Vestibular pathology Flashcards
1
Q
meniere’s
vertigo characteristics
A
Severe vertigo, can be preceded by aura (migraine)
Between attacks often asymptomatic
Those who are symptomatic between attacks have a wide assortment of S&S
2
Q
meniere’s
onset
A
Sudden, spontaneous (unless identifiable trigger)
3
Q
meniere’s
duration and frequency
A
Minutes to up to ~24 hours
Highly variable in frequency, ≥ 2 episodes
4
Q
meniere’s
auditory involvement
A
YES
Ear fullness, fluctuating unilateral tinnitus and hearing loss
5
Q
meniere’s
imbalance
A
YES
Can see OTOLITHIC CRISIS (”Drop attacks”)
6
Q
meniere’s
other S/S
A
diarrhea, diaphoresis, tachycardia,
trembling, anxiety
7
Q
3 stages of progression in meniere’s
A
unpredictable attacks of vertigo
vertigo> tinnitus> hearing loss
hearing loss> balance difficulties> tinnitus
8
Q
lab testing for meniere’s
A
ENG/VNG
VEMP
posturography
9
Q
neuritis
A
Viral infection of the vestibular branch of vestibulocochlear nerve or ganglion
10
Q
labyrinthitis
A
Viral or bacterial inflammation within entire labyrinth
11
Q
neuritis/labyrinthitis
vertigo characteristics
A
acute: severe
chronic: gradual reduction in symptoms. some resolve
12
Q
neuritis/labyrinthitis
duration and frequency
A
acute: days to a week
chronic: weeks to months
13
Q
neuritis/labyrinthitis
onset
A
sudden
spontaneous
14
Q
neuritis/labyrinthitis
auditory involvement
A
neuritis– NO
labyrinthitis– YES
15
Q
neuritis/labyrinthitis
imbalance
A
YES
16
Q
neuritis/labyrinthitis
other S/Sx
A
Can be left with residual complaints of imbalance, persistent feelings of disorientation, or “haziness,” difficulty concentrating are all common
17
Q
tests for acute neuritis/labyrinthitis
A
clinical exam
vHIT/HIT
18
Q
tests for chronic neuritis/labyrinthitis
A
Rotary Chair Test
Audiogram
VEMP
MRI
Blood work
19
Q
mechanism of acoustic neuroma/
vestibular schwannoma
A
slow growing tumor
age 30-60
20
Q
acoustic neuroma
vertigo characteristics
A
usually secondary
21
Q
acoustic neuroma
onset
A
usually gradual
22
Q
acoustic neuroma
duration and frequency
A
constant
23
Q
acoustic neuroma
auditory involvement
A
YES
24
Q
acoustic neuroma
imbalance
A
if vertigo symptoms, YES
25
acoustic neuroma
other S/Sx
check for CN5 and 7 involvement
defer PT until after surgery
26
lab tests for acoustic neuroma
MRI is gold standard
audiogram
27
mechanism of perilymph fistula
opening between middle and inner ear
caused by rupture in the oval window of ear
leads to perilymph leaking into middle ear
28
causes of perilymph fistula
head trauma
usually a direct blow to ear
29
perilymph fistula
vertigo characteristics
worsens with activity, increased altitude, valsalva
improves with rest
30
perilymph fistula
onset
sudden
preceded by trauma
31
perilymph fistula
duration and frequency
dependent on activity
highly variable
32
perilymph fistula
auditory involvement
YES
33
perilymph fistula
imbalance
YES
34
perilymph fistula
other S/Sx
HA and motion intolerance
35
what tests are positive with perilymph fistula
fistula test
valsalva test
36
fistula test
puff in eyes to increase pressure
record eye movements
37
valsalva test
deep breath in, hold it
pretend to have BM
wait 10s and record eye movements
38
mechanism of semicircular canal dehiscence
fistula due to lack of temporal bone covering of anterior SCC
39
semicircular canal dehiscence
vertigo characteristics
precipitated by coughing, loud noises, pressure changes in ear
40
semicircular canal dehiscence
onset
sudden
spontaneous
41
semicircular canal dehiscence
duration and frequency
dependent on activity
highly variable
42
semicircular canal dehiscence
auditory involvement
YES
43
semicircular canal dehiscence
imbalance
YES
44
semicircular canal dehiscence
other S/Sx
internal and external sound sensitivity
45
what tests would be positive with semicircular canal dehiscence
