Vestibular Disorders Flashcards
BPPV timeframe
Seconds
BPPV associated s/s
Posturally evoked
Vestibular Migraine timeframe
minutes to hours to days
Vestibular Migraine hearing loss
Rare
Vestibular Migraine : associated s/s
Photophobia
Aura
Headache
Meniere’s : timeframe
Minutes to hours
Meniere’s : hearing loss
Low frequency
Fluctuating, progressive
Usually unilateral
Meniere’s : associated s/s
aural fullness
Tinnitus
Labrynthitis : timeframe
Days
Labrynthitis : hearing loss
Possible (effusion)
Labrynthitis : associated s/s
URI prodrome
Acoustic neuroma : timeframe
Days to longer
Acoustic Neuroma : hearing loss
Asymmetric
Acoustic Neuroma : associated s/s
Headache
Variable disequilibrium
Superior Semi-circular canal Dehiscence Syndrome : timeframe
Intermittent - after noise/air pressure changes
Superior Semi-circular Canal Dehiscence Syndrome (SCCD) : hearing loss
Supra-normal hearing
Superior Semi-circular Canal Dehiscence Syndrome (SCCD): associated s/s
From head injury
Perilymphatic fistula : timeframe
Seconds to minutes
Perilymphatic fistula : hearing loss
Possible
BPPV : hearing loss
NO
Perilymphatic Fistula : associated s/s
Worse w/ Valsalva or ME fluid
Vestibular neuronitis : timeframe
Sudden, days to weeks
Vestibular Neuronitis : associated s/s
Slow, sometimes incomplete improvement
Proper vestibular history
Onset Duration Triggers Associated complaints Hearing changes
Peripheral vertigo
Inner ear Sudden onset Horizontal nystagmus N/V Fixation to suppression
Central vertigo
Slow onset
Vertical nystagmus
No suppression w/ fixation
Caloric testing
Cows
Electrocochleography to dx
Fluid pressure of inner ear
Meniere’s , endolymphatic hyrops
Auditory brainstem response dx
Brainstem function
Acoustic neuroma
Vertigo Tx
ANTIHISTIMINE DOPE - BLOCKER (metoclopramide) ANTICHOLINERGIC BENZO Meclinzine, scopolamine Steroids Salt/caffeine restrict Vestibular rehab Intratympanic steroid/endolymphatic shunt
Vertigo #1 cause
BPPV - Peripheral
Head position, one direction
Resolves in seconds
Intact hearing
Where do most crystals come from
Otoconia from utricle to
Posterior semicircular canal
BPPV : Dx
Peripheral
Dix hallpike
Nystagmus towards affected side
BPPV : Tx
Peripheral
Eply maneuver
Meniere’s disease : s/s
Peripheral
TINNITUS, VERTIGO, HEARING LOSS
Prolonged vertigo
Fluctuating H.L - low freq tilt
Early stage fullness
Meniere’s : Tx
Peripheral
Salt/caffeine restrict
Benzo (acute)
Diuretics - triamterene, HCTZ
Oral steroid (acute), intratympanic
2nd most common vertigo cause
Vestibular migraine
Peripheral
Migraine correlates w/
Dizziness
Migraine / Meniere’s link
Vasospasm of internal auditory artery –> ischemia in labyrinth
Hearing loss, ELH
Vestibular Neuritis/Labrynthitis: presentation
Peripheral
Sudden violent (continuous) vertigo N/V Hours to days \+/- hearing loss Usually preceded by viral URI Nystagmus - away, rotary
Vestibular Neuritis / Labrynthitis : Tx
Peripheral
STEROIDS
ANTIHISTIMINES (meclizine)
Benzos
Some - vestibular rehab
Perilymphatic Fistula : where
Peripheral
Windows in middle/inner ear
Perilymph fluid leaks in middle ear
Perilymphatic Fistula : s/s
Peripheral
Dizziness Tinnitus Hearing loss HEAD TRAUMA WORSE W/ ACTIVITY/PRESSURE/ALTITUDE
Perilymphatic fistula :
tx
Peripheral
Self-heal
Surgery
Acoustic Neuroma : present
Central
UNILATERAL SENSORINEURAL LOSS
Tinnitus/dizziness
Acoustic Neuroma: Dx
Central
MRI = Dx
Romberg/Tandem Romberg towards affected side
Acoustic Neuroma : Tx
Central
Surgery
Stereotactic radiation
Other central vertigo causes
Lyme Demyelinating disease CVA (basilar, cerebellar) Psychogenic CNS infxn/tumor Drugs
Meniere’s
types
Classical Cochlear (no dizzy) Vestibular (no hearing loss) Bilat (inner ear autoimmune) Subclin Endolympatichydrops Post trauma *years later