DOCSLIB.ORG

Non-Surgical Treatment of Vertigo P

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Non-Surgical Treatment of Vertigo P Non-Surgical Treatment of Vertigo P. GHOSH AND M. S. ROHATGI Majority of the cases with dizziness can be treated medically and physiotherapeutically and very few require surgical interventions. In this report one hundred cases of dizziness have been investigated in a busy otolaryngology clinic, diagnosed and treated with drugs and head and neck exercises. The above have been rationalised on a pragmatic basis as to their modes and sites of actions, interactions with various neuropeptides and recalibration of the vestibular subsystem. Above 80% of the cases were benefited by the regimens laid down in this report. An interestingly significant outcome of this study is that the post-treat- ment neuro-otological findings have not altered much even in those patients who have improved and re- sumed their normal activities. Introduction 'stage of being dysig, meaning stupid fluence or~ the activity of the vesti- or foolish and putting the pragmatic bular nuclei. Thus there are two There is constant interaction aspect of non-surgical treatment of recticulo-vestibular pathways : between the 'phasic' and the 'tonus' dizziness on a rational basis as to the (I) excitatory cholinergic and element and besides havi~.g an sites and modes of actions of different (2) inhibitory monoaminergic. The afferent system, it has also an effec- drugs, their modifying effects on the distribution of nor-epinephrine in tive efferent one, a 'feed-back' and rteuropeptides and, the effect of head the central nervous system is princi- regulating mechanism, that modify and balance exercises with or without pally in the hypothalamus and both the subjective sensation of medications. brainstem reticular system (Vogt, vertigo/imbalance and the objective 1954). The overall activity deperLds findings (Ghosh & Kacker, 1979). Affection of the vestibular sub- upon the balance between these The complexity of the neurones and system, starting from the peripheral transmitters (Eveaton & Goodhill, the synapses in the vestibular 'sub- labyrinth to the cerebral cortex 1968). So dizziness could be due to system' in the central nervous system (temporal lobe and post-central activation of both nor-epinephrine with the co-existence of more than gyrus) leads to dizziness. Nystagmus arid cholinergic reticular areas. one neurotransmitter ir~ a single is the most important manifestation Moreover, the irtterplay between the neurone, multiple pre and post- of vestibular disease. quick-disfiharing and slow-dis- sylxaptic receptors, fast and slow post- charging reticular neurones and synaptic potentials, omnopause neu- Referring to Fig. 1, one can see vestibular nuclei is important (Ghosh rones, reciprocal neuronal units and t[-,at the fibres from the labyrinth and Sen, 1970 ; Ghosh, 1980, 1981). action at sites distant from that of end in the vestibular nuclei and from DizziI).ess would occur when acetyl- release of the transmitters er~ormous- there they relay in the reticular core, choline activation exceeds the capa- ly multiply the problems of assigning eye nuclei (III, IV and VI), dmsa! city of nor-epinephrine system. distir~ct functions to different neuro- nucI.eus of vagus, vomiting centre These are also under the regulation nes and neuropeptides. It has been and chemoreceptor trigger zone, of the inhibitory effects of GABA. electronyst agmographically shown cerebellum (ftoccu]o-nodular lobe that affectiorL of quick and slow- and fastigial nuclei) and temporo- discharging neuronal units in the parietal lobes of cerebral cortex. Habituation to motioal is due to paraxnedian pomine reticular forma- Some fibres (mossy fibres) go directly an enhanced respolLse of the nor- tion are associated with different from the labyrinth via the juxtare- epirLephrine mediated system. The distinct findings on the electronysta- stiform body to the cerebel!um. increased orgalfisation of the neural tagmograph (Ghosh & Kacker, Conversely, cerebral and cerebellar system or mobilization of the enzy- 1979; Ghosh, 1980 & 1981). The fibres converge on the vestibular mes lxecessary for increased nor- psychological aspect of the patient nuclei exertirLg an inhibitory influ- epinephrine activity would be acti- complicates it further. ence. Damage to these enhances vated by repeated exposure to vestibular responses (Ghosh & motion (Wood & Graybiel, 1970, As a clinician, this is a humble Kacker, 1979). 