Week 1.5 - Clinical Aspects of Balance Flashcards
Which sensory systems contribute to the maintenance of balance?
- inner ear
- vision
- proprioception in hips, ankles, feet
What causes balance issues?
issue with one or 2 of our balance sensory systems
What is the output of the 3 sensory mechanisms of balance?
ocular reflex and postural control
What are 3 pathologies that affect balance?
- Benign paroxysmal positional vertigo
- Vestibular Neuritis
- Meniere’s Disease
What may cause otoliths to become loose?
otoliths in the otolith organs - utricle and saccules - may become loose due to:
- age,
- vestibular neuritis,
- menieres disease or
- head trauma
What causes benign paroxysmal positional vertigo?
otolith floating in semicircular canals endolymph - commonly posterior canal. causes extra momentum in movement of cilia when lying down, so causes nystagmus
Which direction of nystagmus do you get during BPPV?
same as whichever canal the otolith is stuck in.
How do you diagnose BPPV?
- dix hallpike manouvre
- put patient on their back and tilt their head to the side. see nystagmus and patient may get vertigo. diagnose.
How do you treat BPPV?
Epley manouvre. once diagnosed, ask patient to go to other side to allow endolymph to move in opposite direction. this should place stone back in the utricle. if recurs, show patient how to do manouvre themselves
What is vestibular neuritis?
inflammation of vestibular nerve of unknown cause - thought to be viral. typically acute onset vertigo, nausea and vomiting - and see nystagmus if caught early enough. one off!
What is labyrinthitis?
hearing loss as well as vertigo. vertigo typically worse if hearing loss present.
What viruses may cause hearing loss in vestibular neuritis/labyrinthitis?
measles, mumps, glandular fever possibly
What is Meniere’s Disease?
triad of vertigo, unilateral hearing loss and tinnitus. often sensation of fullness in ear - 30 mins to >24hrs episodes recurring
What is the role of the endolymphatic sac?
controls how much endolymph is present in the canals
What is the commonest cause of balance issue and virtigo?
migraine. medications help with headache but not virtigo. best management is prophylactic migraine treatment.
