Session 2 pre reading balance problems Flashcards
what is the vestibular system?
the part of the inner ear responsible for balance
what are vestibular lesions?
damage or dysfunction to the vestibular system
how can we tell the are vestibular lesions?
they disrupt the normal balance functions leading to symptoms like: vertigo, dizziness and imbalance
what are the 5 vestibular lesions?
1- BBPV (benign paroxysmal positional vertigo)
2- Labyrinthitis/ Vestibular Neuritis
3- Meniere’s Disease:
4- Perilymph Fistula
5- SSCD (Superior Semicircular Canal Dehiscence)
what is BPPV caused by?
Caused by displaced otoconia (small crystals in the inner ear) affecting the semicircular canals, leading to vertigo triggered by head movements.
what is labyrinthitis?
Inflammation of the entire labyrinth (inner ear), which can affect both balance and hearing.
what is Vestibular Neuritis?
Inflammation of the vestibular nerve, primarily affecting balance without impacting hearing.
what is Meniere’s disease?
A disorder involving excess fluid in the inner ear (endolymphatic hydrops) leading to episodes of vertigo, tinnitus, and fluctuating hearing loss.
What is Perilymph Fistula?
A tear or defect in the bony structure of the inner ear or in the round or oval windows, allowing perilymph (inner ear fluid) to leak into the middle ear, causing dizziness and hearing changes.
what is SSCD?
An opening in the bone that covers one of the semicircular canals, leading to abnormal fluid movement and causing vertigo, hearing issues, and heightened sensitivity to internal sounds.
what is a common cause of dizziness?
BPPV
what does BPPV stand for?
Benign- its not life threatening
Paroxysmal- it comes on suddenly and in brief spells
Positional- triggered by certain head
movements and positions
Vertigo- a false sense of rotational movement
how common is BPPV among older adults?
how common is BPPV among older adults?
what percentage of all dizziness is attributed to BPPV?
20%
what are some symptoms of BPPV?
1-rotatory vertigo
2-head and body movements: rolling over in bed, getting up from bed, bending over, quick head movement
3-sensation of falling/ sinking
4-disorientated
5-veering off to one side
what is the mechanism that causes BPPV?
1- otoconia from the utricle become detached form their gel membrane and move through the endolymph
2- most commonly settling in the PSCC or more rarely in the anterior or horizontal semicircular canals
3-the detached otoconia shift when the head moves
4-this stimulates the cupula to send false signals to the brain which creates a sensation of vertigo
what are causes of BPPV?
1- head injury ( fall or car accident) can dislodge otoconia from their normal position in the utricle, allowing the,m to migrate into the semi-circular canals
-2degeneration of the vestibular system (aging= deterioration of vestibular system=more likely dislodged otoconia=BPPV)
-3idiopathic (without clear reason)
4-secondary to vestibular labyrinthitis (inflamed inner ear structures= disruption of normal functioning of vestibular system= dislodgement of otoconia)
5-secondary to Meniere’s disease ((Meniere’s disease+ fluid build up in inner ear = pressure changes= displacement of otoconia= BPPV)
6-secondary to minor strokes of the anterior inferior cerebella (rare) - (minor stroke affecting area of brain controlling balance = disruption of vestibular function= dislodgement of otoconia- BPPV)
what are the treatments from BPPV?
1- the GOLD standard Dix Hallpike test
2- repositioning manoeuvre; Epley Manoeuvre
3- post Epley instructions
4- home exercises: Brant Daroff exercises
5- refer back to ENT from canal plug surgery (RARE)
how does the GOLD standard Dix Hallpike test work?
assesses how the eyes respond to specific head movements
a positive result causes characteristic eye movement (Nystagmus)
What is the Epley Maneuver, and how does it help?
involves specific head and body movements designed to move dislodged otoconia from the semi-circular canals back into their proper position in the utricle
What are Brandt-Daroff exercises?
home exercises for patients with BPPV, designed to help the brain adapt to changes in balance and reduce symptoms, they involve repeated head movements that encourage the otoconia to settle back in their proper places
What are post-Epley instructions?
after performing the Epley maneuver, patients are give post- Epley instructions to help prevent the reoccurrence of symptoms including:
avoiding sudden head movements
-sleeping in a slightly elevated position (using extra pillows)
staying upright for a specified period after the maneuver
How common is Vestibular Neuritis and Labyrinthitis?
accounts for 5% of all dizziness and affects all ages
what is the canal plug surgery?
involves blocking the affected semicircular canal to prevent the sensation of vertigo
Symptoms of VN/Labyrinthitis
Sudden, severe vertigo (spinning/swaying sensation)
Vertigo can last up from a several days to a couple of weeks.
Random attacks of dizziness
Balance difficulties
Nausea, vomiting
Concentration difficulties
Labyrinthitis (same symptoms as above)
- Hearing loss
- Tinnitus
what are some causes of VN/Labyrinthitis?
Unknown
Viral infection of the inner ear
Viral infection which has occurred somewhere else in the body.
Example: Herpes virus, measles, common flu.
what are some Treatment of VN/Labyrinthitis?
- Medication
- Vestibular suppressants – Betahistine - Stop the incorrect balance
information - Anti – emetics (used for nausea)
- Treating the virus – Antiviral medicine - Acyclovir
- Vestibular rehabilitation
what age ground does Meniere’s affect?
age 40-60 but can affect anyone
how common is Meniere’s disease?
quite rare condition- 1 in 1000
what are the symptoms of Meniere’s disease?
Dizziness or vertigo (attacks of a spinning sensation)
Hearing loss
Tinnitus (a roaring, buzzing, or ringing sound in the ear)
Sensation of fullness in the affected ear
Symptoms tend to come and go together
What are the causes of Meniere’s disease?
-unknown
– Research suggest: Too much endolymph being produced, blocked
endolymphatic duct resulting in inefficient drainage of the
endolymph
what are the treatments of Meniere’s disease?
Medications: Vestibular Suppressants, Anti- Emetics, Diuretics (to control fluid balance)
Diet control
VR to control symptoms in between attacks
Hearing aid
Intratympanic Gentamicin
Surgical intervention:
Labyrinthectomy – Destruction of the labyrinth
Endolymphatic Shunt
Grommet insertion
what are the symptoms of Perilymph Fistula (PF)?
Ear fullness, Fluctuating or ‘sensitive’ hearing, Vertigo (without the spinning), motion intolerance,
Hearing loss, symptoms get worse with changes in altitude.
what causes SSCD (Superior Semicircular Canal Dehiscence)?
True cause of SSCD is unknown: Congenital or may have occurred during the development of the
inner ear.
Ear infections or head trauma.
what causes Perilymph Fistula (PF)?
Head trauma.
Rapid and intense changes in intracranial or atmospheric pressure such as SCUBA
diving, weightlifting or childbirth.
surgery
what are the symptoms of Superior Semicircular Canal Dehiscence (SSCD)?
Vertigo, Oscillopsia (appearance of movement of stationary objects), Autophony
(hearing one’s voice or self-generated sounds like breathing and blinking louder than normal),
Sensitivity to loud sounds, Fullness/pressure in the ears
what is the treatment for SSCD?
surgery- plugging the dehiscence