1973). This would alter the balance attempt at recovering from the of activity in the central nervous The neurot~ansmitters, associated system and prevent motion sickness P. Ghosh, Additional Professor, Department of ENT, with vestibular mechanism, are nor- by allowing nor-epiuephrine system All India Institute of Medical Sciences, adrenaline, acety]cho]ine & Gamma to predominate over the acetylcho- New Delhi-110 029, INDIA, Amino Butyric Acid (Fig. 1). Vesti- line system. For the nervous system (formerly, Lecturer in ENT, Faculty of to recalibrate the relationship bet- l~,ledicine, University of Papua New Guinea). bular receptors are cllolinergic. It M. S. Rohatgi, is likely that a cholilzergic transmis- ween visual, proprioceptive and Specialist Ear, Nose and Throat Surgeon, sion to the vestibular neurones cause vestibular sigI~als, repeated head and P.O. Box-228, Maitand vertigo. The cbolinergic reticuIo- eye movemeI~.ts are essential. If the N. S. W. 2320, AUSTRALIA. vestibular pathways enhance the level of nor-epinephrine activity is Reprints request to : activity witl~in the vestibulo-ocular raised by drugs or habituation, or Dr. P. Ghosh, D-34, Ansari Nagar, reflex. The mono-aminergic reticulo- if acetylcholine activity is blocked New Delhi-110029 vestibular pathways activated by by drugs, motion sickness may be India. amphetamine, has an inhibitory in- prevented. 48 Indian Journal of Otolaryngology, Volume 41, No. 2, June, 1989 Won-surgical Treatment of Vertigo--Ghosh & Rohatgi Material and Methods and PUTATIVE SITES OF ACTION OF ANTIVERTIGINOUS observations DRUGS One hundred cases of vertigo were studied and managed non-surgically. CORTEX The aetiologies were as follows : Group I : Cervical spine trauma sustained 1-2 years back. The age group was between 20-35 years. There were 50 cases. HYPOTHAL Group II : Cervical spondylosis : most of the 25 cases were above 45 years. Group III: Cupulolithiasis-- 3 cases. Group IV : Vertebro-basilar insufficiency--9 cases. Group V : Perilymphatic fistula GABA in the round window--2 cases. PYRDOXINE I Fistulae were closed with fat graft. 9 Mild vertigo persisted for about 3 months and subsequently treated with drugs for 3 months. Group V1 : Undiasnosed : 11 cases. Age range was 45 to 60 years. Since facilities for conducting elec- trooculography or optokinetic nys- tagmography are not available in many institutions, reasonable diag- nosis can be and were made by the following : LOWER 1. History. CENTRES 2. Presence and character of spon- taneous nystagmus. 5, 7 LABYRINTH 3. Kopfschuttel (head-shaking) nys- 8 tagmus. 4. Unterberger's test (stepping with hands clasped infront). BLO04 ' SUPPLY I. -- ANTIHISTAMINE~ 5. Positional test. 2. -- ANTIEMETIC PHENOTH|A~|NES 6. Audiometry. / 3. ~ ANTICHOLINEH~'.~'ICS ~ 4' 7. Cold caloric test with ice-cold 3a -- ADR[NERGIC water. 4. -- VASOD|LATOR$ 8. X-ray cervical spines, internal S* __ DIURETICS 6. -- PSYCHOTHERAPEUTI¢ PRUGS auditory meatus and skull, when 7. -- STEROIDS indicated. 