Vestibular Flashcards
MEDICAL CAUSES of Vertigo
● CARDIOVASCULAR
● HYPOTENSION
● CARDIAC ARRYTHMIA
● CAD
● HYPERTENSION
● INFECTION
● HYPOGLYCEMIA
Causes of vertigo
Medical
- Cardiac
- Metabolic
Neurological
- TBA
- CVA
Vestibular
- Peripheral
- Central
NEUROLOGICAL CAUSES vertigo
● STROKE AND TIA
● VERTIBROBASILAR MIGRAINE
● BASAL GANGLIA DYSFUNCTION
● CEREBELLAR
● SEIZURE
OTOLOGIC CAUSES vertigo
● BPPV
● MENIERES DISEASE
● UNILATERAL VESTIBULAR DYSFUNCTION
● BILATERAL VESTIBULAR DYSFUNCTION
● MIDDLE EAR DYSFUNCTION
● FISTULA
Vertigo
● OVER 5 MILLION MD VISITS PER YEAR IN U.S.
● OVER 75 YEARS OF AGE
● MOST COMMON REASON TO SEE MD
CAUSES OF DIZZINESS
ETIOLOGY
PSYCHOGENIC
CERVICAL
METABOLIC
CENTRAL VESTIBULAR
PERIPHERAL VESTIBULAR
CARDIOVASCULAR
OTHER CAUSES OF VERTIGO
● A - alcohol
● E - epilepsy or exposure (heat stroke, hypothermia)
● I - insulin (diabetic emergency)
● O - overdose or oxygen deficiency (shortness of breath, hyperventilation)
● U - uremia (toxins due to kidney failure)
● T - trauma (head injury or shock)
● I - infection
● P - poisoning or psychosis
● S - stroke
PERIPHERAL VESTIBULAR PROBLEMS - UNILATERAL
● BPPV
● ACUTE UNILATERAL VESTIBULAR DEAFFERENTATION
● VESTIBULAR NEURITIS
● VESTIBULAR LABYRINTHITIS
● PERILYMPHATIC FISTULA
● ENDOLYMPHATIC HYDROPS
● MENIERES DISEASE
● ACOUSTIC NEUROMA
PERIPHERAL VESTIBULAR PROBLEMS - BILATERAL
● OTOTOXICITY
● INFECTION
● ACOUSTIC NEUROMA
● INNER EAR AUTOIMMUNE DISEASE
● MENIERES
● BPPV
BPPV THEORIES (2)
● CUPULOLITHIASIS
● CANALITHIASIS
CUPULOLITHIASIS
● DEBRIS FROM UTRICULAR MACULA SETTLES BY GRAVITY ON TO THE CUPULA OF THE SEMICIRCULAR CANAL
● CUPULA THUS OBTAINS A HIGHER SPECIFIC GRAVITY THAN THE ENDOLYMPH AND BECOMES SENSITIVE TO GRAVITY DURING CHANGES IN HEAD POSITION
Symptoms of Canalithiasis
BRIEF EPISODES OF VERTIGO INDUCED BY CHANGE IN HEAD POSITION
●USUALLY INVOLVES THE POSTERIOR SCC
● CONSISTENT TYPICAL CHARACTERISTICS
CHARACTERISTICS of Canalithiasis
- POSITIONALLY INDUCED
- LATENCY IN THE ONSET OF SYMPTOMS
- MOST COMMONLY TORSIONAL NYSTAGMUS WITH THE SUPERIOR ASPECT OF THE EYE BEATING TOWARD THE AFFECTED EAR WHICH APPEARS WITH THE SAME LATENCY AS THE COMPLAINTS OF VERTIGO
- A CRESCENDO AND DECRESCENDO OF THE VERTIGO AND NYSTAGMUS WITH LASTS LESS THAN 60 SECONDS
MOVEMENT TOWARD THE__________ IS EXCITATORY IN THE HORIZONTAL CANALS, BUT IN THE __________& _____ CANALS, MOVEMENT AWAY FROM THE ________IS EXCITATORY
AMPULLA
ANTERIOR
POSTERIOR
AMPULLA
Syptoms of Canalithiasis
- SHOULD IMPLY A LONGER DURATION OF POSITIONAL NYSTAGMUS
- SIMILAR EVENT OCCURS WITH ETOH
What is Canalithiasis?
