Vestibular System and Pathologies

Question 1

Peripheral Vestibular Dysfunction

Answer 1

typically involves vertigo
symptoms provoked by head movements
symptoms fluctuate
onset is sudden

Question 2

Peripheral Vestibular System Disorders

Answer 2

BPPV
unilateral vestibular hypofunction
bilateral vestibular hypofunction
Meniere’s disease
neuritis
labyrinthitis

Question 3

Central Vestibular Dysfunction

Answer 3

symptoms are persistent
complaints go beyond vestibular
-dysphagia, diplopia, dysmetria
symptoms are often more vague
pure downbeating or upbeating, or direction changing nystagmus

Question 4

Central Vestibular Disorders

Answer 4

brainstem strokes
head trauma
migraine-related vestibulopathy
multiple sclerosis
cerebellar degeneration

Question 5

BPPV

Answer 5

acute episodes of vertigo that begin after ~ 1-2 second latency period, increase over the next ~10 seconds, last for ~30-60 seconds, and will go away if the precipitating position is maintained (responds to rest)

symptoms are strictly vestibular
-no hearing loss, tinnitus, aural fullness

geotropic nystagmus: beats toward ground when lying on affected side
ageotrophic nystagmus: beats toward ceiling when lying on affected side

Question 6

Unilateral Vestibular Hypofunction

Answer 6

vertigo, nausea, spontaneous nystagmus

Question 7

Bilateral Vestibular Hypofunction

Answer 7

oscillopsia with head movement
imbalance/postural instability
difficulty in walking in the dark/uneven surfaces

*most common cause of acute vertigo - alcohol (bed spins)

Question 8

Meniere’s Disease

Answer 8

fullness of ear, reduction in hearing, tinnitus
rotational vertigo
postural imbalance
nystagmus
nausea/vomiting

vertigo persists 30min-24 hrs with gradual reduction of sxs
hearing may gradually return to baseline, but some hearing loss may persist

Question 9

Meniere’s Disease Tx

Answer 9

motion sickness medication (betahistine)
vestibular suppresants
vestibular exercises NOT appropriate during acute episodes, but may be useful if there is permanent damage

Question 10

Dix-Hallpike Test

Answer 10

key dx test for BPPV, tests posterior semicircular canal dysfunction in dependent ear

pt placed in long sitting with the head rotated to one side, then rapidly moved into supine

examined for nystagmus, vertigo or nausea, sensations of discomfort and apprehension

Question 11

Supine Head Roll Test

Answer 11

• if pt has horizontal or no nystagmus on Dix-Hallpike
• performed to test for horizontal semicircular canal BPPV
  1. supine with head in 30 degrees of flexion
  2. quickly rotate to one side
  3. back to straight
  4. quickly rotate to other side

Question 12

Semont/Liberatory Maneuver

Answer 12

posterior semicircular canals
1. start sitting with head turned away from affected side
2. side lying on affected side with head turned “up”
3. opposite sidelying while maintaining head position so head is turned “down”
4. back up to sitting

Question 13

BBQ Roll/Lempert

Answer 13

BPPV from horizontal semicircular canals
1. supine with head turned towards affected side
2. turn patient/head to unaffected side
3. turn patient/head to nose down
4. turn patient/head back to affected side
5. sit them up

Question 14

Epley’s Maneuver

Question 15

Gufoni

Answer 15

horizontal semicircular canals
1. sitting
2. side lying towards unaffected side (geotrophic) or affected (ageotrophic)
3. turn head to nose down
4. sit up with head maintained

Question 16

Vestibular Reflexes

Answer 16

VOR: maintains stable vision during head motion
VSR: provides postural stability via head and body movement to maintain balance and prevent falls

Question 17

Signs of Vestibular Dysfunction

Answer 17

vertigo: illusion of turning/moving in a stationary env

pathologic nystagmus: non-voluntary rhythmic oscillation of one or both eyes (described by direction of the fast component)

oscillopsia: feels like you are moving back and forth
nausea
postural ataxia
fullness of ear, hearing loss, tinnitus

Question 18

Assessments for nonBPPV vestibular dxs

Answer 18

typically begin with oculomotor assessments after ROS

Question 19

Central Vestibular Disorder Tests

Answer 19

smooth pursuit: the following object L to R
saccade: look at tip of pen and then my nose
-watch for over/undershooting
convergence: finger to nose, distance of double vision
VOR cancellation: focus on fixed object
cover/cross-cover
optokinetic

Question 20

Peripheral Vestibular Disorder Tests

Answer 20

head thrust: horizontal canal hypofunction (VOR)
head shaking: when head stops shaking, check for nystagmus
-3 or more horizontal beats is suggestive of peripheral, while vertical would indicate central
dynamic visual acuity