8, ~ ANT|BACTERIAL I* GASA Fig. I. VG - Vestibular ganglion, VN - Vestibular nuclei, RF - Reticular formation, Table I represents the anamnesia, Supprn - Supperssion, NA - Nor-adrenaline, ACtt - Acetylcholine Activa - Activation, CTZ - chemoreceptor Trigger Zone, VC- Vomiting centre, GABA- GammaAmino Butyric which has been tabulated taking the Acid, MR - Med, Rectus, LR - Lateral rectus, Ant - Anterior, Post - Posterior, III& VI-Eye help of available literature and per- nuclei, Fasti - Fastigious nucleus. sonal experience, is helpful in differ- ential diagnosis. In quite a good number of eases, history alone could sient numbness and tingling of face, Spontaneous nystagmus was look- point to tlxe proper diagnosis. In the especially in the periora] region. ed for in sitting and head-erect group with vertebro-basilar insuffi- None of the cases showed any neu- position. This was present in 5 cases ciency, the patients had only tran- rological deficit. of cervical spine trauma, 2 cases of Indian Journal of Otolaryngology, Volume 41, No. 2, June, 1989 49 °Volt-surgical Treatment of Vertigo--Ghosh & Rohatgi TABLE I Dizziness (aetlology and site of pathology; of sudden onset t hronlc Below 50 yrs. of age Above 50 yrs. Episodic Non-episodic D,'ithout cochlear \Vith eochh:ar a) vascular disorders With cochlear Without cochlear I. A~oeiated with symptoms symptoms involving lab) rin- symptoms symptoms fainting or uncon- (a) vestibular (a~ Viral labyrinthiti,. thine blood flow (a) CSO.XIand 1. Positional : scionsness :-- neuronitis ,>f (common) from the vertebro- mastoiditis. (:t~ Cupulolithiasis (a) V. B. insufficiency bacterial, vir~d (b) Bacterial tabvrin- basi!ar system. (b) M~eniere's (BPPV) (T.I.A.) or metabolic thitis (rare) b) Strokes :-cerebral, disease, (Idiopathic, fi)llow- (b) Epilepsy origin. (el Meningitis brain-stem and syphilis and ing head injury & (c) Orthostatic hypo- (b) Tabes dor,ali~. (d/ May follow : cerebellar. Cogan's cfisease vascular episodes tension. (i) Physical activity ~c) Arteriosclerosis. (c Acoustic involving the (d) Carotid arterio- e.g., extreme :d) Hypertensive neurinoma & anterior vestibular sclerosisann carotid exertion,
Load more

Recommended publications
  • Treatment of Vertebrobasilar Insufficiency– Associated Vertigo with a Fixed Combination of Cinnarizine and Dimenhydrinate
    International Tinnitus Journal, Vol. 14, No. 1, 57–67 (2008) Treatment of Vertebrobasilar Insufficiency– Associated Vertigo with a Fixed Combination of Cinnarizine and Dimenhydrinate Volker Otto,1,2 Bernhard Fischer,1,3 Mario Schwarz,4 Wolfgang Baumann,4 and Rudolf Preibisch-Effenberger1 1 Ear, Nose, and Throat Clinic, Otto-von-Guericke University, Magdeburg; 2 Schönebecker Kreiskrankenhaus, Schönebeck; 3 Ear, Nose, and Throat Clinic, Marienhospital Osnabrück; and 4 Department of Clinical Research, Hennig Arzneimittel, Flörsheim am Main, Germany Abstract: Thirty-seven patients suffering from vertigo associated with vertebrobasilar insuf- ficiency participated in our prospective, single-center, double-blind, comparative study. Patients were randomly allocated to treatment with placebo; betahistine (12 mg betahistine dimesylate, one tablet three times daily); or the fixed combination of 20 mg cinnarizine and 40 mg dimen- hydrinate (one tablet three times daily) for 4 weeks. The primary efficacy end point was the decrease of the mean vertigo score (SM), which was based on the patients’ assessments of 12 in- dividual vertigo symptoms after 4 weeks of treatment. Patients treated with the fixed combi- nation showed significantly greater reductions of SM as compared to patients receiving placebo ( p Ͻ .001) or the reference therapy betahistine ( p Ͻ .01). The vestibulospinal parameter lat- eral sway (Unterberger’s test) improved to a significantly greater extent in patients taking the fixed combination as compared to those receiving placebo ( p Ͻ .001). No serious adverse event was reported in any therapy group. The tolerability of the fixed combination was judged as very good or good by 91% (betahistine, 73%; placebo, 82%). In conclusion, the fixed com- bination proved to be statistically more effective than the common antivertiginous drug beta- histine in reducing vertebrobasilar insufficiency–associated vertigo symptoms.
