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Neuro II > Peripheral Hypofunction Vestibular Pathology > Flashcards

Peripheral Hypofunction Vestibular Pathology Flashcards

1
Q

What causes the onset of Meniere’s?

A

Unknown

Potentially has a viral, allergic, autoimmune or genetic component.

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2
Q

What is the mechanism of injury behind Meniere’s Disease?

A

Swelling in inner ear = increased pressure and damage within the membranous labyrinth (hair cell death +/- mechanical changes in the ear)

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3
Q

Describe the Meniere’s Disease presentation

A

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

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4
Q

How do patients feel between Meniere’s attacks?

A

Often asymptomatic between attacks, or a wide assortment of S&S

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5
Q

How do Meniere’s Disease symptoms change in severity as the disease progresses?

A
  1. Unpredictable attacks of vertigo
  2. Vertigo > tinnitus > hearing loss
  3. Hearing Loss > balance difficulties > tinnitus
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6
Q

Does bilateral involvement occur with Meniere’s Disease?

A

YES! 1 in 5 will progress to bilateral

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7
Q

How is Meniere’s Disease diagnosed?

A

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

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8
Q

What tests might these patients undergo?

A
  • Audiogram
  • Electrocochleography
  • MRI
  • ENG/VNG
  • VEMP (vHIT)
  • Posturography
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9
Q

What is the mechanism of injury behind vestibular neuritis and labyrinthitis?

A

Neuritis: viral infection
Labyrinthitis: viral or bacteria infection

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10
Q

T/F both vestibular neuritis and labyrinthitis originate form GI infections?

A

False.
Neuritis: URI + GI infection
Labyrinthitis: URI

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11
Q

Neuritis Presentation

A

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

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12
Q

Labyrinthisis Presentation:

A

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

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13
Q

What happens if labyrinthitis becomes recurrent?

A

Diagnosis is changes to Meniere’s disease

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14
Q

How is vestibular and labyrinthitis neuritis diagnosed?

A

Acutely - diagnosis of exclusion

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15
Q

What tests might neuritis and labyrinthitis patients
undergo?

A

Acute: vHIT/HIT
Chronic/Severe:
- Rotary chair test
- Audiogram
- VEMP
- MRI/blood work (rule out)

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16
Q

What type of patient populations are acoustic neuromas most prevalent?

17
Q

Mechanism of Acoustic Neruoma

A

slow-growing tumor derviced from Schwann cells of the vestibulocochlear nerve or internal auditory canal.

18
Q

As an acoustic neuroma grows, what other neurological structures could be involved?

A

CN 5 +/- 7, cerebellum or brainstem

19
Q

Describe all the characteristics of an acoustic neuroma.

A

VERTIGO | 2º if present at all
ONSET | gradual
DURATION + FREQUENCY| Constant
AUDITORY? | YES (TINNITUS #1)
IMBALANCE | if vertigo, yes
OTHER | CN 5, 7 involvement

20
Q

How are acoustic neuromas diagnosed?

A

MRI with contrast (gold standard)
Audiogram

21
Q

What is the mechanism of injury behind perilymph fistulas?

A

opening between middle and inner ear (rupture) that causes perilymph to leak into middle ear.

22
Q

What causes a perilymph fistula?

A
  • head trauma (direct hit);
  • ear trauma/object perforating ear drum
  • Rapid increase in ICP (weightlifting/childbirth)
23
Q

Describe all the characteristics of perilymph fistulas.

A

VERTIGO | Worsens with activity, increased altitude +/- Valsalva; improves with rest
ONSET | Sudden, often preceeded by trauma
DURATION + FREQUENCY | Dependent on activity, highly varibale.
AUDITORY | YES - FLUCTUATING
IMBALANCE | YES
OTHER | HA, motion intolerance common

24
Q

What test will be posiitve for a perilymph fistula?

A
  • Fistula test
  • Valsalva test
25
Q

How is a perilymph fistula diagnosed?

A
  • Fistula testing: pressurizing test while recording eye movements
  • Valsalva test
  • Audiogram: helps determine side invovled
  • ENG/VNG
  • MRI (rule out CNS)
26
Q

What is the mechanism of injury behind a semicircular canal dehiscence (SCD)?

A

fistula due to lack of temporal bone covering of anterior SCC, often congential that worsens with age (40-60s) or trauma

27
Q

What is the most common semicircular canal invovled in dehiscence?

A

Anterior/Superior

28
Q

Describe SCD Presentation

A

VERTIGO | precipitated by coughing, loud noises, pressure changes in ear
ONSET | sudden, spontaneous
DURATION + FREQUENCY | dependent on activity, highly variable
AUDITORY | YES - FLUCTUATING
IMBALANCE | YES
OTHER | Internal and external sound sensitivity

29
Q

What special tests might be positive with SCD?

A
  • Tulio’s Phenomenon
  • Valsalva Test
  • Bone Sensitivity Test
30
Q

How is a SCD Diagnosed?

A
  • Bedside evaluation (Tulio’s, Valsalva, bone conduction sensitivity tests)
  • Radiographic Imaging (CT Scan)
  • Audiogram
31
Q

What is the mechanism of injury/etiologies behind bilateral vestibular hypofunction
(BVH)?

A
  • Idiopathic
  • Ototoxic agents
  • Autoimmune inner ear disease
  • Chemotherapy
  • Sequential vestibular neuritis
  • Meniere’s disease
  • Meningitis
  • Neurodivergent conditions (ex: MS)
32
Q

What are ototoxic agens that can lead to BVH?

A
  • Aminoglycosides (gentamycin, streptomycin)
33
Q

Bilateral Vestibular Hypofunction Presentation

A

VERTIGO | ONLY if sequential in nature
ONSET | Dependent on cause
DURATION + FREQUENCY | Tends to be constant, worsened by head movements
AUDITORY | Dependent on cause, ototoxicity? YES
IMBALANCE | YES
OTHER | SEVERE OSCILLOPSIA

34
Q

How will the clinical presentation of BVH differ if caused by ototoxic agents versus other etiologies such as bilateral Meniere’s Disease?

A

Ototoxic: oscillopsia will be main complaint
Bilateral Meneiere’s - vertigo, auditory involvement, worsened with head movements

35
Q

How is Bilateral vestibular hypofunction diagnosed?

A

Clinical Exam:
- HIT bilaterally
- Dynamic Visual Acuity
- Caloric testing bilaterally
- Rotary chair Test - gold standard

Neuro II (17 decks)

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