vestib prac

Question 1

What 3 pieces of information from the subjective would support this diagnosis?

Answer 1

TYPE: spinning (self or the world), rocking, light-headedness, or imbalance.
DURATION: last for seconds, minutes, hours or days? Is her dizziness constant, intermittent or mixed?
ASSOCIATED SYMPTOMS: hearing loss or fullness of the ear, vision loss, nausea,

Question 2

PERIPHERAL:

Answer 2

• BPPV
• UVL
  • Meniere’s
  • Fistula / Dehiscence
  • Acousitc Neuroma - labrinythsis
  • Neuritis
• BVL = migraine, meniere’s disease, infection, Ototoxic

Question 3

CENTRAL

Answer 3

– won’t fatigue
• Vascular
• Traumatic
• De‐myelination

OTHER
• Cervico‐genic
• Concussion

Question 4

PERIPHERAL 2:

Answer 4

• Will fatigue with fixation
• Primarily horizontal and slightly torsional
• Peripheral will evoke less positions of provocation
• Nystagmus:
• Towards < center < away (last to go)

Question 5

Vestibular neuritis

Answer 5

: INFLAMMATION OF CN 8 (VESITVULAR NERVE) – generally post viral infection
SUPERIOR: AFFECTS ANTERIOR AND HORIZONTAL CANAL AND UTRICLE
POSTERIOR: POSTERIOR CANAL AND SACCULE
TYPE: acute onset of prolonged rotatory vertigo/spinning
DURATION: more than 1, less than 4 days
ASSOCIATED SYMPTOMS: no hearing loss, TINNITUS, aural fullness (unless only inferior), postural imbalance/nausea (vomiting), exacerbated by head mvmt but present continously

Question 6

Vestibular neuritis observations

Answer 6

VISUAL OBSERVATIONS: Nystagmus ‐ horizontal‐rotary nystagmus beating away from affected ear (may not be felt or called jumpy eyes by the patient)…
AFFTER EPISODE:
Type: giddiness but symptom free at rest
Duration: ‐ constant… as recovers/ intermittent
Associated symptoms: postural imbalance / nausea / fatigue / jumpy vision – blurred with
Movement …. May or may not see nastagmus

Question 7

Vestibular Labryrinth:

Answer 7

presentation is identical to neuronitis however with additional hearing loss – lesion site at labyrinth

Question 8

Meniere’s Disease and Endolymphatic Hydrops

Answer 8

• Swelling of fluid causing disorder of inner ear function.
• Two variants:
  o Vestibular
  o Cochlear
• Usually has onset in the 4-6th decades
• Up to 25% bilateral
  TYPE: vertigo
  DURATION: minutes to hours but less than a day
  ASSOCIATED SYMPTOMS: postural imbalance / nausea / directional propulsion, hearing: hearing loss +/- aural fullness (feels like pressure in the ear), tinnitus (low pitch) (UNILATERAL), exacerbated by head mvmt, but continuously present during acute phase
  VISUAL OBSERVATIONS: Nystagmus towards during episode - ringing

Question 9

Meniere’s Disease and Endolymphatic Hydrops

Answer 9

AFTER ACUTE PERIOD:
Type: giddiness
Duration: constant/intermittent
Associated Symptoms: hearing ISQ or return to normal – each progressive attack often not
return to Normal. Postural imbalance / nausea / fatigue / jumpy vision – blurred with
movement, postural imbalance / nausea / fatigue / jumpy vision – blurred with movement
After episode - horizontal nystagmus opposite way

Question 10

Perilymphatic Fistula/ Semi Circular Canal Dehsisence

Answer 10

Perilymphatic Fistula - hear a ‘pop’- Abnormal opening between the air‐filled middle ear and the fluid‐filled inner ear
/ Semi Circula Canal Dehsicence – most common fistula, Dehiscence of the superior semicircular canal = loss of bone over roof of semicircular canal
TYPE: vertigo but not always
DURATION: constant/intermittent

Question 11

Perilymphatic Fistula/ Semi Circular Canal Dehsisence

symptoms and observations

Answer 11

ASSOCIATED SYMPTOS: hearing loss, postural imbalance / nausea / fatigue / jumpy vision – blurred with movement. Provoking positions/movement‐head movements / busy environments / visual stimulation / noisy environments (tullios phenomenon / pressure inducing postures actions(Hennebert’s sign)
OBSERVATIONS: horizontal‐rotary nystagmus beating toward affected ear (may not be felt or called jumpy eyes by the patient)…
• FEELS NOISY INSIDE HEAD, VERY RARE

Question 12

ACOUSTIC NEUROMA

Answer 12

: Non-malignant tumour on the vestibular portion of the vestibular nerve (CN 8) – NEED MRI TO DIAGNOSE/CT SCAN IS USELESS
TYPE: giddiness / rocking / directional propulsion – NO VERTIGO/SPINNING BEVAUSE TUMOUR IS SLOWLY GROWING SO BODY HAS TIME TO COMPENSATE/ADAPT
DURATION ‐ constant / intermittent… depends on growth rate

Question 13

ACOUSTIC NEUROMA observations and symptoms

Answer 13

ASSOCIATED SYMPTOMS: unilateral hearing loss (generally first sign), tinnitus, postural imbalance / nausea / fatigue / jumpy vision blurred with movement/ head aches / facial weakness / facial numbness, provoking positions/movement‐head movements / busy environments / visual stimulation
Visual observations: No nystagmus unless acute and poorly adapted
ANY HEARING LOSS AND CHANGE ON ONE SIDE REQUIRES IMMEDIATE REFFERAL