    [Show full text]
  • Multiple Sclerosis Revealed by Intrapontine Axial Lesion of Peripheral Nerves
    Central Annals of Otolaryngology and Rhinology Case Report *Corresponding author Sébastien Schmerber, Department of Oto-Rhino- Laryngology, Otology, Neurotology, Auditory implants, Multiple Sclerosis Revealed by Cochlear Implant Centre of the French Alps, University Hospital of Grenoble, CHU A. Michallon, BP 217 38043 Grenoble cedex 09 France, Tel : 33 4 76 76 56 62 ; Fax : Intrapontine Axial Lesion of 33 4 76 76 51 20; Email: Submitted: 11 April 2016 Peripheral Nerves Accepted: 01 August 2016 Published: 03 August 2016 Georges Dumas1, M. Filidoro2, Cindy Colombé1, and Sébastien ISSN: 2379-948X Schmerber1* Copyright 1Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, © 2016 Schmerber et al. France 2Department of ENT, CHR Chambery, France OPEN ACCESS Abstract Keywords • Multiple sclerosis Multiple sclerosis(MS) is most often revealed by motor, sensitive symptoms with • Cranial nerves paresthesia, ocular symptoms, and more seldom by symptoms with rapidly installed • Vertigo hearing loss and vertigo.We report an observation with initialsymptoms of a peripheral • Facial palsyl pathology mimicking a meningo-neuritis. A 22 years old young woman was addressed • hearing loss as anemergency for a sudden peripheral symptomatology associating a sudden right hearing loss with ear fullness,vertigo with vomiting and a right peripheral facial palsy. The patient had a spontaneous nystagmus beating toward the left side suppressed by fixation and sensory neural hearing loss on low frequencies. The Fukuda tests initially deviated toward the right side. The caloric test showed a right hypofunction at 75% and a correlated consistent left preponderance. The head shaking test (HST) and skull vibration induced nystagmus test (SVINT) revealed a left nystagmus.
    [Show full text]
  • Decoding Vestibular Migraine for Easier Diagnosis
    International Journal of Otorhinolaryngology and Head and Neck Surgery Vazhipokkil AC et al. Int J Otorhinolaryngol Head Neck Surg. 2019 May;5(3):699-704 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20191733 Original Research Article Decoding vestibular migraine for easier diagnosis Anoop C. Vazhipokkil*, Ashwini Shenoy Department of ENT, Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India Received: 02 January 2019 Revised: 22 February 2019 Accepted: 25 February 2019 *Correspondence: Dr. Anoop C. Vazhipokkil, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Due to the absence of a unified set of diagnostic criteria, vestibular migraine is always an underdiagnosed entity. This study was undertaken to find specific pointers in the diagnostic protocol which can help in diagnosing vestibular migraine and also to assess our treatment module for vestibular migraine. Methods: An elaborate proforma was prepared for evaluating each patient at our vertigo clinic for a time period of two years. A detailed history is followed by general examination, ENT examination, specific tests for eyes, tests for vestibulospinal tract, and also a few more tests such as Doppler, pure tone audiogram, ECHO etc. when the diagnosis was in doubt. A total of 206 patients were evaluated.
