Vestibular Flashcards
Diseases that have hearing loss
- Meniere’s disease
- superior canal dehiscense
- labyrinthitis
- acoustic neuroma / vestibular schwannoma (unilateral hearing loss)
- perilympatic fistula (fluctuating hearing loss)
- can have unilateral hearing loss with AICA stroke
- sometimes with Bilateral vestibular toxicity and TIA
Hearing loss with Meniere’s disease
low to mid frequency
Sound induced hearing loss
“divots” around ~4,000hz
Age related hearing loss
- Symmetrical
- High frequency
- non-pulsatile (continuous)
What does caloric testing test?
- test the horizontal semi-circular canal and determines whether it is intact or not (PNS)
+ and - caloric test?
- Positive: decreased or absent nystagmus
- Negative: COWS: Cold water/air: the fast beat of the nystagmus is opposite of the ear being tested. Warm water/air fast beat nystagmus is towards the ear being tested
What does the rotary chair test?
- compares speed of head movement to speed of eye movement (tests VOR- PNS
- Assesses the horizontal semi-circular canal and / or superior vestibular nerve
- gold standard for testing for Bilateral vestibular loss
What does VEMP testing test?
the otolith organs / vestibular nerve
Peripheral components of Vestibular system
- 2 Otoliths (utricle and Saccule)
- 3 semi-circular canals (anterior, horizontal, posterior)
- Vestibular portion of Cranial nerve 8 (Superior vestibular nerve and inferior vestibular nerve)
Central components of vestibular system
- 4 Vestibular nuclear complex located in the brain stem
- vestibular nuclear complex pathways
- Vestibular cerebellum
What does the superior vestibular nerve supply?
- Utricle
- Anterior semicircular canal
- horizontal semicirular canal
what does the inferior vestibular nerve supply?
- Saccule
- Posterior semicircular canal
pathway for vestibular information
afferent information–> vestibular nuclei in the brainstem–> modulated by the cerebellum —> vestibulospinal tracts directly coordinate responses
what does the utricle sense?
- horizontal gravity (left and right) IE when a car or train stops
- static tilt: yes/no and maybe
what does the saccule sense?
vertical (up and down) acceleration IE elevator
- cervical flexion / extension is a combination of both
VOR vs COR
VOR: maintains a steady image when the head is moving. For high frequency head movements
COR: cervical prioprioceptors drive eye movement to keep image stable. For slower head speeds. Can use this to compensate for vestibular loss
Characteristics of BPPV
- sudden onset
- brief episodes of vertigo with positional changes and/or head movements
- symptoms fatigue with repetition
- there is a slight latency of seconds
- c/o vertigo and nystagmus
what does Dix hallpike test ?
- Tests: Anterior and posterior semicircular canal
positive dix pallpike test interpretation
- up/down beat plus torsional
- up = posterior semicircular canal
- down = anterior semicircular canal
- laterality = fast beat is towards the involved ear (should be the testing ear/ the ear that is down)
what does a roll test test?
- tests: horizontal canal
roll test interpretation
- Geotropic nystagmus (towards the earth) = canalithiasis. Increased nystagmus with involved ear down.
- Ageotrophic (away): < 60 seconds = canalithiasis
>60 seconds= cupulolithasis. Increased nystagmus with UNINVOLVED EAR DOWN
head position for dix hallpike vs roll test
- Dix: 20 degrees of cervical extension and 45 degrees of cervical rotation TOWARDS the testing ear
- roll test: maintain 20 degrees of neck flexion throughout. ONLY HEAD ROLLS. Body stays in supine. Start supine, head rotates 90 degrees to left, wait one minute, return to supine, then to the right
- for both: always test bilaterally
Treatment for posterior/anterior Canalithiasis
test and test position)
- Epley Maneuver aka canal repositioning maneuver
- from testing position (involved ear is down), head to rotated 45 degrees towards the UNINVOLVED ear (wait 30-60 sec), body is then turned to sidelying position (wait 30-60 sec). Then sit up
Treatment for posterior/anterior Cupulolithiasis
test and test position
- Liberatory (semont) Maneuver
- start seated edge of mat, cervical extension 20 degrees, cervical rotation 45 degrees AWAY from the testing ear, testing ear is brought down to mat; maintain head position and go rapidly to the other side (nose should be pointing down). Wait up to 2 minutes. Return to sitting with cervical rotation maintained
Treatment for horizontal canalithiasis
BBQ roll
treatment for horizontal cupulolithiasis
test and test position
Modified liberatory (semont) maneuver
Modified test for hall pikedix
sidelying test
- seated edge of mat, cervical extension 20 degrees, cervical rotation 45 degrees AWAY from the testing ear, testing ear is brought down to mat
