unilateral vestibular disorders - medbridge Flashcards
what is vestibular neuritis and how would you recognize it?
- viral insult to the vestibular nerve
- typically impacts superior vestibular nerve (innervation of anterior and lateral semicircular canals and utricle)
- spontaneous symptoms typically (50%) preceded by respiratory of GI infection (HSV-type 1 virus)
- NO auditory symptoms, marked imbalance and oscillpsia
What is the typical treatment for neuritis
- Steroid dose pack
- NO vestibular suppressants
- vestibular adaptation exercises (compensations)
The anterior vestibular artery supplies what parts of the vestibular organ
supplies the utricle, superior saccule, and ampulae of the anterior and lateral semicircular canals
How would you recognize anterior vestibular artery ischemia
- Vascular risk factors
- spontaneous onset of vertigo (typically days) with nausea/vomiting and imbalance
- NO auditory symptoms
What is the typical treatment for anterior vestibular artery ischemia
- Medical management - of vascular risk factors
- Good rehab candidate for developing compensation
How would recognize labyrinthitis
- sponaneous onset of vertigo (typically lasting days) with associated nausea/vomiting and imbalance
- AUDITORY symptoms
- Viral or bacteria infection
What is the typical treatment for labyrinthitis
- Antibiotics/steriods
- Short course of vestibular suppressants
- Good rehab candidate
- Need a hearing test
What type of hearing loss would you expect with labyrinthitis
- high and low tone loss of 15% or more compared to the unaffected side
What are the diagnostic criteria for Meniere’s disease
- 2 or more spontaneous vertigo of a least 20 minutes to 24 hours
- Audiometrically documented hearing loss
- tinnitis or aural fullness
- exclusion of other causes
what causes Meniere’s disease
- cause is unclear,
- malapsorption of endolymph in the endolympathic duct or sac
Descire the incidence of Meniere’s disease
- audiological symptoms develop within one year
- males=females
- onset usually the 4th decade
- typically last 7 years
- (B) involvement in 19% of cases
Describe the pattern of hearing loss with Meniere’s disease
- low frequency asymmetric loss
- usually within one year of symptom develop
- can fluctuate with symptoms
what is a “otolithic crisis event of Tumarkin”
- conscious drop attack (aware of fall)
- no warning
- violent
- brief
- occurs in late stance of Meniere’s disease
- no vertigo, feels like they were pushed
How is Meniere’s disease managed
- vestibular suppresants during acute attacks only
- limit sodium intake
- dyazide (diuretic)
- Steroids have questionable value
- 1/3 of cases require surgical ablation of the vestibular nerve, labyrinthectomy, or gentamycin injection
what role does physical therapy play in Meniere’s disease
- no indicated in patients with frequent episodes
- fair potential with stable conditions
- address secondary BPPV
- Good potential post surgical intervention