    [Show full text]
  • Bedside Neuro-Otological Examination and Interpretation of Commonly
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2004.054478 on 24 November 2004. Downloaded from BEDSIDE NEURO-OTOLOGICAL EXAMINATION AND INTERPRETATION iv32 OF COMMONLY USED INVESTIGATIONS RDavies J Neurol Neurosurg Psychiatry 2004;75(Suppl IV):iv32–iv44. doi: 10.1136/jnnp.2004.054478 he assessment of the patient with a neuro-otological problem is not a complex task if approached in a logical manner. It is best addressed by taking a comprehensive history, by a Tphysical examination that is directed towards detecting abnormalities of eye movements and abnormalities of gait, and also towards identifying any associated otological or neurological problems. This examination needs to be mindful of the factors that can compromise the value of the signs elicited, and the range of investigative techniques available. The majority of patients that present with neuro-otological symptoms do not have a space occupying lesion and the over reliance on imaging techniques is likely to miss more common conditions, such as benign paroxysmal positional vertigo (BPPV), or the failure to compensate following an acute unilateral labyrinthine event. The role of the neuro-otologist is to identify the site of the lesion, gather information that may lead to an aetiological diagnosis, and from there, to formulate a management plan. c BACKGROUND Balance is maintained through the integration at the brainstem level of information from the vestibular end organs, and the visual and proprioceptive sensory modalities. This processing takes place in the vestibular nuclei, with modulating influences from higher centres including the cerebellum, the extrapyramidal system, the cerebral cortex, and the contiguous reticular formation (fig 1).
    [Show full text]
  • Balance Disorders in Children
    Balance disorders in children Prof. Dr. Balasubramanian Thiagarajan (drtbalu) Reassurance plays a vital role Introduction 8% of children 1. Young children don’t usually complain of in the age group of 1-15 vertigo years 2. History can be elusive experienced 3. Diagnosis can be elusive vertigo 4. Other than middle ear disease & congenital or hereditary sensorineural conditions excluded migraine is the condition associated with giddiness 5. Posterior fossa diseases should be considered in older children Cinnarizine If appropriate can be used antimigraine treatments are effective Maturation of the vestibular system Phylogenetically vestibular At 4 months of age the baby system is older than auditory. Otic capsule can tilt its Each stage in development is in develops early in head to keep advance of auditory system gestation between it vertical 4th – 12th week of intrauterine life Vestibular system is the Vestibular first sensory nerve system to myelinates by develop. Full 16 weeks term babies demonstrate doll’s eye response By 24 weeks there is a primitive vestibulo- ocular reflex present Moro reflex is present in normal child Cochlear duct at birth has two and half coils by 50 mm stage Semicircular canals are formed from the utricular portion of otic vesicle by 30 mm stage After Birth Normal ENG values for canal paresis and directional preponderance calculations are 1. Maturation of vestibulospinal & wider than those seen in adults. vestibulo ocular reflexes continues and are maximal at 6-12 months of age Maximum slow phase velocity 2. Bithermal caloric responses can be readings are often similar to demonstrated in 9 month old babies those in adults 3.
    [Show full text]
  • Gait Disorders in Older Adults
    ISSN: 2469-5858 Nnodim et al. J Geriatr Med Gerontol 2020, 6:101 DOI: 10.23937/2469-5858/1510101 Volume 6 | Issue 4 Journal of Open Access Geriatric Medicine and Gerontology STRUCTURED REVIEW Gait Disorders in Older Adults - A Structured Review and Approach to Clinical Assessment Joseph O Nnodim, MD, PhD, FACP, AGSF1*, Chinomso V Nwagwu, MD1 and Ijeoma Nnodim Opara, MD, FAAP2 1Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, USA Check for 2Department of Internal Medicine and Pediatrics, Wayne State University School of Medicine, USA updates *Corresponding author: Joseph O Nnodim, MD, PhD, FACP, AGSF, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, 4260 Plymouth Road, Ann Arbor, MI 48109, USA Abstract has occurred. Gait disorders are classified on a phenom- enological scheme and their defining clinical presentations Background: Human beings propel themselves through are described. An approach to the older adult patient with a their environment primarily by walking. This activity is a gait disorder comprising standard (history and physical ex- sensitive indicator of overall health and self-efficacy. Impair- amination) and specific gait evaluations, is presented. The ments in gait lead to loss of functional independence and specific gait assessment has qualitative and quantitative are associated with increased fall risk. components. Not only is the gait disorder recognized, it en- Purpose: This structured review examines the basic biolo- ables its characterization in terms of severity and associated gy of gait in term of its kinematic properties and control. It fall risk. describes the common gait disorders in advanced age and Conclusion: Gait is the most fundamental mobility task and proposes a scheme for their recognition and evaluation in a key requirement for independence.
