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Neuro 2 > Peripheral Vestibular Disorders Pt 1 > Flashcards

Peripheral Vestibular Disorders Pt 1 Flashcards

1
Q

List peripheral vestibular disorders

A
  1. Meniere’s Disease
  2. Vestibular Neuritis
  3. Labyrinthitis
  4. Acoustic Neuroma/Vestibular Schwannoma
  5. Perilymph Fistula
  6. Semicircular Canal Dehiscence
  7. Benign Paroxysmal Positional Vertigo
  8. Bilateral Vestibular Dysfunction
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2
Q

what goes into creating your differential dx list for vestibular conditions?

A
  1. Dizziness characteristics
    • description of dizziness
    • severity
    • temporal
  2. Onset
    • sudden vs gradual
    • spontaneous vs motion-induced
  3. Duration and frequency
  4. +/- auditory involvement
    • hearing loss?
    • tinnitus?
    • ear fullness?
  5. +/- imbalance
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3
Q

what is meniere’s disease?

A

a chronic incurable disorder characterized by recurrent, episodic bouts of vestibular symptoms

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4
Q

what is the mechanism that leads to meniere’s disease?

A

swelling in inner ear resulting in increased pressure and damage within membranous labyrinth including:

  • hair cell death
  • mechanical changes in ear (otolith)
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5
Q

what is the cause of meniere’s diseaes?

A

UNKNOWN

however pts can sometimes report “triggers” leading to attacks

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6
Q

what are some triggers that may result in an attack in a pt w/meniere’s disease?

A
  1. stress
  2. fatigue
  3. emotional distress
  4. additional illness
  5. pressure changes
  6. diet
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7
Q

what is the incidence of meniere’s disease?

A

most prevelant onset 40-60s

*can develop at any age

number 2 most common peripheral vestibular dysfunction

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8
Q

Describe the clinical presentation of meniere’s disease

A

Periodic “attacks”

  1. symptoms including:
    • vertigo
    • oscillopsia
    • ear fullness
    • fluctuating unilateral tinnitis and hearing loss
    • can be preceded by an aura
  2. attacks last minutes to 24 hours
  3. otolithic crisis
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9
Q

what is an otolithic crisis?

A
  1. drop attacks → no warning and high safety concern
    • pt may be conscious when it occurs
  2. attributed to sudden mechanical changes in otoliths
  3. if present very treatable → responds well to meds
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10
Q

define aura

A

a specific set of warning symptoms

for meniere’s this may include:

  1. imbalance
  2. dizziness or lightheadedness
  3. headaches
  4. sound sensitivity
  5. vague feeling of uneasiness
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11
Q

T/F: between attacks a meniere’s disease pt may be asymptomatic?

A

TRUE

but they may also have symptoms and it is a wide assortment

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12
Q

describe the typical 3 stage progression of meniere’s disease

A
  1. Unpredictable attacks of vertigo
  2. vertigo > tinnitis > hearing loss
  3. hearing loss > balance difficulties > tinnitis
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13
Q

how is meniere’s disease diagnosed?

A

Dx of exclusion

  1. Two or more episodes of spontaneous vertigo of at least 20 min to 24 hours
  2. audimetrically documented hearing loss → audiogram
  3. tinnitus or aural fullness → electrocochleography test, MRI
  4. exclusion of other causes
  5. Lab tests
    • ENG/VNG
    • vEMP (alongside vHIT)
    • posturography
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14
Q

describe conservative intervention approaches for meniere’s disease

A
  1. Diet restrictions
    • reduced salt, chocolate, caffeine
  2. Medications
    • diuretics
    • vestibular and CNS suppressants → manage symptoms during attacks
    • steroids (limited evidence)
  3. Vestibular rehab
    1. not during attacks
    2. most appropriate after surgical interventions
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15
Q

describe invasive/surgical intervention approaches for meniere’s disease

A

typically considered after failed conservative measures (20-40%)

  1. Intratympanic Gentamicin
  2. Vestibular nerve section
  3. Labryinthectomy
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16
Q

What is the mechanism for vestibular neuritis?

A

a viral infection of the vestibular branch of the vestibulocochlear nerve or ganglion

  • usually preceding an upper respiratory or gastrointestinal infection (50% of cases)
  • Herpes (HSV-Type I) is also common preceding virus
17
Q

what is the incidence of vestibular neuritis?

A

cause behind 7% of dizziness

across all age groups

3rd most common peripheral vestibular dysfunction

18
Q

describe the acute clinical presentation of vestibular neuritis

A
  1. Spontaneous onset of vertigo associated N/V and imbalance
    • sudden onse t
    • typically days in duration
  2. auditory sytem WNL → NOT IMPACTED
19
Q

describe the chronic clinical presentation of vestibular neuritis

A
  1. period of gradual recovery that may last several weeks, some will have symptoms completly resolved
    • can take months to completely resolve
  2. others left w/residual complaints of imbalance and oscillopsia w/head movements
    • can interfere with participation
    • persistent feeling of disorientation or “haziness”
    • difficulty concentrating and thinking common
20
Q

how is acute vestibular neuritis diagnosed?

A
  1. Clinical Exam
    • dx of exclusion
  2. vHT/HIT
    • +vHT w/symptoms that last longer than a few days are highly suspecting of neuritis
21
Q

how is chronic/severe vestibular neuritis diagnosed?

A
  1. Rotary chair test
  2. Audiogram
  3. vEMP
  4. MRI
  5. Blood work
22
Q

how is vestibular neuritis treated?

A
  1. Medications
    • vestibular suppressants
      • anticholinergics, antihistamines, benzos
    • steroids + antivirals
  2. Vestibular rehab
    • vestibular adaptation exercises appear to speed recovery (tend to do very well in rehab)
    • recovery can take 2-12 months
23
Q

T/F: having a pt on vestibular suppressants to treat vestibular neuritis does not impact recovery timelines

A

FALSE

may prolong if used for too long

24
Q

what is labryinthitis?

A

inflammation within the labyrinth

a sudden onset of vertigo, N/V, disequilbirum that lasts days

25
Q

what are some potential causes of labryinthitis?

A
  1. Viral → most common cause
    • viral upper respiratory tract infection
    • herpes, influenza, measles, MMR, polio, hepatitis, Epstein-Barr, varicella
  2. Bacterial → more common in children
    • bacterial meningitis
    • ear infections
26
Q

what are the symptoms of labryinthis?

A

symptoms of neuritis + hearing loss

vertigo, N/V, disequilibrium

gradual abatement within a few weeks

27
Q

how is labyrinthis treated?

A

same meds as vestibular neuritis, plus an antibiotic such as amoxicillin if there is evidence for a middle ear infection

28
Q

if a pt has recurrent labyrinthitis, what is is called?

A

the diagnosis changes to Meniere’s disease

Neuro 2 (29 decks)

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