tulio's phenomenon (have patient talk louder)
valsalva test
bone sensitivity test (tuning fork to lateral malleoli)
46
bilateral vestibular hypofunction
vertigo characteristics
ONLY if loss is sequential in nature
47
bilateral vestibular hypofunction
onset
dependent on cause
48
bilateral vestibular hypofunction
duration and frequency
tends to be constant
worsened by head movements
49
bilateral vestibular hypofunction
auditory involvement
dependent on cause
if ototoxicity-- YES
50
bilateral vestibular hypofunction
imbalance
YES
51
bilateral vestibular hypofunction
other S/Sx
primary complaint is severe oscillopsia
52
gold standard for bilateral vestibular hypofunction
rotary chair test
53
Weber
sensorineural
louder in the good ear
54
Weber
conductive
louder in the bad ear if congenital,
sounds the same if traumatic
55
Rinne
sensorineural
can't hear vibration on the bone or next to the ear
56
Rinne
conductive
can hear vibration on mastoid process but not in the air
57
sensorineural loss is dysfunction of
inner ear
damage to neurological structures
58
conductive loss is dysfunction of
middle ear
something is physically in the way
59
3 features of peripheral vestibular nystagmus
effect of fixation: nystagmus decreases
direction of fast phase: usually mixed (horizontal and torsional)
effect of gaze: nystagmus increases with gaze toward direction of quick phase
60
3 features of central vestibular nystagmus
effect of fixation: nystagmus either does not change or it increases
direction of fast phase: usually single-plane horizontal (torsional or vertical)
effect of gaze: nystagmus either does not change or it reverses direction
61
peripheral vestibulopathy
UNI directional
alexander's law applies
present with acute lesion
rare for chronic lesions
decreases if fixation is available
62
central dysfunction
changes direction
alexander's law does NOT apply
seen in acute or chronic
increases or stays the same if fixation is available
63
1st degree nystagmus
only present when gaze directed towards fast phase
64
2nd degree nystagmus
present in primary gaze and when gaze directed towards fast phase
strongest when gaze directed towards fast phase
65
3rd degree nystagmus
present in all gazes
strongest when gaze directed towards fast phase
66
use of fixation blockers? :
look for spontaneous nystagmus
YES
67
use of fixation blockers? :
assess dynamic visual acuity
NO
68
use of fixation blockers? :
assess head impulse test
NO
69
use of fixation blockers? :
assess head shaking nystagmus test
YES
70
use of fixation blockers? :
look for skew eye deviation
NO
71
use of fixation blockers? :
examine visual tracking and saccades
NO
72
use of fixation blockers? :
look for eye movements elicited during maneuvers
YES
73
use of fixation blockers? :
examine stance and gait
NO
74
abnormal findings of VOR testing
corrective saccades
nystagmus
75
abnormal findings of head thrust/head impulse test
corrective saccades// post-thrust nystagmus
normal with +vertigo sensation
76
abnormal findings of head shake test
PVD: more than 3 beats of post head shaking nystagmus
CVD: vertical nystagmus
77
abnormal findings of dynamic visual acuity
more than 3 line degradation
78
abnormal findings of optokinetic nystagmus
asymmetrical response
direction of reduced motion leads to non-compensated vestibular condition
79
abnormal findings of skew deviation
deviation of one eye while it is being covered
followed by refixation after uncovering it
80
abnormal findings of VOR cancellation
+ corrective saccades ipsilateral to cerebellar lesion
81
what is HINTS test
HI-- head impulsive test
N-- nystagmus observation
TS-- test of skew
82
concern for CNS-- INFARCT
I-- impulse
N-- normal
F-- fast phase nystagmus
A-- alternating
R-- refixation during
C-- cover
T-- test
83
score for mild vestibular dysfunction
0-10
84
