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Implications of Vestibular Dysfunction Among the Aging Population: a Pocket Guide for Health Care Professionals City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 5-2019 Implications of Vestibular Dysfunction Among the Aging Population: A Pocket Guide for Health Care Professionals Maia L. Weisenfeld The Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/3145 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] IMPLICTIONS OF VESTIBULAR DYSFUNCTION AMONG THE AGING POPULATION A Pocket Guide for Health Care Professionals by MAIA WEISENFELD A capstone research project submitted to the Graduate Faculty in Audiology in partial fulfillment of the requirements for the degree of Doctor of Audiology, The City University of New York 2019 © 2019 MAIA WEISENFELD All Rights Reserved ii IMPLICTIONS OF VESTIBULAR DYSFUNCTION AMONG THE AGING POPULATION A Pocket Guide for Health Care Professionals by MAIA WEISENFELD This manuscript has been read and accepted for the Graduate Faculty in Audiology in satisfaction of the capstone project requirement for the degree of Au.D. ___________________ ___________________________________________ Date ___________________________________________ Chair of Examining Committee ___________________ ___________________________________________ Date ___________________________________________ Acting Executive Officer The City University of New York iii Abstract IMPLICTIONS OF VESTIBULAR DYSFUNCTION AMONG THE AGING POPULATION A Pocket Guide for Health Care Professionals by Maia Weisenfeld Advisor: Dr. Barbara Weinstein, Ph.D. The goal of this health information booklet is to provide healthcare professionals with the appropriate tools and information required to ensure all patients with a vestibular impairment are cared for and treated appropriately. The following guide includes overview of the vestibular system, vestibulotoxic medications, and common vestibular disorders. These notable areas are required for appropriate treatment and referral to other professionals for treatment. Keywords: vestibular dysfunction, central pathology, peripheral pathology, vestibulotoxicity, balance iv TABLE OF CONTENTS Abstract .......................................................................................................................................... iv List of Tables ................................................................................................................................ vii List of Figures .............................................................................................................................. viii Introduction ......................................................................................................................................1 The Vestibular System .....................................................................................................................4 The Aging Vestibular System ..........................................................................................................7 How to Assess Balance and Gait .....................................................................................................8 Cognitive and Emotional Ailments and the Aging Vestibular System ..........................................11 Hearing Loss and The Aging Vestibular System ...........................................................................12 Vestibular Disorders ......................................................................................................................14 Peripheral Vestibular Disorders .....................................................................................................16 Benign Paroxysmal Positional Vertigo ...................................................................................16 Meniere’s Disease ..................................................................................................................19 Vestibular Neuritis..................................................................................................................22 Labyrinthitis ...........................................................................................................................24 Acoustic Neuroma/Vestibular Schwannoma ..........................................................................25 Semicircular Canal Dehiscence ..............................................................................................26 Central Vestibular Disorders..........................................................................................................29 Vestibular Migraine ................................................................................................................29 Vestibular Ischemic Stroke .....................................................................................................31 Vestibulotoxic Drugs .....................................................................................................................32 Aminoglycosides ........................................................................................................................34 Loop Diuretics ............................................................................................................................34 v Non-Steroidal Anti-Inflammatory Drugs ...................................................................................35 Chemotherapeutic Agents ..........................................................................................................35 Antimalarials ..............................................................................................................................35 Appendices .....................................................................................................................................39 References .....................................................................................................................................46 vi LIST OF TABLES Table 1. Structures of the Bony and Membranous Labyrinths ........................................................4 Table 2. Informal Observations .......................................................................................................8 Table 3. Tinetti Balance and Gait Test. Balance Questionnaire ......................................................8 Table 4. Tinetti Balance and Gait Test. Gait Questionnaire ............................................................9 Table 5. Classification of Dizziness...............................................................................................14 Table 6. Classification of Meniere’s Disease ................................................................................20 Table 7. Differentiating Labyrinthitis and Vestibular Neuritis ......................................................24 Table 8. Overview of Peripheral Vestibular Disorders .................................................................28 Table 9. ICHD-3 Beta Diagnostic Criteria of Vestibular Migraine ...............................................30 Table 10. Classification of Vertebrobasilar Ischemic Stroke .......................................................31 Table 11. Classification of Common Ototoxic Medications ........................................................36 vii LIST OF FIGURES Figure 1. The Bony and Membranous Labyrinths of The Inner Ear. ..............................................4 Figure 2. Superior and Inferior Vestibular Nerve Innervation .......................................................5 Figure 3. Cupula Deflection During Angular Acceleration. ...........................................................5 Figure 4. Deflection of Kinocilium And Stereocilia During Linear Acceleration .........................6 Figure 5. The Relationship between Hearing Loss and Vestibular Impairment on Risk of Falls and Fear of Falling .........................................................................................................................12 Figure 6. Effects of Hearing Instruments on Falls .........................................................................13 Figure 7. Symptoms Of BPPV .......................................................................................................17 Figure 8. Displacement of Otoconia In Cupulothiasis BBPV and Canalithiosis BPPV ................17 Figure 9. Performance of The Dix Hallpike Maneuver .................................................................18 Figure 10. Healthy Inner Ear vs. Pathologic Inner Ear Affected by Meniere’s Disease ...............19 Figure 11. Dehiscence of The Superior Semicircular Canal ..........................................................26 viii Introduction By the year 2030, it is estimated that 20% of the United States population will be persons aged 65 and over. From 2000 to 2010 alone this age group grew 15% from 35 million to 40.3 million. This increasing population will have a substantial effect on the health care system, particularly emergency medicine. From 2009 to 2010, a total of 19.6 million emergency department visits in the United States were made by persons aged 65 and over. Of those visits, 29% were related to injury and an even higher percentage for those aged 85 and over (Albert, McCaig & Ashman, 2013). In the United States, unintentional falls are the most
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