● LOOSE PARTICLES DISPLACED INTO SCC WHICH WOULD INDUCE A MOVEMENT AWAY FROM THE AMPULLA, PULLS ON THE CUPULA AND EXCITES THE NEURONS
● SHORT DURATION OF NYSTAGMUS WHEN SCC PLACED IN THE SAME PLANE WITH GRAVITY
SURGERY for BPPV
- LABYRINTHECTOMY
- CHEMICAL LABYRINTHECTOMY
- VESTIBULAR NERVE SECTION
- PERILYMPHATIC FISTULA REPAIR
- POSTERIOR CANAL PARTITIONING
- ACOUSTIC NEUROMA REMOVAL
- CHOLESTEATOMA REMOVAL
- ENDOLYMPHATIC SAC DECOMPRESSION PROCEEDURES
VESTIBULAR NEURITIS
- USUALLY VIRAL
- DURING OR FOLLOWING AN UPPER RESPIRATORY INFECTION
- PEAK OF CASES IN WOMEN IN THE 4TH DECADE, MEN IN THEIR 60’S
- DIZZINESS NAUSEA AND VOMITING
- CALORIC TESTS IPSILATERAL HYPORESPONSIVENESS
ACUTE VESTIBULAR DEAFFERENTATION
● AFTER SURGICAL ABLATION
● ACUTE PHASE OF VESTIBULAR NEURITIS
What is the acute phas of vestibular neutitis called?
Vestibular Deafferentation
PERIYMPHATIC FISTULA MOE
- HEAD TRAUMA
- BAROTRAUMA
- SURGERY
- PENETRATING INJURY
Perilympathic Fistula S&S
- LOUD POPPING SOUND
- SEVERE VERTIGO
- HEARING LOSS
- TINNITUS
- TULIO’S PHENOMENON
PERILYMPHATIC FISTULA location
BETWEEN THE MIDDLE EAR AND THE PERILYMPH
Perilympathic fistula agg factors
- SNEEZING,
- COUGHING
- STRAINING
- NOSE BLOWING WILL REPRODUCE THE SYMPTOMS
Treatment for Perilympathic Fistula
- Bed rest
- REQUIRES IMMEDIATE SURGERY IF SNHL IS PRESENT
BAROTRAUMA - causes
- Implosion on descent
- Explosion on ascent
● USUALLY INVOLVES RUPTURE OF UTRICLE AND SACCULE
ENDOLYMPHATIC HYDROPS
- INNER EAR FLUID CHEMISTRY SHOULD REMAIN CONSTANT
- MALFUNCTION OF THE MECHANISMS WHICH MAINTAINS PRESSURE AND COMPOSITION CONSTANT
- NERVE ENDINGS BECOME ABNORMALLY STIMULATED
S&S of Endolympathic Hydrops
- AURAL FULLNESS
- TINNUTUS
- HEARING LOSS
- VERTIGO
MENIERES DISEASE
- IDEOPATHIC SYNDROME OF ENDOLYMPHATIC HYDROPS
- MALFUNCTION OF RESORPTIVE FUNCTION OF ENDOLYMPHATIC SAc
S&S of Menieres Disease
- AURAL FULLNESS
- DECREASED HEARING LOSS
- TINNITUS
- SEVERE VERTIGO AND DYSEQUILIBRIUM 30 MIN TO 24 HOURS
Coservative treatment for Minieres Disease
- Salt reduced diet
- Dieuretic / Betaserc
- Pressure chamber
- Treatment with local overpressure
Surgical and / destructive treatment for Minieres
- Surgery of endolympathic sac
- Gentamyacin injection
- Vestibular nerve section
- Complete destruction of inner ear
IDEOPATHIC VESTIBULAR DEGENERATION
- OCCURS WITH AGING
- COMMON IN PATIENTS WITH EARLY BALDING OR GRAYING
- ESPECIALLY IS GRAYING OCCURRED BEFORE AGE 30
Acoustic Neuroma -cause
- MAY BE INHERITED TENDENCY
- TUMOR ON ACOUSTIC NERVE
S&S of Acoustic Neuroma
- PROGRESSIVE HEARING LOSS
- TINNITUS IN ONE EAR
