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Acquired Auditory Vestibular Disorders > Vestibular Disorders > Flashcards

Vestibular Disorders Flashcards

Lecture 14

You may prefer our related Brainscape-certified flashcards:
Preparativo Vestibular e ENEM flashcards
1
Q

the vestibular system is a somatosensory portion of the nervous system that provides?

A

awareness of the spatial position of the head and body (proprioception) and conscious awareness of active and passive limb movements and body position

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2
Q

3 components of the vestibular system

A

1) a peripheral sensory apparatus (inner ear)
2) central vestibular system (structures within the brainstem and cerebellum)
3) a motor output (connections with various motor nuclei and muscles)

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3
Q

the peripheral sensory apparatus is also called

A

vestibular labyrinth

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4
Q

the peripheral sensory apparatus is housed in the inner ear and consists of two types of motion sensors

A

three semicircular canals
two otolith organs - utricle / saccule

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5
Q

the semi circular canals are sensors for?

A

angular or rotational acceleration of the head
- detect movement in three dimensional space

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6
Q

otolith organs - utricle and saccule are sensors for?

A

Linear acceleration with respect to gravity

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7
Q

the utricle is sensitive to a change in ?

A

linear movement
sideways or up/down

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8
Q

the saccule gives information about?

A

vertical acceleration
- in a elevator

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9
Q

information regarding head movement is relayed peripheral to the central vestibular system by ?

A

vestibular portion of the vestibulocochlear nerve (Cranial nerve VIII)

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10
Q

why do disorders affecting the vestibular labyrinth often affect the cochlea to?

A

cochlea and vestibular labyrinth share blood supply

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11
Q

vestibular symptoms

A

dizziness and equilibrium

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12
Q

cochlear symptoms

A

hearing loss, tinnitus, or both

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13
Q

Central vestibular system receives input from ?

A

peripheral vestibular mechanism by vestibular division of CN VIII

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14
Q

input from vestibular labyrinth is processed in association with?

A

Visual sensory and somatosensory input

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15
Q

output from vestibular nuclei influences

A

eye movement
truncal stability
spatial orientation

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16
Q

motor output of the vestibular system is integrated into three vestibular reflexes

A

vestibulo ocular reflex (VOR) Gaze stabilizing reflex

vestibulospinal reflex (VSR)

vestibulocollic reflex (VCR)

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17
Q

when the head rotates about any axis (horizontal/vertical) distant visual images are stabilized by

A

rotating eyes about the same axis but in the opposite direction to stabilize

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18
Q

oscillopsia

A

disparity between head and eye movement is unstable gaze during head movement

illusion of unstable visual world , objects in visual field oscillate

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19
Q

vestibulospinal reflex (VSR)

A

stabilizes posture

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20
Q

vestibulocollic reflex

A

stabilizes head

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21
Q

the three components of the vestibular system work together to ?

A

Maintain balance by orienting a persons body position and motion in space

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22
Q

lesions in the cerebellum associated with?

A

nystagmus
gait ataxia

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23
Q

vestibular mechanism damaged, common manifestations are

A

sense of imbalance
dizziness/vertigo
nystagmus

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24
Q

vertigo is a type of dizziness specific to ?

A

vestibualr system disorders

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25
Q

self

A

subjective vertigo

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26
Q

environment

A

objective vertigo

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27
Q

true vertigo is almost always caused by deficits within the ?

A

peripheral labyrinth or its connections to the cental vestibular system

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28
Q

vertigo can be

A

peripheral or central origin

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29
Q

True vertigo it is

A

associated with an illusory sense of motion or rotation over which individuals have no control

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30
Q

major conditions that produce episodic vertigo include

A

menieres
reccurrent vestibular neuritis
benign paroxysmal positional vertigo
migraine associated vertigo
SSCD
posttraumatic vertigo - labyrinthine fracture

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31
Q

nystagmus refers to

A

disturbance of ocular movement characterized by rhythmic oscillations or rapid jerky movements of one or both eyes

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32
Q

what forms basis of detection, nature of nystagmus in response to eye gaze. positional changes, and vestibular stimulation

A

electronystagmography (VNG) tests

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33
Q

vestibular compensation involves changes in the

A

central vestibular nuclei that leads to partial restoration of lost neural activity within affected nuclei which reduces the asymmetry and rebalances vestibular activity

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34
Q

symptoms occur with acute unilateral peripheral vestibular injury because of?

