Peripheral Vestibular Disorders Pt.2 Flashcards
what is an acoustic neuroma?
slow-growing tumor derived from Schwann cells of the vestibulocochlear nerve or internal auditory canal
describe the clinical presentation of an acoustic neuroma
- Gradual or sudden onset of tinnitus, hearing loss, vertigo or disequilibrium
- hearing loss, tinnitus most common 1st symptom
- balance, vertigo, disequilbirum (~50%)
- Symptoms tend to depend on location of tumor
- small tumor → hearing may be preserved, pt may be asymptomatic
- as it grow, it can compress CN V or VII
- can cause pressure on brainstem or cerebellum if large enough
how is an acoustic neuroma diagnosed?
- MRI w/contrast - gold standard
- Audiogram
What are some interventions for acoustic neuroma?
- Surgical removal
- Radiation
- Monitoring (depening on size/location)
- Vestibular rehab only once tumor has been fully resected
what is a perilymph fistula?
an opening in between middle and inner ear that is caused by rupture of the oval window resulting in perilymph leaking into middle ear
what are typical causes of perilymph fistula?
most commonly associated with head trauma
- usually trauma involves direct blow to the ear
- other causes:
- ear trauma
- objects perforating ear drum
- rapid increases in ICP (weighlifting, childbirth)
describe the clinical presentation of perilymph fistula
- sudden onset of:
- vertigo
- motion intolerance
- ear fullness
- fluctuating hearing
- severe HA, N/V can also occur
- Symptoms worsen w/activity but improve w/rest
- Tulio’s phenomenon
what types of things worsen symptoms of perilymph fisutla?
changes in altitude
valsalva-eliciting activities
what is Tulio’s phenomenon?
use of one’s own voice or musical instrument will cause dizziness
how is perilymph fistula diagnosed?
A confident dx is difficult
- Fistula test
- pressurizing test while recording eye movements
- Valsalva test
- pt holds breath while recording eyes
- Audiogram → helps determine involved side
- ENG/VNG
- MRI (rule out CNS)
List some intervention strategies for perilymph fistulas
- Smaller fistulas → conservative management
- rest
- avoid lifting or any activity that would increase ICP
- if pt can take it easy, most cases resolve on their own
- Surgical repair
- exploratory tympanotomy
- vestibular nerve section
- Vestibular Rehab post-surgical repair often warranted
what is SCC Dehiscence?
the bony labyrinth that surrounds the membranous labyrinth of our canals degrades over time
fistual due to lack of temporal bone covering of superior SCC
which canal is most common affected by SCC dehiscence?
superior/anterior canal
(aka SCDS)
what is the incidence of SCC dehiscence?
- middle age disorder
- up to 60% can report premorbid trauma that shifted symptoms
- 25% bilateral
describe the clinical presentation of SCC dehiscence
- Transient vertigo precipitated by coughing, loud noises and pressure changes in ear
- Pressure sensitivity
- sneezing, coughing, Valsalva, lifting, bowel movement
- Sound sensitivity
- Internal → heel strike w/gait, eye movement, hear beat, own voice
- External
- Imbalance
- may be constant
- accentuated w/head movement, dark environment
- Hearing loss, tinnitus, aural fullness
how is SCC dehiscence diagnosed?
- Bedside eval
- Test for Tulio’s phenomena
- Valsalva test
- Bone conduction sensitivity test
- tuning fork on lateral malleoli (+test = pt hears sound in inner ear)
- Radiographic imagining (CT scan)
- Audiogram
What are some intervention options for SCC Dehiscence?
Will not benefit from rehab
- Conservative
- avoid offending stimuli
- noise (earplug)
- exertion
- avoid offending stimuli
- Surgery
- canal “plugging”
- resurfacing surgery
- Rehab possibly after surgery
what causes bilateral vestibular hypofunction?
- Idiopathic in 50% of cases
- Typically caused by otoxic agents
- Other etiologies include:
- autoimmune inner ear disease
- chemo agent → Cisplatin
- sequential vestibular neuritis
- meniere’s disease
- meningitis
- neurodegenerative conditions
describe the clincial presentation for bilateral vestibular hypofunction
- primary complian → severe oscilopsia
- particulary during walking (imbalance, possibly due to hearing loss)
- Vertigo only if loss is sequential in nature
- functional tasks become inefficient and exhausting
how is bilateral vestibular hypofunction diagnosed?
- Clinical exam
- +HIT (bilaterally)
- +Dynamic Visual Acuity
- +Caloric testing
- Rotary chair test - gold standard
List some interventions for bilateral vestibular hypofunction
- Medical management
- meds typically not helpful
- vestibular suppressant meds typically worsen symptoms
- no surgical intervention available to restore vestibular function
- Vestibular rehab
what is the impact of vestibular rehab on bilateral vestibular hypofunction?
- improvement in postural control and gaze stability w/predictable > unpredictable head movements noted
- sig functional improvements noted by pts
- however, typically w/residual impairment
- difficulty driving due to oscillopsia, especially at night
- imbalance w/moving about in dark environment
- however, typically w/residual impairment
