Peripheral Hypofunction Vestibular Pathology Flashcards
What causes the onset of Meniere’s?
Unknown
Potentially has a viral, allergic, autoimmune or genetic component.
What is the mechanism of injury behind Meniere’s Disease?
Swelling in inner ear = increased pressure and damage within the membranous labyrinth (hair cell death +/- mechanical changes in the ear)
Describe the Meniere’s Disease presentation
VERTIGO | SEVERE, maybe aura
ONSET | Sudden, spontaneous
DURATION | Min - 24 H
FREQUENCY | 2 or more episodes
AUDITORY? | YES (Unilateral HL, tinnitus, fullness)
IMBALANCE | Otolith crisis (drop attacks) are a potential
OTHER | Non-vestibular S&S: diarrhea, diaphoresis, tachycardia, trembling, anxiety
How do patients feel between Meniere’s attacks?
Often asymptomatic between attacks, or a wide assortment of S&S
How do Meniere’s Disease symptoms change in severity as the disease progresses?
- Unpredictable attacks of vertigo
- Vertigo > tinnitus > hearing loss
- Hearing Loss > balance difficulties > tinnitus
Does bilateral involvement occur with Meniere’s Disease?
YES! 1 in 5 will progress to bilateral
How is Meniere’s Disease diagnosed?
Diagnosis of Exclusion
- 2 or more episodes of spontaneous vertigo at least 20 minutes to 24 hours
- audiometrically documented hearing loss
- Tinnitus or aural fullness
- Exclusion of other causes
What tests might these patients undergo?
- Audiogram
- Electrocochleography
- MRI
- ENG/VNG
- VEMP (vHIT)
- Posturography
What is the mechanism of injury behind vestibular neuritis and labyrinthitis?
Neuritis: viral infection
Labyrinthitis: viral or bacteria infection
T/F both vestibular neuritis and labyrinthitis originate form GI infections?
False.
Neuritis: URI + GI infection
Labyrinthitis: URI
Neuritis Presentation
VERTIGO | acute: severe, chronic: gradual reduction in symptoms
ONSET | sudden, spontaneous
DURATION | Acute: days to week, chronic: weeks to months
Auditory involvement? NO
Imbalance: YES
Anything else: Can be left with residual complains of imbalance, persistent feelings of disorientation, or “haziness”, difficulty concentrating all common
Labyrinthisis Presentation:
VERTIGO | acute: severe, chronic: gradual reduction in symptoms
ONSET | sudden, spontaneous
DURATION | Acute: days to week, chronic: weeks to months
Auditory involvement? YES
Imbalance: YES
Anything else: Can be left with residual complains of imbalance, persistent feelings of disorientation, or “haziness”, difficulty concentrating all common
What happens if labyrinthitis becomes recurrent?
Diagnosis is changes to Meniere’s disease
How is vestibular and labyrinthitis neuritis diagnosed?
Acutely - diagnosis of exclusion
What tests might neuritis and labyrinthitis patients
undergo?
Acute: vHIT/HIT
Chronic/Severe:
- Rotary chair test
- Audiogram
- VEMP
- MRI/blood work (rule out)