- VESTIBULAR BRANCH COMPRESSION
- IMBALANCE
- VERTIGO
- MAY BE SLOW GROWING
CHOLESTEATOMA
- CYST LIKE GROWTH
- COMMONLY FORMS IN Pts WITH CHRONIC MID EAR INFECTION OR PERFORATED EAR DRUM
- BENIGN TUMOR OF MIDDLE EAR
- ERODES THE BONE OF THE INNER EAR
SS of Cholesteatoma
- HEARING LOSS
- VERTIGO
- FOUL DRAINAGE FROM THE EAR
Causes of Bilateral Vestibular Loss
- OTOTOXIC DRUGS
- BILATATERAL MENIERES DISEASE
- AUTOIMMUNE DISEASE SJORGRENS
- SYPHILLIS
- BILATERAL ACOUSTIC NEUROMA
- INFECTION
- OTOSCLOSIS
- PAGETS DISEASE
BILATERAL VESTIBULAR LOSS impairments
- SEVERE OSCILLOPSCIA
- GAIT SEVERELY IMPAIRED WITH HEAD MOVEMENT
- UNABLE TO DO TANDEM STANCE WITH EYES OPEN
- POOR OUTCOME ON FUKUDA STEP TEST
BILATERAL VESTIBULAR LOSS SS
- IF EQUAL ON BOTH SIDES NO VERTIGO NYSTAGMUS OR SKEW DEVIATION
- NO GAZE STABILIZATION WITH HEAD MOVEMENT
- SEVERELY IMPAIRED GAIT
- VISUALLY AND PROPRIOCEPTIVELY DEPENDENT
Ototoxic drugs - Antibiotics
- AMINOGLYCOSIDES
- STREPTOMYCIN
- NEOMYCIN
- GENTAMICIN
- TOBRAMYCIN
OTHER ANTIBIOTICS
- ERYTHROMYCIN
- VANCOMYCON
- CAPREOMYCIN
Ototoxic Drugs- Anti Neoplastic Drugs
- Cispatin
- Carboplatin
- Vincristin
- Bleomycin
Ototoxic Drugs- Loop Dieuretics
● Furosemide
● Ethacrynic Acid
● Bumetanide
Ototoxic Drugs- Anti-Inflammatory Drugs
- SALICYLATES
- INDOMETHACINN
- IBUPROPHEN
- PIROXICAM (FELDANE)
Ototoxic Drugs- Anti-Malaria Drugs
● QUININE
● CHOLOQUINE
Ototoxic Drugs- Miscellaneous
- HEAVY METALS
- INDUSTRIAL CHEMICALS
- ARSENICALS
- LEAD
- CARBON MONOXIDE
- MERCURY
VERTIBROBASILAR INSUFFICIENCY
- COMMON CAUSE OF VERTIGO IN THE ELDERLY
- OCCURS SUDDENLY NO WARNING
- LASTS SEVERAL MINUTES
- OFTEN WITH NAUSEA AND VOMITING
- HEADACHE IMPAIRED VISION CAN ALSO OCCUR
Common cause of vertigo in elderly
Vertibrobasalar insufficiency
Etilogy of Dizziness- Timing
- SUDDEN ONSET USUALLY PERIPHERAL
- GRADUAL ONSET USUALLY CNS
- INTERMITTENT USUALLY PERIPHERAL
- CONTINUOUS USUALLY CNS
Etiology of Dizziness- Associated Symptoms
- NUMBNESS
- DYSARTHRIA
- CHANGE IN LOC
- LINKED TO INJURY
- LINKED TO RESPIRATORY ILLNESS
- SCUBA ● RELATED TO POSITION
Etiology of Dizziness- Peripheral
- Neuritis
- Menieres
- BPPV
- Barotrauma
- Ototoxia
- Surgery
- Trauma
- Acoustic Neuroma
- Otosclerosis
Etiology of Dizziness- Central
- VERTIBROBASILAR INSUFFIENCY
- MIGRAINE
- LABYRININE
- CEREBELLAR
- BRAINSTEM INFARCTION
- TIA
- STROKE
Ethiology of Dizziness- Medical
- HYPOTENSION
- HYPERTENSION
- CARDIAC ARRYTHMIA
- CORONARY ARTERY DISEASE
- INFECTION
- MEDICATION
- HYPOGLYCEMIA
Etiology of Dizziness- Phychophysiologic
- ACUTE ANXIETY
- CHRONIC ANXIETY
- PANIC ATTACKS
- SECONDARY GAIN
