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NPTE > Vestibular > Flashcards

Vestibular Flashcards

1
Q

Peripheral vestibular pathologies

A

Labyrinth related

BPPV
Vestibular neuritis
Labyrinthitis
Acoustic neuroma

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2
Q

Central vestibular pathologies

A

Brain related

CVA
Cerebellar disorder
MS

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3
Q

Central vestibular pathology presentation

A

Ataxia
Abnormal smooth pursuit/saccades
Diplopia/red flags
No hearing loss
Pendular or persistent vertical nystagmus
Visual fixation does not improve sxs

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4
Q

Peripheral vestibular pathology presentation

A

No ataxia
Normal smooth pursuit/saccades
Hearing loss/fullness in ears/tinnitus
Jerk nystagmus (slow/fast phases)
Visual fixation improves sxs

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5
Q

Anatomy of peripheral vestibular system

A

Labyrinth = semicircular canal + otolith organs

Semicircular canals
- posterior
- horizontal
- anterior

Otolith
- utricle
- saccule

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6
Q

BPPV

A

Cause
- infection
- head trauma
- vestibular weakness
- advancing age

s/s
- vertigo w/ change in head position
- nystagmus

*most common cause of dizzy in older individ

Otoconia (calcium carbonate crystals) displaced from utricle in canals

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7
Q

Dix-Hallpike

A

Vertical canal assessment
- posterior = upbeating
- anterior = downbeating

Head rot 45 deg
Affected ear down
20-30 deg cervical ext in supine

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8
Q

Posterior canalithiasis treatment

A

“Epley” or Canalith Repositioning Maneuver (CRM)

Each position held for 1-2 min or until vertigo/nyst subside.

  1. dix-hallpike position, affected down
  2. Rotate to opp side, same pos
  3. Roll to uninvolved SL, nose down
  4. Maintain head position and sit up

Return to neutral sitting > keep head upright for 3-4 min > repeat until no sxs seen (1-2x per session)

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9
Q

Posterior cupulolithiasis treatment

A

Semont or liberatory maneuver

  1. rotate head away from affected side > lay SL on affected side
  2. maintain head position > quickly transition to unaffected SL (nose down)
  3. Return to sitting

Maintain each position for 1 min.

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10
Q

Brandt Daroff Exercise

A

Uses:
Mild vertigo (even after CRM)
For pt that may not tolerate CRM
HEP

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11
Q

Supine roll test

A

Horizontal canal assessment

Both sides tested
Return to neutral b/t each side
30 deg neck flexion

Duration not significant

Geotrophic = canalithiasis on side that is more intense

Apogeotrophic = cupulolithiasis on side that is less intense

(direction of nystagmus points to affected side)

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12
Q

Horizontal canalithiasis treatment

A

BBQ roll

  1. Start with affected ear down
  2. Roll to supine
  3. Roll to unaffected SL
  4. Roll to prone
  5. Sit up from prone

Maintain 20-30 deg cervical flexion in all positions

Hold each position 15 seconds or until sxs stop

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13
Q

Horizontal cupulolithiasis treatment

A

Gufoni

  1. Seated
  2. Neutral SL affected ear down
  3. Quickly rotate nose down 45 deg
  4. Maintain position and return to seated
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14
Q

Labyrinthitis

A

Peripheral

Inflammation of labyrinth (otolith and semicircular canals)

Sudden onset of vertigo, n/v

Positive head-impulse test

Duration: days to weeks

HEARING LOSS
TINNITUS

Labyrinth = Loss

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15
Q

Vestibular neuritis

A

Peripheral

Inflammation of nerve

Sudden onset of vertigo, n/v

Positive head-impulse test

Duration: days to weeks

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16
Q

Vestibulo-ocular reflex (VOR)

A

Gaze stability

Responsible for maintaining focus on an image during rapid head movements

Must generate rapid compensatory eye mvmts in the direction opposite head rotation

Indicates central dysfunction

17
Q

Head impulse/thrust test

A

Assesses VOR

Affected side = side of thrust + abnorm response

18
Q

Meniere’s disease

A

Peripheral

Overproduction of fluid within the inner ear > increase in pressure > vertigo

s/s
- vertigo
- hearing loss
- tinnitus
- aural fullness***

Duration: minutes to hours

Tx: dec salt in diet to dec fluid in ear

19
Q

Acoustic neuroma/vestibular schwannoma

A

Peripheral

Slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear

CN VII and VIII

s/s
Hearing loss
Tinnitus
LOB
Vertigo
Facial numbness and weakness or loss of muscle mvmt (CN VII can be affected - gradual onset)

+HIT

tx: surgery, radiation therapy, observation

20
Q

Unilateral vestibular hypofunction

A

Gaze stability: improves VOR (x1 and x2)

Postural stability and balance

Habituation (do whatever is causing sxs)

21
Q

Bilateral vestibular hypofunction

A

HIT positive bilat

Gaze stability: VOR x1 only (unless asymm involvement)

Imaginary targets (VOR x 1 with EC head turns - EO to look at target w/ head turned)

Walking

22
Q

Clinical test for sensory integration and balance

A

CTSIB

  1. stable, EO
  2. stable, EC
  3. stable, visual conflict
  4. unstable, EO
  5. unstable, EC
  6. unstable, visual conflict

available system = affected
unavailable system = dependent

NPTE (40 decks)

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