    [Show full text]
  • Evaluation of the Vestibulocochlear System in Patients with Pseudoexfoliation Syndrome
    Bilgeç et al. Vestibulocochlear System in Pseudoexfoliation Syndrome DOI: 10.4274/tjo.galenos.2020.14892 Turk J Ophthalmol 2021;51:156-160 Ori gi nal Ar tic le Evaluation of the Vestibulocochlear System in Patients with Pseudoexfoliation Syndrome Mustafa Değer Bilgeç*, Nagehan Erdoğmuş Küçükcan**, Leman Birdane***, Armağan İncesulu****, Nilgün Yıldırım* *Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey **Çukurova Dr. Aşkım Tüfekçi State Hospital, Clinic of Otorhinolaryngology, Adana, Turkey ***Yunus Emre State Hospital, Clinic of Otorhinolaryngology, Eskişehir, Turkey ****Eskişehir Osmangazi University Faculty of Medicine, Department of Otorhinolaryngology, Eskişehir, Turkey Abstract Objectives: Patients with pseudoexfoliation syndrome (PES) can also have sensorineural hearing loss as well as balance problems. Our aim was to evaluate vestibulocochlear system involvement in PES patients. Materials and Methods: The study included 16 subjects with PES (study group) with a mean age of 66.12±5.64 years and 17 healthy subjects (control group) with a mean age of 61.70±8.46 years. Both groups underwent ophthalmological, neuro-otological, audiological, and vestibular evaluation. Pure-tone audiometry and tympanometry were performed as audiological tests and bithermal caloric test and vestibular-evoked myogenic potential (VEMP) testing were used as vestibular tests. The Romberg, tandem Romberg, and Unterberger tests were also performed. Results: In the PES group, bithermal caloric tests revealed right canal paresis in 6 patients, left canal paresis in 3 patients, and bilateral stimulation loss in 2 patients, despite no clinical evidence of balance loss. Paresis was not detected in any of the control subjects. Unilateral VEMP responses could not be obtained in 3 patients in the PES group.
    [Show full text]
  • Admission* N % Peripheral Vestibular Disorder Acute Vestibula
    Supplement Table 1. Admission diagnosis of the patients (N=1262) Admission* N % Peripheral vestibular disorder 842 67.5 Acute vestibular neuritis 381 30.1 Benign paroxysmal positional vertigo 202 16.0 Meniere disease** 105 8.3 Other inner ear diseases 35 2.8 Unclassified peripheral vestibular syndrome 119 9.4 Unclassified 242 18.2 Central vestibular disorder 102 8.3 Stroke 44 3.5 Tumor 5 0.4 Head injury 8 0.6 Migraine 5 0.4 Other brain diseases 8 0.6 Unclassified central vestibular disorder 32 2.5 Cardiovascular syndrome 72 5.6 Vertebrogenic syndrome*** 3 0.2 Somatoform syndrome 1 0.1 *The ICD-Codes (ICD-10-GM) behind these diagnosis categories were: R42 (vertigo and dizziness), H81.0 (Meniere disease), H81.1 (benign paroxysmal positional vertigo), H81.2 (acute vestibular neuritis), H81.3 (other types of peripheral vestibular disorders), H81.4 (central vestibular disorder), H81.8 (other vestibular disorders), H81.9 (vestibular disorders, not specified), H82* (vertigo syndromes, otherwise not classified), H83.0 (labyrinthitis), H83.2 (hypofunction of the labyrinth). The descriptions of the codes are translations by the authors as the German modification (GM) was used. The ICD-codes sometimes did not allow a direct allocation to the diagnosis groups. The allocation is explained in Supplement Methods 1. **admission because of acute exacerbation or first episode of Meniere disease ***This category is controversial, but was upheld, as it was used as initial diagnosis in 3 cases. This category was not used for final diagnosis. 1 Supplement
    [Show full text]
  • Balance Disorders and Vestibular Function Testing
