8/20/2019 Important Note* Why the ‘eyes are the liars’ Images in this presentation are used with permission from the sources or as set out Relevance of the AVNS in in the rules of use Patient Care and Management They are not to be reproduced without in whiplash & mTBI Patients permission or used for distribution Referencing and acknowledgment of these copyrights are provided Brenda E. Berge, Au.D. , F-ADA Doctor of Audiology, Fellow ADA Membranous Labyrinths Anterior (superior) semicircular canal and duct Ampullae Dura mater Posterior semicircular Endolymphatic sac canal and duct Endolymphatic duct in Common crus and duct vestibular aqueduct Lateral semicircular Utricle canal and duct Saccule Stapes in oval (vestibular) window Helicotrema of cochlea Incus Ductus reuniens Scala vestibuli Malleus Cochlear duct Tympanic cavity Scala tympani External acoustic meatus Tympanic membrane Cochlear aqueduct Round (cochlear) window (closed by Vestibule secondary tympanic membrane) Vestibulocochlear Nerve: Schema Auditory (Eustachian) tube 1 8/20/2019 Inner Ear Superior division of vestibular nerve (from Anterior (superior) utricle and anterior and lateral ampullae) semicircular duct Anterior membranous ampulla Utricle Lateral membranous ampulla Cochlear duct (basal turn) Common membranous Cochlear nerve duct Lateral semicircular duct Vestibulocochlear nerve (VIII) Posterior semicircular duct Vestibular nerve Saccule Posterior Vestibular ganglion membraneous ampulla Endolymphatic duct Inferior division of vestibular nerve (from saccule and posterior ampulla 2 8/20/2019 Axial T2 MRI Cochlea http://www.emedicine.com/ent/images/Large/597REVD622Ccloseupnorm_2.jpg http://www.emedicine.com/ent/images/Large/664698FIG11.JPG Superior Canal Dehiscence http://www.emedicine.com/ent/images/Large/21472147SCDS.jpg 3 8/20/2019 Auriculotemporal Nerve 4 8/20/2019 Muscles of Neck: Anterior View 5 8/20/2019 VCR VSR VESTIBULOCOLLIC VESTIBULO- REFLEX SPINAL REFLEX ACTS ON THE MUSCLES SENDS DESCENDING IN THE NECK TO MOTOR CONTROL STABLIZE THE HEAD. SIGNALS TO THE THE HEAD RESPONDS MUSCULOSKETAL TO MOVEMENT SENSED BY THE SYSTEM FOR OTOLITHIC OR SCC POSTURAL CONTROL ORGANS. From Halmagyi & Curthoys, In Herdman Cervical Reflexes VOR COR - Cervico-Ocular: Eye movements driven VESTIBULOCULAR by the neck muscle proprioceptors. COR REFLEX supplements the VOR. ALLOWS VISUAL CSR - Cervicospinal: Changes in limb position STABILIZATION driven by neck muscle afferent activity. CSR DURING ACTIVE supplements the VSR. HEAD MOVEMENT CCR - Cervicocollic: Cervical reflex that stabilizes the head on the body. 6 8/20/2019 Peripheral Modified Fully-Supported Hallpike - BPPV pathways for vertigo and nystagmus Medial longitudinal fasciculus Labyrinth IV nerve Vestibular nuclei VI nerve III nerve Scarpa’s Vestibular ganglion nerves Internal auditory canal Vertebral Artery Test VOG Screening- Congenital Nystagmus 7.