Peripheral Vestibular Disorders Pt 1 Flashcards
List peripheral vestibular disorders
- Meniere’s Disease
- Vestibular Neuritis
- Labyrinthitis
- Acoustic Neuroma/Vestibular Schwannoma
- Perilymph Fistula
- Semicircular Canal Dehiscence
- Benign Paroxysmal Positional Vertigo
- Bilateral Vestibular Dysfunction
what goes into creating your differential dx list for vestibular conditions?
- Dizziness characteristics
- description of dizziness
- severity
- temporal
- Onset
- sudden vs gradual
- spontaneous vs motion-induced
- Duration and frequency
- +/- auditory involvement
- hearing loss?
- tinnitus?
- ear fullness?
- +/- imbalance
what is meniere’s disease?
a chronic incurable disorder characterized by recurrent, episodic bouts of vestibular symptoms
what is the mechanism that leads to meniere’s disease?
swelling in inner ear resulting in increased pressure and damage within membranous labyrinth including:
- hair cell death
- mechanical changes in ear (otolith)
what is the cause of meniere’s diseaes?
UNKNOWN
however pts can sometimes report “triggers” leading to attacks
what are some triggers that may result in an attack in a pt w/meniere’s disease?
- stress
- fatigue
- emotional distress
- additional illness
- pressure changes
- diet
what is the incidence of meniere’s disease?
most prevelant onset 40-60s
*can develop at any age
number 2 most common peripheral vestibular dysfunction
Describe the clinical presentation of meniere’s disease
Periodic “attacks”
- symptoms including:
- vertigo
- oscillopsia
- ear fullness
- fluctuating unilateral tinnitis and hearing loss
- can be preceded by an aura
- attacks last minutes to 24 hours
- otolithic crisis
what is an otolithic crisis?
- drop attacks → no warning and high safety concern
- pt may be conscious when it occurs
- attributed to sudden mechanical changes in otoliths
- if present very treatable → responds well to meds
define aura
a specific set of warning symptoms
for meniere’s this may include:
- imbalance
- dizziness or lightheadedness
- headaches
- sound sensitivity
- vague feeling of uneasiness
T/F: between attacks a meniere’s disease pt may be asymptomatic?
TRUE
but they may also have symptoms and it is a wide assortment
describe the typical 3 stage progression of meniere’s disease
- Unpredictable attacks of vertigo
- vertigo > tinnitis > hearing loss
- hearing loss > balance difficulties > tinnitis
how is meniere’s disease diagnosed?
Dx of exclusion
- Two or more episodes of spontaneous vertigo of at least 20 min to 24 hours
- audimetrically documented hearing loss → audiogram
- tinnitus or aural fullness → electrocochleography test, MRI
- exclusion of other causes
- Lab tests
- ENG/VNG
- vEMP (alongside vHIT)
- posturography
describe conservative intervention approaches for meniere’s disease
- Diet restrictions
- reduced salt, chocolate, caffeine
- Medications
- diuretics
- vestibular and CNS suppressants → manage symptoms during attacks
- steroids (limited evidence)
- Vestibular rehab
- not during attacks
- most appropriate after surgical interventions
describe invasive/surgical intervention approaches for meniere’s disease
typically considered after failed conservative measures (20-40%)
- Intratympanic Gentamicin
- Vestibular nerve section
- Labryinthectomy
What is the mechanism for vestibular neuritis?
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
what is the incidence of vestibular neuritis?
cause behind 7% of dizziness
across all age groups
3rd most common peripheral vestibular dysfunction
describe the acute clinical presentation of vestibular neuritis
- Spontaneous onset of vertigo associated N/V and imbalance
- sudden onse t
- typically days in duration
- auditory sytem WNL → NOT IMPACTED
describe the chronic clinical presentation of vestibular neuritis
- period of gradual recovery that may last several weeks, some will have symptoms completly resolved
- can take months to completely resolve
- 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
how is acute vestibular neuritis diagnosed?
- Clinical Exam
- dx of exclusion
- vHT/HIT
- +vHT w/symptoms that last longer than a few days are highly suspecting of neuritis
how is chronic/severe vestibular neuritis diagnosed?
- Rotary chair test
- Audiogram
- vEMP
- MRI
- Blood work
how is vestibular neuritis treated?
- Medications
- vestibular suppressants
- anticholinergics, antihistamines, benzos
- steroids + antivirals
- vestibular suppressants
- Vestibular rehab
- vestibular adaptation exercises appear to speed recovery (tend to do very well in rehab)
- recovery can take 2-12 months
T/F: having a pt on vestibular suppressants to treat vestibular neuritis does not impact recovery timelines
FALSE
may prolong if used for too long
what is labryinthitis?
inflammation within the labyrinth
a sudden onset of vertigo, N/V, disequilbirum that lasts days
what are some potential causes of labryinthitis?
- Viral → most common cause
- viral upper respiratory tract infection
- herpes, influenza, measles, MMR, polio, hepatitis, Epstein-Barr, varicella
- Bacterial → more common in children
- bacterial meningitis
- ear infections
what are the symptoms of labryinthis?
symptoms of neuritis + hearing loss
vertigo, N/V, disequilibrium
gradual abatement within a few weeks
how is labyrinthis treated?
same meds as vestibular neuritis, plus an antibiotic such as amoxicillin if there is evidence for a middle ear infection
if a pt has recurrent labyrinthitis, what is is called?
the diagnosis changes to Meniere’s disease