    Balance disorders and vestibular function testing Rahul Kanegaonkar Consultant Ear, Nose and Throat Surgeon Spire Alexandra Hospital Visiting Professor in Otorhinolaryngology Professor in Medical Innovation Canterbury Christ Church University President of the British Balance Network Contact: [email protected] Myths and misconceptions “There is nothing you can do for dizzy patients…”. “Live with it…”. “Ménière’s disease is a common cause of dizziness”. “All patients with dizziness are mad”. Objectives • Understanding the balance system • Management of common vestibular pathology Balance overview Vestibular ganglion Anterior semicircular canal Vestibular nerve Utricle Facial nerve Saccule Posterior semicircular canal Horizontal semicircular canal Cochlear nerve Ampulla Orientation of hair cells in the utricle Cochlea Orientation of hair cells in the saccule 6/30/2017 5 6/30/2017 6 6/30/2017 7 6/30/2017 8 Management of balance disordered patients Appropriate Intervention History investigations Three blind men and the elephant… 6/30/2017 9 History • History, may be very difficult. • First episode • Frequency and severity • Last episode • “Vertigo”, “light headed”, “dizzy”, “swimmy” • Hearing loss, tinnitus, positional, headache, photophobia, phonophobia Examination • Ear examination • Cerebellar signs • Cranial nerves • Romberg’s test • Nystagmus • Tandem Romberg’s • Saccades • Unterberger’s test • Smooth pursuit • Dix-Hallpike test • Head thrust test • Gait • Head shake test 6/30/2017 11 Romberg’s test and Unterberger’s tests D+R Balance app Measures postural sway Innovation award Chartered Society of Physiotherapists 6/30/2017 12 Examination • Ear examination • Cerebellar signs • Cranial nerves • Romberg’s test • Nystagmus • Tandem Romberg’s • Saccades • Unterberger’s test • Smooth pursuit • Dix-Hallpike test • Head thrust test • Gait • Head shake test 6/30/2017 13 Dix-Hallpike test Special investigations Investigations • Pure tone audiometry • Tympanometry It is not possible to directly assess the peripheral vestibular system.
    [Show full text]
  • Assessment and Treatment of Dizziness
    J Neurol Neurosurg Psychiatry 2000;68:129–136 129 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.68.2.129 on 1 February 2000. Downloaded from EDITORIAL Assessment and treatment of dizziness “There can be few physicians so dedicated to their art that they do not experience a slight decline in spirits when they learn that their patient’s complaint is giddiness. This frequently means that after exhaustive enquiry it will still not be entirely clear what it is that the patient feels wrong and even less so why he feels it.” From W B Matthews. Practical Neurology. Oxford, Blackwell, 1963. These words are not quite as true today as when Bryan Convinced? One can be reasonably sure then that the Matthews wrote them nearly 40 years ago. There is now patient who is happy to move around while dizzy does not cause for cautious optimism. Recent clinical and scientific have vertigo, and that the patient who is dizzy all the time developments in the study of the vestibular system have and whose dizziness is not made better by keeping still, made the clinician’s task a little easier. We now know more either hasn’t got vertigo or hasn’t got the story right. Now about the diagnosis and even the treatment of conditions that we are sure that our patient has vertigo the next ques- such as benign paroxysmal positioning vertigo, Menière’s tion to answer is whether the vertigo attacks are spontane- disease, acute vestibular neuritis, migrainous vertigo, and ous or positional. But before we go on to answer that let us bilateral vestibulopathy than we did in 1963 and our consider briefly the diagnosis of other common paroxysmal purpose here is to introduce the clinician to facts worth disorders such as syncope, seizure, hypoglycaemia, and knowing.
