Vestibular Pathology Flashcards

1
Q

Describe the mechanism behind Meniere’s

A

abnormally large amount of endolymph> inner ear swelling> increased pressure and membranous labyrinth>hair cell death and mechanical change in otolith

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2
Q

Describe Meniere’s presentation

A

-vertigo sometimes w/ aura(may or not be symptomatic between attacks)
-sudden and spontaneous
-minutes-24 hrs episodes variable in frequency
-ear fullness/fluctuating tinnitus /hearing loss
-drop attacks
-sympathetic NS symptoms

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3
Q

What are the 3 stages of Meniere’s Progression

A
  1. unpredictable vertigo attack
  2. vertigo>tinnitus>hearing loss
  3. Hearing loss>balance difficulties>tinnitus
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4
Q

Describe the mechanism behind neuritis

A

viral infection of the vestibular branch of vestibulocochlear nerve ganglion
-preceding upper respiratory or GI infection in 50% of cases

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5
Q

Describe the mechanism behind labyrinthitis

A

viral or bacterial inflammation within entire labyrinth; viral is most common and usually post-upper respiratory tract

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6
Q

Describe Neuritis and Labyrinthitis presentation

A

-severe acute vertigo that gradually reduces in severity
-spontaneous and sudden onset
-acute (days-week) vs chronic (weeks to months)
-labyrinthitis (hearing loss) vx neuritis
-imbalance and disorientation + oscillopsia

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7
Q

What are examination findings for ACUTE labyrinthitis and neuritis?

A

dx of exclusion, +vHIT with symptoms more than a few days

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8
Q

What are examination findings for CHRONIC labyrinthitis and neuritis?

A

rotary chair test, audiogram, VEMP, MRI, blood work

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9
Q

Describe the mechanism behind acoustic neuroma/Schwannoma

A

slow growing tumor from schwann cells of CN 8 or internal auditory canal

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10
Q

Describe acoustic neuroma presentation

A

usually vertigo is secondary and onset is gradual
constant w/ auditory involvement
tumor can hit CN 5 & 7 as well

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11
Q

How are acoustic neuromas diagnosed?

A

MRI w/ contrast is gold standard but there is also audiograms for hearing dom dx

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12
Q

Describe the mechanism behind perilymph fistulas.

A

opening between middle and inner ear mostly assoc w/ head trauma or rapid increases in ICP> dysfn to labyrinth and cochlea+leaking perilymph

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13
Q

Describe perilymph fistula presentation.

A

vertigo worsens with activity and pressure changes, traumatic onset, fluctuating hearing symptoms, imbalance, commonly HA and motion intolerance

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14
Q

How are perilymph fistulas diagnosed?

A

fistula test, valsalva test, audiogram, ENG/VNG, MRI (CNS rule out)

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15
Q

Describe the mechanism behind semicircular canal dehiscence (superior/anterior most common)

A

can result from premorbid trauma or congenital structure> a fistula due to lack of temporal bone covering semicircular canal

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16
Q

Describe semicircular canal dehiscence (superior/anterior most common) presentation

A

vertigo triggered by pressure changes, spontaneous onset, activity dependent duration and frequency, fluctuating auditory involvement, imbalance w/ sound sensitivity

17
Q

How are SCDs diagnosed?

A

Bone conduction sensitivity test (tuning fork on lat malleoli)
Tulio’s Phenomenon
Valsalva Test
Radiograph+ Audiogram

18
Q

Describe the mechanisms behind bilateral vestibular hypofunction

A

can be idiopathic or secondary to ototoxic agents (often antibacterial)

19
Q

Describe bilateral vestibular hypofunction presentation.

A

vertigo is sequential and onset depends on cause, constant symptoms that worsen with head movement, imbalance and hearing issues if ototoxic, severe oscillopsia

20
Q

How is bilateral vestibular hypofunction

A

rotary chair test is gold standard

clinical exam: HIT bilaterally, Dynamic visual acuity, bilateral caloric testing