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NCS Exam > Vestibular > Flashcards

Vestibular Flashcards

1
Q

Diseases that have hearing loss

A
  • 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
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2
Q

Hearing loss with Meniere’s disease

A

low to mid frequency

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3
Q

Sound induced hearing loss

A

“divots” around ~4,000hz

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4
Q

Age related hearing loss

A
  • Symmetrical
  • High frequency
  • non-pulsatile (continuous)
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5
Q

What does caloric testing test?

A
  • test the horizontal semi-circular canal and determines whether it is intact or not (PNS)
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6
Q

+ and - caloric test?

A
  • 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
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7
Q

What does the rotary chair test?

A
  • 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
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8
Q

What does VEMP testing test?

A

the otolith organs / vestibular nerve

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9
Q

Peripheral components of Vestibular system

A
  • 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)
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10
Q

Central components of vestibular system

A
  • 4 Vestibular nuclear complex located in the brain stem
  • vestibular nuclear complex pathways
  • Vestibular cerebellum
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11
Q

What does the superior vestibular nerve supply?

A
  • Utricle
  • Anterior semicircular canal
  • horizontal semicirular canal
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12
Q

what does the inferior vestibular nerve supply?

A
  • Saccule

- Posterior semicircular canal

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13
Q

pathway for vestibular information

A

afferent information–> vestibular nuclei in the brainstem–> modulated by the cerebellum —> vestibulospinal tracts directly coordinate responses

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14
Q

what does the utricle sense?

A
  • horizontal gravity (left and right) IE when a car or train stops
  • static tilt: yes/no and maybe
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15
Q

what does the saccule sense?

A

vertical (up and down) acceleration IE elevator

- cervical flexion / extension is a combination of both

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16
Q

VOR vs COR

A

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

17
Q

Characteristics of BPPV

A
  • 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
18
Q

what does Dix hallpike test ?

A
  • Tests: Anterior and posterior semicircular canal
19
Q

positive dix pallpike test interpretation

A
  • 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)
20
Q

what does a roll test test?

A
  • tests: horizontal canal
21
Q

roll test interpretation

A
  • 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
22
Q

head position for dix hallpike vs roll test

A
  • 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
23
Q

Treatment for posterior/anterior Canalithiasis

test and test position)

A
  • 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
24
Q

Treatment for posterior/anterior Cupulolithiasis

test and test position

A
  • 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
25
Q

Treatment for horizontal canalithiasis

A

BBQ roll

26
Q

treatment for horizontal cupulolithiasis

test and test position

A

Modified liberatory (semont) maneuver

27
Q

Modified test for hall pikedix

A

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

NCS Exam (13 decks)

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