    [Show full text]
  • Bilateral Sudden Sensorineural Deafness with Vertigo As the Sole Presenting Symptoms of Diabetes Mellitus - a Case Report
    Indian J Otolaryngol Head Neck Surg (April–June 2010) 62(2):191–19462(2):191–194; DOI: 10.1007/s12070-010-0023-7 191 Clinical Report Bilateral sudden sensorineural deafness with vertigo as the sole presenting symptoms of diabetes mellitus - a case report Vilas Misra · C. G.Agarwal · Naresh Bhatia · G. K. Shukla Abstract This Paper reports a late uncontrolled diabetic Case history presenting to an otolaryngologist with sudden severe sen- sorineural hearing loss of immediate origin with vertigo A 55-year-old engineer was admitted to CSJMM University, and tinnitus as the symptoms. Appropriate investigative and upgraded KGM University, Lucknow as an emergency with treatment measure resulted in deterioration of hearing in the sudden loss of hearing in both ears with vertigo and tinnitus. right ear and mild improvement of hearing in the left ear, He noticed a very brief sound in his right ear lasting about with no recovery of imbalance. a second. He then become completely deaf in both ears and complained of vertigo and high pitched tinnitus. There was Keywords Sudden severe sensorineural hear- no history of facial weakness or discharge from his ears. ing loss · Vertigo · Tinnitus · Diabetes mellitus There was no history of external trauma or sudden straining (NIDDM) prior to the onset. There was no history suggestive of a viral infection. There was no family history of deafness. He was a known late diabetic and a hypertensive. There was no other significant past medical history. He was not on any regular medication and described himself as perfectly healthy prior to admission. The hearing in both his ears was known to be normal 12 months before this recent episode.
    [Show full text]
  • Journal 2018
    Journal of ENT masterclass ISSN 2047-959X Journal of ENT MASTERCLASS® Journal of Journal ENT MASTERCLASS ® www.entmasterclass.com VOL: 11 No: 1 Year Book 2018 Volume 11 Number 1 YEAR BOOK 2018 VOLUME 11 NUMBER 1 JOURNAL OF ENT MASTERCLASS® Volume 11 Issue 1 December 2018 ENT Masterclass® Contents The FREE International training platform CALENDER OF RESOURCES 2019 Editorial 3 Hesham Saleh 8th Advanced ENT Emergencies Masterclass® Venue: Doncaster Royal Infirmary, 28th June 2019 Child maltreatment for the ear, nose and throat surgeon 4 Adal H Mirza, Steven J Frampton and Michael Roe 12th Thyroid & Salivary Gland Masterclass® Venue: Doncaster Royal Infirmary, 29th June 2019 ENT manifestations of paediatric immune dysfunction 9 Alasdair Munro and Saul N. Faust 10th ENT Radiology Masterclass® Venue: Doncaster Royal Infirmary, 30th June 2019 Laryngeal clefts 15 Kumar S and Wyatt ME ® ENT Masterclass Bahrain Clinical law: Treating children 20 Bahrain, 14th Feb 2019 Robert Wheeler 2nd ENT Masterclass® Pakistan Paediatric gastroesophageal reflux disease 24 Ali Hakizimana and Nadeem Ahmad Afzal Lahore, 16-17th Feb 2019 nd ® Assessment and management of pediatric dysphonia 31 2 ENT Masterclass South Africa Anne F. Hseu, Jennifer A. Brooks and Michael M. Johns III Cape Town, 19-21st April 2019 Scalp defect - Reconstruction protocol 36 4th ENT Masterclass® China Ali A. Alshehri, Alwyn D’Souza and Anil Joshi Beijing, 24-26th May 2019 Clinical challenges in management of keloids: th ® A review of literature 41 4 ENT Masterclass Europe Ali A. Alshehri, Alwyn D’Souzaand Anil Joshi3 Bucharest, Romania, 6-7th Sept 2019 Algorithm for the management of lateral crural pathology 45 2nd ENT Masterclass® Switzerland Saleh Okhovat and Natarajan Balaji Lausanne, 8-9th Nov 2019 Osteoma and Exostosis 54 o Limited places, on first come basis.
    [Show full text]