score for moderate vestibular dysfunction
11-30
85
score for severe vestibular dysfunction
31-100
86
provoked S/SX of motion sensitivity quotient
episodic dizziness
pallor
diaphoresis
tiredness
salivation
nausea
vomiting
imbalance
vertigo
disorientation
87
MCID for dizziness handicap inventory
18
88
MCID for mini-best test
4
89
MCID for BESS test
3points (3 errors)
90
vestibular cut off for 4 square step test
>12s
indicates risk for falls
91
abnormal findings of romberg, sharpened romberg, and timed unipedal stance
unable to maintain balance
falls towards side of injury
92
migraine characteristics
unilateral
tend to last 4-72 hours
pulsating sensation
aggravated by routine/activity
can have N/V
93
3 causes of cerebellar degenerative disorders
1. genetics/ congential
2. alcoholism
3. paraneoplastic disorders
94
persistent postural-perceptual dizziness (PPPD or 3PD)
chronic dizziness with or without vertigo and fluctuating imbalance provoked by personal, social, or environmental stimuli
95
3PD symptoms can present for
present for months but occur daily
96
criteria for 3PD diagnosis
1. >1 symptom of dizziness or unsteadiness present on most days for 3 months or longer
2. persistent symptoms without specific provocation, but are exacerbated by upright position, active or passive motion, and exposure to moving visual stimuli or complex visual patterns
3. precipitated by conditions that cause vertigo, unsteadiness, dizziness, or problems with balance
4. symptoms cause significant distress or functional impairment
5. all other dx ruled out
97
menieres interventions
conservative
diet restrictions: salt, chocolate, caffeine
medications: diuretics, vestibular and CNS suppressants, steroids
98
menieres
vestibular rehabilitation therapy DOs and DONTs
do: for those that are symptomatic between attacks
don't: not during attacks, no for those with frequent episodes
MOST APPROPRIATE-- after surgical interventions
99
intratympanic gentamicin
injects medication into membrane
medication kills off labyrinth
VERY high risk of hearing loss
100
vestibular nerve section
takes vestibular branch of the vestibulocochlear nerve and cuts it out
**high risk because surgery has to open the brain
HEARING IS SPARED
101
labyrinthectomy
labyrinth and cochlea taken out
100% HEARING LOSS
102
neuritis and labyrinthitis
medications
neuritis: vestibular suppressants, steroids, and antivirals
labyrinthitis: treated with same meds but also antibiotic
103
neuritis and labyrinthitis
vestibular rehabilitation
adaptation exercises speed up recovery
recovery can take up to 2 months but patients tend to do well
104
acoustic neuroma interventions
surgical removal
radiation to shrink the tumor before
vestibular rehab ONLY once the tumor is fully resected
105
what population is radiation preferred for in those with acoustic neuroma
elderly population
patients in poor health
bilateral neuroma
if affecting their only hearing ear
106
perilymph fistula interventions
smaller= conservative (avoid lifting or increasing ICP)
surgery= occurs if 6months or more pass without healing
107
exploratory tympanotomy
tries to patch fistula up with a graft
(usually a surgeons go-to)
108
vestibular nerve section for perilymph fistula
clip out vestibular branch of vestibulocochlear nerve
these are the patients you work with due to their system imbalance
109
do we treat perilymph fistulas
NO
110
semicircular canal dehiscence
conservative intervention
avoid offending stimuli
- noise
- exertion
111
semicircular canal dehiscence
surgical intervention
canal plugging
resurfacing surgery
112
do we treat semicircular canal dehiscence before surgery
NO
113
bilateral vestibular hypofunction
interventions
medications are not helpful
need for vestibular rehabilitation
- postural control
- gaze stabilization
**will ALWAYS have some type of residual impairment
114