A

asymmetry input between right and left central vestibular nuclei

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35
Q

bilateral peripheral deficits generally

A

DO NOT show vestibular compensation

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36
Q

central vestibular pathology

A

DOES NOT show vestibular compensation

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37
Q

what is vestibular labyrinthitis

A

inflammation of inner ear labyrinth

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38
Q

vestibular neuritis is?

A

inflammation of vestibular nerve

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39
Q

labyrinthitis and vestibular neuritis often preced by infections

A

cold/flu/otitis media
measles/mumps
meningititis

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40
Q

what is single most common complication of acute or chronic OME?

A

serous labyrinthitis

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41
Q

Cochlear symptoms are present in vestibular labyrinthitis or vestibular neuritis?

A

Vestibular labyrinthitis

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42
Q

Cochlear symptoms of in vestibular labyrinthitis

A

aural fullness
tinnitus
high frequency SNHL

43
Q

Vestibular symptoms of vestibular labyrinthitis and neuritits?

A

actue vertigo
nausa/vommitting
nystagmus

44
Q

electronystagmography (ENG) or videonystagmography (VNG) results indicate

A

peripheral vestibular anomalies

45
Q

treatment of labyrinthitis and vestibular neuritis

A

antibiotic/antiviral drugs
vestibular suppressant drugs
steroids for HL

46
Q

labyrinthitis and vestibular neuritis differential diagnosis

A

otitis media with effusion
perilymphatic fistula
benign paroxysmal positional vertigo - no HL

47
Q

what is the primary arterial supply to cochlea?

A

Labyrinthine

48
Q

vascular occlusion of labyrinthine artery

A

occlusion causes sudden and profound SNHL and vestibular dysfunction

49
Q

migraine headaches is

A

severe, episodic, and disabling neurological condition

50
Q

migrane charactersized by

A

unilateral head throbbing
fatigue
auditory/visual inputs
nausea/ vomitting

51
Q

Migraine associated vertigo should have migraine symptoms in at least

A

50% of vertigo episodes

52
Q

Benign paroxysmal Positional Vertigo is

A

most common cause of vertigo if peripheral origin

53
Q

benign

A

not life threatening

54
Q

Paroxysmal

A

sudden; brief spells

55
Q

Positional

A

triggered by certain head movements or positions

56
Q

Vertigo

A

false sense of rotational movement

57
Q

BBPV etiology

A

55 average
idiopathic
head trauma
vestibular neurititis
menieres
migrane
diabetes
osteoporosis

58
Q

Clinical presentation of BBPV

A

mild intense diziness
getting out of bed, HEAD POSITIONING
worse in morning and evening

59
Q

what does BBPV involve?

A

posterior semicircular canal

60
Q

BBPV takes one of three forms:

A

1) acute; resolves over 3 months
2) intermittent ; active and inactive
3) Chronic; continous

61
Q

BBPV pathophysiology

A

otolith organs contain otoconia or otoliths, sensitive to gravity

otoliths become dislodged and migrate into fluid filled semicircular canals

otoliths move with gravity while fluid in semi circular canals do not, fluid moves when it is normally still

when particles accumulate in canals they interfere with normal fluid movement that canals use to sense head motion

inner ear sends false signals to brain that head is moving, resulting in diziness

62
Q

BBPV evaluation

A

audiogram/MRI normal

DIX HALLPIKE TEST

63
Q

BBPV management

A

Epley maneuver
surgery in cases to stop vertigo

64
Q

Menieres Syndrome

A

idiopathic syndrome characterized by endolymphatic hydrops

65
Q

Menieres pathophysiology

A

result of overproduction or under absorption of endolymph

66
Q

Menieres epidemiology

A

peak age 30-60
unilateral but can become bi lateral

67
Q

Menieres clinical presentation

A

intermittent episodes of vertigo
fluctuating SNHL
tinnitus
aural fullness

68
Q

what is required for a definitive diagnosis of menieres

A
  • two or more definitive episodes lasting 20 minutes or longer
  • a least two of the four characteristic symptoms should be present
69
Q

acute cases of menieres

A

vertigo lasts from 2-4 hours but can last up to 12 to 24
- vertigo of long duration with other smyptoms is indicative of menieres
- hearing can return to normal

70
Q

as menieres progresses,

A

attacks more frequent
HL does not return to normal
WRS continues to deteriorate
recruitment becomes permanent

71
Q

menieres disease and hearing loss

A

acoustic distortion at first, affecting speech understanding
- loudness recruitment

