Test 2: vestibulopathies Flashcards
describe vestibulopathies
peripheral vestibular dysfunction
can be unilateral or bilateral
may require habituation or adaptation or both
CPG applies if VRT is appropriate based on etiology
types of vestibulopathies
vestibular neuritis
labyrinthitis
meniere’s disease
acoustic neuroma
superior canal dehiscence syndrome
perilymphatic fistula
labryinthine concussion
ototoxicity
what is a videonystamography
video goggles used to track for nystagmus with various conditions
what is a electronystagmography
electrodes used around the eye to record electric activity
what is a rotary chair
sit in a chair in a dark room that spins around
what is video head impulse test
studies VOR at high frequency
more sensitive than clinical head impulse test
what is vestibular evoked myogenic potential
applying a repetitive sound stimulus to one ear and then averaging the reaction of the muscle activity in response to each sound click or pulse
CVEMP (cervical mm)
OVEMP (ocular mm)
what is computerized dynamic posturography
detects postural sway by measuring shifts in the center of gravity (COG) as a person moves within their limits of stability
what is caloric testing
water or air in ear to see electrical activity
describe vestibular neuritis
inflammation of balance portion of CN VIII (can be inferior or superior portion)
precipitated by viral illness (usually a few weeks prior)
acute onset vertigo
lasts min to hours
likely have N&V
usually no hearing impact
often unilateral but can be bilateral
diagnosis of vestibular neuritis
head impulse test, caloric testing, VEMP
management of vestibular neuritis
glucocorticoids in first 3 days since symptom onset
want to reduce the inflammation
is vestibular neuritis responsive to vestibular rehabilitation treatment (VRT)
yes
how long until vestibular neuritits improves
6 weeks to 3 months
what is labyrinthitis
bacterial or viral infection of labryrinth
if bacterial it is generally meningitis
will affect hearing and balance
prolonged vertigo
N&V
will have tinnitis
often unilateral but can be bilateral
diagnosis of labyrinthitis
head impulse test
caloric testing
vestibular evoked myogenic potential
will also test CSF, auditory markers, and MRI in case of bacterial
treatment of labyrinthitis
bacteria = antibiotics
autoimmune/viral = steroids
is labyrinthitis responsive to VRT
yes
describe meniere’s disease
aka endolymphatic hydrops
ischemia or fibrosis of endolymphatic sac causing abnormalities in endolymph drainage
often the catch all term for vestibular disorders
may have N&V
may have fluctuating hearing loss
may have tinnitus that sounds like roaring
starts unilateral and progresses to bilateral
episodic
diagnosis of menieres
audiogram is important; will show low frequency hearing loss
may test positive on vestibular hypofunction tests
treatment for menieres
not curable
2g/day of sodium to control fluids
diuretics to lower extracellular fluid
does menieres respond to VRT
may respond to VRT at first but need to move to habituation as it gets worse
what is an acoustic neuroma
aka vestibular schwannoma
benign tumor CN VIII
often presents in the internal auditory canal but can present other places as well
symptoms dependent on tumor location
if in IAC - will have hearing and balance impairment
tumors are slow growing so symptom onset can be slow
typically unilateral
diagnosis of acoustic neuroma
may be positive on other CN VIII screens like Renne and Webber
MRI and CT needed
