Vestibular

Question 1

Common cause for Bilateral Vestibular hypofunction

Answer 1

ototoxic agents like gentamicin, PVH also

BL Meniere’s disease
trauma, autoimminune, neurodegenerative, alchohol

*pathologic, not just positional like BPOPV

Question 2

Describe oscillopsia

Answer 2

Sensation of moving objects (oscillating)
Usually BL pathology

Question 3

Diff between unilateral and BL vestibular hypofunction

Answer 3

UVH - vertigo and nystagmus due to imbalance between two sides

BVH - Typically not vertigo, nystagmus b/c balanced pathology, but there is disequilibrium, oscillopsia, instability with posture/gait

Question 4

What is a diagnostic test for posterior canal BPPV

Answer 4

Dix Hallpike is the test
Epleys Maneuver is treatment

No saccades or smooth pursuit issues

Question 5

What is diagnostic test and treatment for horizontal canal BPPV

Answer 5

Supine roll is the test
Barbecue roll is the manuever

Question 6

What are some signs of a central lesion

Answer 6

Pure ubeating or downbeating nystagmus, wide BOS, direction-changing nystagmus, catch up saccades,

abnormal smooth pursuits b/c coordination of eyes not intact

Pendular nystagmus (equal speeds)

Question 7

Interventions for central lesions

Answer 7

balance training, gaze stabilization exercises, etc.

Question 8

Interventions for UVH

Answer 8

Habituation training, balance training,
Amount of training is 1-2 times per week
Greater amount of weeks for BL or chronic vs UL acute

Question 9

Signs of peripheral lesion (general)

Answer 9

Slow and fast paced jerk nystagmus (not equal speed)

normal smooth pursuit and saccades because coordination of eyes intact

Question 10

Wha is an abnormal saccade

Answer 10

inaccurate, jerky too fast or too slow when looking back and fourth

Question 11

What is an abnormal smooth pursuit

Answer 11

Cant follow moving target

Question 12

Unilateral hypofunction causes

Answer 12

Menieres disease, trauma, surgery, ototoxic medication

Question 13

Push pull relationship

Answer 13

corresponding planes on one side vs the other. One side is excited while the other is inhibited

Question 14

VOR

Answer 14

Vestibular Ocular Reflex

Question 15

VSR

Answer 15

Vestibular spinal reflex

controlled by vestibulospinal tracts and reticulospinal tracts

Question 16

Vertigo is

Answer 16

Mismatch between vestibular inputs and the expected based on movement completed

Question 17

Peripheral dx

Answer 17

unilateral, BL hypofunctions, BPPV, Menieres

Question 18

BPPV diagnostic criteria

Answer 18

1-2 second latency, then increases early on, lasts 30 sec to 2 min, will go away after precipitating positon maintained

Movement provoked,

Question 19

Dix hallpike steps and results

Answer 19

Sitting turn head 45 degrees to affected side
Bring down to supine with head into 30 ext off table
Hold 1 - 2 min

Confirmed w/ upbeat torsional and slight horizontal, fast beating

Question 20

Canalithiasis vs cupulithiasis (stuck)

Answer 20

Key difference
The canal has latency and set time 30 sec to 2 min
cupulo (octonia stuck) so NO latency and stays until position is changes because it is stuck

Question 21

Menieres Disease

Answer 21

Starts with fullness of the ear, tinnitus, loss of hearing, then UVH symptoms

Intervention: MEDS, no vestibular exercisers in acute phase.