Vestibular Pathology Management

Question 1

Meniere’s Disease Conservative Interventions

Answer 1

• Diet restrictions (↓ Na, Chocolate, caffeine)
• Medications: diuretics, vestibular + CNS suppressants,
• Steroids

Question 2

Conservative management of meniere’s disease shows some degree of improvement in ______ of patients

Answer 2

60-80%

Question 3

Of the availble conservative treatments for Meniere’s what are the most common approaches?

Answer 3

Diet changes and diuretics

Question 4

When is vestibular rehabilitation therapy contradindicated for those with Meniere’s?

Answer 4

• During an attack
• Those with frequent episodes.

Question 5

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

Answer 5

d. after surgical intervention

Question 6

T/F vestibular rehabilitation therapy will not provide support for Meniere’s patients who have symptomatic periods between attacks.

Answer 6

False

Question 7

What invasive/surgical approaches are available to those with Meniere’s?

Answer 7

• Intratympanic Gentamicin
• Vestibular nerve section
• Labyrinthectomy

Question 8

Which invasive approach for Meniere’s will definely result in hearing loss?
Which one spares hearing?

Answer 8

Hearing Lost: labyrinthectomy
Hearing Spared: Vestibular n. section

Question 9

Intratympanic Gentamicin

Answer 9

Antiobiotic that kills off hair cells in labyrinth to treat Meniere’s

High risk of hearing loss

Question 10

Vestibular N. section

Answer 10

Vestibular branch of vestibulocohlear n. is cut off (NO INNERVATION)

Major open brain surgery!

Question 11

Labyrinthectomy

Answer 11

Removal of labryinth and cochlea

ABSOLUTE hearing loss

Question 12

Conservative treatment for vestibular neuritis/labyrinthitis

Answer 12

• Vestibular suppressants (anticholingergics, antihistamines, benzodiazepines)
• Steroids + Antivirals (neuritis) or Antibiotics (labyrinthitis)

Question 13

Vestibular neuritis/labyrinthitis is often treated with vestibular suppressant medications - what is am important piece of patient education regaurding this medication?

Answer 13

Use for too long prolongs recovery!

Question 14

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.

Answer 14

b. 14 days after onset of symptoms

Question 15

Vestibular rehab for neuritis/labrynthitis should focus on ________________ to speed recovery.

Answer 15

Vestibular adaptation

Question 16

How long is recovery for those with neuritis/labrynthitis in vestibular rehab?

Answer 16

Typically 2 months but can take up to a year.

Question 17

Acoustic Neuroma/Vestibular Schwannoma interventions

Answer 17

• Surgical removal
• Radiation
• Monitoring
• Vestibular Rehabilitation

Question 18

Why would a patient recieve radiation for an acoustic neuroma?

Answer 18

• Elderly
• Poor health (surgical candidate)
• Bilateral neuromas
• Tumor affect only hearing ear
• Large tumor size

Question 19

When is a patient a candidate for vestibular rehabilitation therapy with an acoustic neuroma?

Answer 19

After tumor has been fully removed, unless surgery is not in POC or compensatory techniques/safety warrents treatment pre-surgery.

Question 20

Perilymph Fistula Conservative management

Answer 20

Rest, avoid lifting or any activity that would increase ICP x7-14 days

(many will self-resolve if pt is compliant)

Question 21

Perilymph Fistula surgical repair indication

Answer 21

> 6 months without healing (larger fistulas)

Question 22

Exploratory Tympanotomy

Answer 22

patch whole with graft

Typically don’t need PT post-op

Question 23

If an exploratory tympanotomy is unsuccessful, what surgery is performed next for those with perilymph fistula?

Answer 23

vestibular nerve section

Would need PT post-op

Question 24

If your patient has had a vestibular nerve section - what is the goal of PT?

Answer 24

Habituation (upweigh vision/somatosensory)

Question 25

What conservative treatment is present for those with a semicircular canal dehiscence?

Answer 25

Avoid offending stimuli until surgery. (Earplugs, decrease exertion)

Question 26

What surgical options exsist for those with semicircular canal dehiscence?

Answer 26

• Canal plugging
• Resurfacing surgery

Question 27

Canal plugging

Answer 27

plugs whole in SCC

Requires VRT post-op

Question 28

Resurfacing surgery

Answer 28

use of bone graft to cover whole.

Question 29

Bilateral Vestibular Hypofunction medical management

Answer 29

Medications NOT helpful!! Typically worsens symptoms.

Immediate call to prescribing MD.

Question 30

Vestibular rehabilitation for BVH includes

Answer 30

• Postural control
• Gaze stabilization exercises

Often will always have SOME type of residual impairment

Question 31

What surgical interventions are available for BVH?

Answer 31

NONE

Question 32

For those with central disorders and vestibular pathology - when is vestibular rehab appropriate?

Answer 32

Once symptoms are stable

Question 33

Early on what does vestibular rehab focus on?

Answer 33

Neuroplasticity by targeting vestibular system

Question 34

For chronic central disorders, what is the focus of vestibular rehab?

Answer 34

• Sensory reorganization - upweight somatosensory and vision.
• Pt education for lifestyle modifications

Question 35

When is vestibular rehab appropriate for migraine patients?

Answer 35

When patients have residual, lingering symptoms.

Question 36

3PD/PPPD management includes

Answer 36

• VRT if residual vestibular symptoms are present
• Cognitive behavioral therapy