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Reflex acting on the neck
Vestibulocollic
Otoconia detaches and floats in one of the semicircular canals, causing severe vertigo when moving head a specific direction
BPPV
Which disease of the ear lasts hours to days?
Menieres
If the nystagmus is up-boasting torsional, which canal is affected?
Posterior canal
Which types of BBPV: symptoms stop when movement stops in 20-30 seconds
Canalithiasis
Reflex acting on limbs and trunk
Vestibulospinal
Damage in the inner ear or sensory organs, CN VIII or the auditory N
Sensorineural hearing loss
Which disease of the ear last days to weeks?
Hydrops (typically younger patients)
If the nystagmus is down-beating torsional, which canal is affected?
Anterior canal
Intense vertigo with change of head position; stops after 20-30 seconds of static position; nausea, reports of spinning inside head; autonomic changes (increased HR, sweating, syncope); nystagmus; canalithiasis vs cupulolithiasis
BPPV
1. Vestibulocolic
2. Vestibulospinal
3. Vestibulo-ocular
4. STNR
5. ATNR
Reflexes associated to vestibular system
Reduced function in one or both sides of peripheral vestibular organs, or central components
Vestibular hypofunction
Overaccumulation of endolymph; pushes membranous labyrinth into perilymph space; episodic; vertigo; fullness in the ear; tinnitus (ring, buzz, clicking, crackling)
Meniere's endolymphatic hydrops
If the nystagmus is horizontal, which canal is affected?
Horizontal canal
Which types of BBPV: dizziness does not stop within 20-30 seconds of movement. Stuck on cupula is the thought
Cupulolithiasis
Excess endolymph, causing tinnitus and severe vertigo
Meniere's disease
Which sections of the ear are conductive?
External and middle ear
Episodic, intense vertigo related to head position; mechanical disorder of the labyrinths; spontaneous or traumatic onset; 40% recurrence; otoconia escape otolith and clump together into a canalith; most commonly posterior canal
BPPV: Benign paroxysmal positional vertigo
Sudden onset of vertigo; spontaneous horizontal nystagmus; nausea; vomiting; intense disequilibrium; eyes closed - illusion of self spinning; eyes open - illusion of environment spinning; lateropulsion to the side of the lesion
Viral infection - neuritis labyrinthitis
Vertigo and oscillopsia (eyes are jumping) induced by loud noises or changes to pressure in middle ear; chronic disequilibrium
Anterior canal: break or opening through bone at top part of the canal, fluid is coming through and irritating anterior canal
Superior semicircular canal dehiscence
Trouble transferring sound waves along peripheral pathway; damage to ossicles
Conductive hearing loss
Which section of the ear is sensorineural related?
Inner ear
Abnormal communication at either the round or oval window of the middle ear; vestibular and/or hearing issues; caused by pressure changes internally or externally, congenital malformations, prior ear surgery; conjugate contralateral slow deviation of the eyes with vertigo occurs with positive pressure applied to the suspected ear; 50% improvement with surgery; extra hole on top of round and oval window; usually some change in pressure for a long period of time, trauma, congenital, surgery in past
Peri lymphatic fistula (should not fly because will lose function in the ear)
2 types of bilateral peripheral hypofunctions
1. ototoxicity
2. Mal de debarquement
Ototoxicity usually occurs because
Strong antibiotic - gentomyoside