 4

What disorder?
Patient complaints
- Continue experience imbalance (especially dark, busy visual environments)
- Sensitivity to head movements

Answer 4

Vestibular Neuritis - Chronic

Question 5

What disorder?
Oculomotor exam - Acute
- spontaneous nystagmus
- gaze holding nystagmus toward unaffected ear (more neurally active ear)

Answer 5

Vestibular Neuritis

Labyrinthitis

Question 6

What disorder?
Oculomotor exam - Chronic
- Normal or see Positive Head Impulse test toward affected ear

Answer 6

Vestibular Neuritis

Labyrinthitis

Question 7

What disorder?
Postural Stability
- Romberg - Normal
- Sharpened Romberg with eyes closed - Abnormal
- Ambulate with little head or trunk rotation
- When asked to move head while ambulating, gait becomes ataxic

Answer 7

Vestibular Neuritis

Labyrinthitis

Question 8

Vestibular Neuritis

Medical intervention - Acute?

Answer 8

• Vestibular suppressants - avoid for long-term use, impede central compensations
• Oral corticosteroids
• Medication for nausea, vomiting

Question 9

Vestibular Neuritis &
Labyrinthitis
Medical intervention - Chronic?

Answer 9

Surgical intervention (eg. labyrinthectomy, vestibular nerve section) if central compensation does not occur

Question 10

Vestibular Neuritis &
Labyrinthitis
Vestibular rehabilitation?

Answer 10

• Vestibular Adaptation exercise - gaze stabilization (VORx1, VORx2)
• • Start ASAP, better outcome if start earlier
• Habituation exercise
• Balance exercises
• • Acute may use walker for balance, improve

Question 11

Vestibular Neuritis &
Labyrinthitis
Positive Outcomes?

Answer 11

• Symptoms usually self-limiting for ~ 6 weeks

- Full recovery in 6 months

Question 12

Vestibular Neuritis &
Labyrinthitis
Negative Outcomes?

Answer 12

• Prolonged use of vestibular suppressants increase time for central compensation to occur
• Lack of compliance of exercises, unstable lesion, CNS pathology, increased age, other sensory system involvement impact patient’s ability to recovery

Question 13

Labyrinthitis

Pathophysiology?

Answer 13

Infection in membranous labyrinth caused by bacteria or virus
- Initially affects otic capsule, then perilymphatic space, finally membranous labyrinth

Question 14

What disorder?
Patient complaints
- Acute onset, peak within 24 hours, last 3-4days
- Hearing loss
- Vertigo
- Nausea/vomit

Answer 14

Labyrinthitis - Acute

Question 15

What disorder? 
Patient complaints
- Residual hearing loss
- Sensitivity to head movements
- Imbalance, especially dark and busy visual environment

Answer 15

Labyrinthitis - Chronic

Question 16

Labyrinthitis

Medical intervention - Acute?

Answer 16

• Vestibular suppressants - avoid for long-term use, impede central compensations
• Oral steroids if viral infection
• Antibiotic if bacterial infection
• Medication for nausea, vomiting