what are peripheral vestibular disorders?
- viral labyrinthitis
- bacterial labyrinthitis
- vestibular neuritis
- benign paroxysmal positional vertigo
- acoustic neuroma
- meniere disease
what is viral labyrinthitis?
- URI often proceeds
- sudden unilateral HL & severe vertigo, n/v
- pt often bedridden w/sxs
- vertigo may subside after several days-wks, but unsteadiness & positional vertigo may persist for several mos
PE findings of viral labyrinthitis?
- spontaneous nystagmus towards normal side
- diminished or absent caloric responses in affected ear
- hearing loss mild to moderate
what is a unique form of viral labyrinthitis? SSxs?
- herpes zoster oticus (ramsay-hunt syndrome)
- reactivation of varicella-zoster virus infxn yrs after primary infxn
- SSxs: initial deep burning auricular pain followed by eruption of vesicular rash in external auditory canal and concha, vertigo, HL, facial weakness
what is bacterial labyrinthitis?
- direct bac invasion or pass of bac toxins into inner ear
- meningitis affects both ears, spread via CSF
- infections of middle ear or mastoid commonly spread via dehiscent horizontal semicircular canal
SSxs of bacterial labyrinthitis?
-profound HL, severe vertigo, ataxia, n/v
what is vestibular neuritis?
- benign & temporary disorder of vestibular nerve
- URI often proceeds
- more common in spring & early summer
- commonly viral
SSxs of vestibular neuritis?
-sudden acute vertigo w/o HL
PE findings of vestibular neuritis?
- horizontal nystagmus
- some gait instability
- NO HEARING LOSS
what is benign paroxysmal positional vertigo?
-sudden vertigo from provacative positions, triggering nystagmus
what are canalithiasis?
- canal rocks
- particles in canal portion of SCCs, free floating & mobile
- cause vertigo by exerting a force
what are cupulolithiasis?
- densities adhered to cupula of crista ampullaris
- not free floating
risk factors for benign paroxysmal positional vertigo?
- inactivity
- alcohol
- caffeine
- major surgery
- CNS dz
causes of BPPV?
- idiopathic
- vestibular neuritis
- head/ear trauma
- OM
- meniere disease
SSxs of BPPV?
- sudden onset, while trying to sit up, lying down, rolling over in bed
- start suddenly, gone in 20-30 secs
PE findings for BPPV?
- generally unremarkable
- Dix-hallpike maneuver
what is an acoustic neuroma?
-benign slow growing tumor derived from schwann cells of CN 8
SSxs of acoustic neuroma?
- unilateral, progressive SN hearing loss
- vertigo, tinnitus, disequilibrium
- H/A in 50-60% of pts
what is unilateral SNHL always considered until proven otherwise?
ACOUSTIC NEUROMA
what is meniere disease? cause?
- increased vol & pressure in endolymph in inner ear
- idiopathic
SSxs of meniere disease?
- triad: waxing & waning SNHL, tinnitus & vertigo
- prodrome: fullness or blocked sensation in 1 ear
- tinnitus followed by decrease in hearing
- n/v, diarrhea, pallor, sweating w/acute attack
- vertigo w/or shortly following hearing sxs
- lasts mins-hrs or several days
- H/A, unsteady gait may persist for several days
what is the course of meniere disease?
- after acute attack hearing may return to normal
- recurrence is common but unpredictable
- hearing may decrease over time
weird sign with meniere disease?
-sometimes pts may experience such severe vertigo they may collapse= Tumarkin crises
diagnostic criteria for meniere?
- isolated attacks of whirling, vertigo w/n/v for at least 20 mins up to several hrs
- tinnitus
- SNHL
