Lecture 5 Vestibular System

Most common vestibular disorder in the elderly?

Label the following on a picture:

Resting output of the vestibular nerve is _______.

In an intact system, eye movement in VOR is a result of _______ in signal sent from vestbular nerve on each side.

Key subjective questions regarding onset of dizziness?

What are the characteristics of vertigo?

Specific follow-up questions regarding vertigo

Disequilibrium is the sense of unsteadiness or _______. It occurs mainly during ________ or _______ and gets better when _______ or ________.

What are some key follow-up questions for disequilibrium?

What are some common symptoms of hypotension-related dizziness?

What are some follow-up questions if patient has hypotention-related dizziness?

Name some associated symptoms with vestibular problems.

Name the 4 Ds

What some special tests for vestibular disorders?

Rationale for MRI?

Rationale for CT?

What is auditormetric exam trying to differentiate?

T/F: Unilateral hearing loss is a sign of aging.

What is ENG/ VNG?

Name the tests that can assess inner ear responses.

Nystagmus is a (reflexive/voluntary) oscillation of the eyes.

The fast beat is in the direction of the ear with (increased/decreased) neural activity.

T/F: Nystagmus at visual end range and during optokinetic stimulation is normal.

T/F: Nystagmus suggests central dysfunction.

Direction fixed nystagmus is (peripheral/central)

If the lesion is peripheral, nystagmus (increases/decreases) with visual fixation.

If the patient has peripheral vestibular problem and is experiencing left-beating nystagmus, having him/her looking to the left will (increase/decrease) the nystagmus.

General direction of nystagmus caused by central vestibular dysfunction:

Nystagmus caused by peripheral vestibular dysfunction is (pure/mixed) in direction.

What are some non-vestibular causes of dizziness?

match the following with peripheral/ central vestibular dysfunctions.
1. BPPV
2. Cerebellar disorders
3. acoustic neuroma
4. tumors
5. Migraines
6. vestibular neuritis/ labrynthitis
7. MS
8. TBI/ Concussion
9. Meniere disease
10. TIA/ stroke
11. ototoxicity

What is the pathology of BPPV?

Other than idiopathic BPPV, what are some etiologies?

What are the two forms of BPPV?

Mechanism of canalithiasis

Mechanism of cupulolisthiasis

If BPPV lasts for <60sec, it is more likely ____________ while if it lasts more than 60 sec, it is more likely _________.

Briefly describe the timeline of BPPV.

If you suspect BPPV involving anterior and posterior canals, what test should you do?

If you suspect BPPV involving horizontal/lateral canals, what test should you do?

T/F: BPPV symptoms remain the same intensity with repeated testing.

BPPV is central or peripheral?

BPPV involves labyrinth or nerve?

Age of population commonly affected by vestibular neuritis/ labyrinthitis

Women are usually affected by vestibular neuritis/ labyrinthitisin their _____s while men are usually affected in their ____s.

Possible causes of vestibular neuritis and labyrinthitis?

T/F: neuritis and labyrinthitis are usually bilateral.

How may the symptoms of unlateral vestibular dysfunction be exacerbated?

Outline the general timeline of vestibular neuritis/ labyrinthitis.

T/F: There is no change in hearing due to vestibular neuritis/labyrinthitis.

How is VOR affected by neuritis/labyrinthitis?

Diagnostic test to confirm/rule out vestibular neuritis/ labyrinthitis:

Short-term treatment for vestibular neuritis.

Long-term treatment for neuritis/ labyrinthitis.

Is vestibular neuritis/ labyrinthitis central or peripheral?

T/F: Meniere's disease is usually inulateral.

The onset of Meniere's disease is usually ____ years old.

Pathogenesis fo Meniere's disease:

When patients have Meniere's disease, they are likely experiencing _________________, increased pressure and volume causing abdominal firing of hair cells.

Is Meniere's disease episodic? How long can it last?

Is prognosis better for acute or chronic Meniere?

What is the general timeline like for Meniere's Disease?

Spectrum of hearing loss.

Diagnostic tests for Meniere's disease

Treatment options for Meniere's disease.

What is the 3rd most common intracranial tumor?

Which part of the vestibular system is mostly affected by ototoxicity?

Which part of CN VIII is affected by acoustic neuroma?

What are some common locations of tumors for acoustic neuroma?

T/F: Symptoms of acoustic neuroma is usually bilateral.

General timeline of acoustic neuroma

Gold standard to dx acoustic neuroma

What are the top 3 medications that cause ototoxicity?

Is ototoxicity usually unilateral or bilateral?

T/F: HIT is positive in ototoxicity.

What are some signature symptoms of ototoxicity?

Diagnostic test for ototoxicity:

T/F: Ototoxicity has a faster and better prognosis compared to unilateral vestibular hypofunction.

T/F: With good PT, pt. with ototoxicity can regain previous balance.

Which situations should your patient avoid if they are diagnosed with ototoxicity?

What are some possible reasons that may trigger central vestibular dysfunction?

What is oscillopsia?

What are some symptoms of central vestibular dysfunction?

What are some signs of central vestibular dysfunction?