Vestibular Pathology Management Flashcards
Meniere’s Disease Conservative Interventions
- Diet restrictions (↓ Na, Chocolate, caffeine)
- Medications: diuretics, vestibular + CNS suppressants,
- Steroids
Conservative management of meniere’s disease shows some degree of improvement in ______ of patients
60-80%
Of the availble conservative treatments for Meniere’s what are the most common approaches?
Diet changes and diuretics
When is vestibular rehabilitation therapy contradindicated for those with Meniere’s?
- During an attack
- Those with frequent episodes.
When is vestibular rehabilitation therapy MOST appropriate for Meniere’s disease
a. Between attacks
b. 24 hours after an attack
c. before and after surgical intervention
d. after surgical intervention
d. after surgical intervention
T/F vestibular rehabilitation therapy will not provide support for Meniere’s patients who have symptomatic periods between attacks.
False
What invasive/surgical approaches are available to those with Meniere’s?
- Intratympanic Gentamicin
- Vestibular nerve section
- Labyrinthectomy
Which invasive approach for Meniere’s will definely result in hearing loss?
Which one spares hearing?
Hearing Lost: labyrinthectomy
Hearing Spared: Vestibular n. section
Intratympanic Gentamicin
Antiobiotic that kills off hair cells in labyrinth to treat Meniere’s
High risk of hearing loss
Vestibular N. section
Vestibular branch of vestibulocohlear n. is cut off (NO INNERVATION)
Major open brain surgery!
Labyrinthectomy
Removal of labryinth and cochlea
ABSOLUTE hearing loss
Conservative treatment for vestibular neuritis/labyrinthitis
- Vestibular suppressants (anticholingergics, antihistamines, benzodiazepines)
- Steroids + Antivirals (neuritis) or Antibiotics (labyrinthitis)
Vestibular neuritis/labyrinthitis is often treated with vestibular suppressant medications - what is am important piece of patient education regaurding this medication?
Use for too long prolongs recovery!
When should your patient been scheduled for vestibular rehabilitation with vestibular neuritis/labyrinthitis?
a. 1 day post-onset of symptoms
b.14 days after onset of symptoms.
c. 7 days after onset of symptoms.
d. 5 days after onset of symptoms.
b. 14 days after onset of symptoms
Vestibular rehab for neuritis/labrynthitis should focus on ________________ to speed recovery.
Vestibular adaptation
How long is recovery for those with neuritis/labrynthitis in vestibular rehab?
Typically 2 months but can take up to a year.
Acoustic Neuroma/Vestibular Schwannoma interventions
- Surgical removal
- Radiation
- Monitoring
- Vestibular Rehabilitation
Why would a patient recieve radiation for an acoustic neuroma?
- Elderly
- Poor health (surgical candidate)
- Bilateral neuromas
- Tumor affect only hearing ear
- Large tumor size
When is a patient a candidate for vestibular rehabilitation therapy with an acoustic neuroma?
After tumor has been fully removed, unless surgery is not in POC or compensatory techniques/safety warrents treatment pre-surgery.
Perilymph Fistula Conservative management
Rest, avoid lifting or any activity that would increase ICP x7-14 days
(many will self-resolve if pt is compliant)
Perilymph Fistula surgical repair indication
> 6 months without healing (larger fistulas)
Exploratory Tympanotomy
patch whole with graft
Typically don’t need PT post-op
If an exploratory tympanotomy is unsuccessful, what surgery is performed next for those with perilymph fistula?
vestibular nerve section
Would need PT post-op
If your patient has had a vestibular nerve section - what is the goal of PT?
Habituation (upweigh vision/somatosensory)
What conservative treatment is present for those with a semicircular canal dehiscence?
Avoid offending stimuli until surgery. (Earplugs, decrease exertion)
What surgical options exsist for those with semicircular canal dehiscence?
- Canal plugging
- Resurfacing surgery
Canal plugging
plugs whole in SCC
Requires VRT post-op
Resurfacing surgery
use of bone graft to cover whole.
Bilateral Vestibular Hypofunction medical management
Medications NOT helpful!! Typically worsens symptoms.
Immediate call to prescribing MD.
Vestibular rehabilitation for BVH includes
- Postural control
- Gaze stabilization exercises
Often will always have SOME type of residual impairment
What surgical interventions are available for BVH?
NONE
For those with central disorders and vestibular pathology - when is vestibular rehab appropriate?
Once symptoms are stable
Early on what does vestibular rehab focus on?
Neuroplasticity by targeting vestibular system
For chronic central disorders, what is the focus of vestibular rehab?
- Sensory reorganization - upweight somatosensory and vision.
- Pt education for lifestyle modifications
When is vestibular rehab appropriate for migraine patients?
When patients have residual, lingering symptoms.
3PD/PPPD management includes
- VRT if residual vestibular symptoms are present
- Cognitive behavioral therapy