72
Q

change in hearing that is considered significant is

A

shift of >15 dB HL for average threshold of 0.5, 1, 2,3 khz
shift in word rec scores of 15to 20% or greater

73
Q

early state of menieres, audiometric configuration

A
  • low frequency rising SNHL
    worse from 250 to 1000 with normal hearing from 2000 and up
  • flat configuration ; moderate to moderately severe SNHL
    W/ bi laterla disease an asymmetery of >25 dB HL reported
74
Q

Middle stage, audiometric configuration

A

hearing sensitivity is reduced at all frequencies but worse at high and low frequencies
- reverse cookie bite configuration

75
Q

Late (burn out stage) audiometric configuration

A

flat severe sensorineural hearing loss
- peaks at 1000 and 2000

76
Q

menieres disease immittance

A

normal tymps
reflexes present at lower sensation levels

77
Q

diplacusis

A

same tone presented to both ears sounds different and or distorted in menieres ear

78
Q
A
79
Q

loudness recruitment

A

abnormal growth of loudness for signals at suprathresholds itensities
-ARTs obtained at lower SL

80
Q

electrocochleography

A

test that reflects elevation of inner ear pressure, distention of the basilar membrane of the inner ear

81
Q

what is considered significant/positive for Menieres disease

A

> 0.42 0r 42%

82
Q

menieres management during an acute attack

A

sedatives and tranquilizers to control vertigo and nausea

83
Q

long term management of menieres

A

decreasing the endolymph - low sodium diet

increasing vascualr circulation of the inner ear

84
Q

Are cochlear implants useful for menieres?

A

YESSS excellent option

85
Q

menieres differential diagnosis

A

acoustic neuroma
labyrinthine viral infections
idiopathic vertigo
perilymphatic fistula
cogan syndrome

86
Q

Superior Semicircular Canal Dehiscence

A

sscd creates a third mobile window into the inner ear that alters the normal fluid mechanics of vestibulocochlear system

87
Q

Etiology of SSCD

A

developmental anomaly of temporal bone (congenital)
- head trauma such as skull fractures
idiopathic

88
Q

SSCD signs and symptoms

A

vestibular symptoms alone or auditory systems alone
both symptoms
no symptoms

89
Q

SSCD can mimic several auditory and vestibular systems (differential diagnosis)

A

Patulous (open) eustachian tube

90
Q

SSCD vestibular symptoms can be evoked by loud noises or maneuvers that change middle ear intracranial pressure

A

S/S caused by excessive movement of perilymph
- vertigo/diziness
- nystagmus
- tullios phenomenon
- Oscillopsia

91
Q

Conductive and/or fluctuating HL can occur with SSCD mimicking

A

otosclerosis or menieres

92
Q

for SSCD patients show what kind of audiometric configuration 70%

A

low frequency air bone gap (worse at 250 through 1000 hz)

93
Q

what is an important test for differential diagnosis of otosclerosis and SSCD

A

ARTS
otoslcerosis is abnormal SSCD
SSCD ARTS remain normal

94
Q

diagnosis of SSCD

A

vestibular treatment
high resolution temporal bone CT scans
EcochG

95
Q

Treatment of SSCD
mild to moderate

A

conservative treatment for mild to moderate symptoms
- ear plugs to avoid loud sounds

96
Q

Treatment of SSCD
debilitating symptoms

A

surgical repair with bony cement or soft tissue plugging

97
Q

Mal de debarquement

A

illusion of movement felt after long travel on water by boat

sickness of disembarkment

98
Q

Etiology of mal de debarquement

A

middle aged women

99
Q

symptoms of mal de debarquement

A

rocking, swaying, and disequilibrium after return to land
anxiety and depression
worse in enclosed spaces when motion less

100
Q

Diagnosis of mal de debarquement

A

no specific tests
subjective history
objective diagnostic such as vestibular testing and radiologic imaging

101
Q

Treatment of mal de devarquement

A

no treatment
standard drugs for motion sicknees
vestibular rehabilitation

102
Q

vestibular dysfunction in children is often accompanied by

A

hearing loss

103
Q

genetic conditions with HL that affect vestibular system

A

CHARGE
EVA
BOR
Bilateral waardenburg
Usher

104
Q

if a child has a hearing loss of >60 dB HL and has not walked by 14.5 months

A

suspect vestibular dysfunction

Acquired Auditory Vestibular Disorders (3 decks)

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