3. INTRODUCTION
The vestibular system is made up of:
Vestibule (sensory organ) ( SCC+OTOLITH )
Cranial NerveVIII
Brainstem vestibular nuclei
Cerebellar pathways
Provides information about head motion and orientation
in respect to gravity.
Generates eye movements to promote gaze stabilization
and postural righting responses involving the head and
trunk.
5. Vestibule (sensory organ)
1.Semicircular canals
3 bony canals in each ear – Superior/Anterior,
Posterior, & Horizontal
The canals are positioned at a 90° angle from one
another, with the horizontal canal tippedbackwards
20-30 degrees
6. THE PARTS OFTHE CANALS INCLUDE:
Endolymph – fluid that fills the canals
Ampulla - dilated space at the end of each canal
Cupula - gel-like bud, embedded with sensory hair
cells, that sits within the ampullated (dilated) portion
of each canal
Hair Cells – krinocilia and stereocilia
The semicircular canals detect angular accelerations
of the head through displacement of the cupula
7. 2. Otolith Organs (Utricle and Saccule)
These organs make up the medial portion of
the vestibule
The semicircular canals originate from the
utricle
Calcium carbonate crystals called otoconia are
attached to both the medial wall of the saccule
and floor of the utricle
Otoconia – detects tilts and translations of the
head, because they respond primarily to linear
acceleration forces like gravity
10. PHYSIOLOGY AND MOTOT CONTROL
1.Vestibular-ocular Reflex (VOR)
TheVOR generates compensatory eye movements in order
to stabilize gaze during head motion (i.e. Rotation of head to
the left results in rightward compensatory eye movement)
11. 2.Balance and postural control
The brain uses vestibular input to help it stabilize the head
and body in space through neck, trunk and hip muscle
activation
Activation of distal muscles is primarily the responsibility of
the somatosensory system
12. 3.Vestibulo-spinal Reflex (VSR)
Maintains vertical alignment of the trunk
When the head tips in one direction, the body elongates tothat
side and shortens on the other
13. 4.Vestibulo-collic Reflex (VCR)
Activates the neck musculature to stabilize the head in
space
Compensates for displacements of the head that occur
during gait
14. 5.Push -Pull Mechanism
Head movement and
direction compared
between two SSC.
Exa: head is turned to the
right side
Right horizontal SSC
Increase firing rate
Left horizontal SSC
Decrease firing rate
15. MOVEMENTS
SIDE ROTATION : HORIZONTAL SCC
FLEXION-EXTENSION :ANTERIORSCC
SIDE FLEXION : POSTERIOR SCC
LINEAR MOVEMENT :UTRICLE
UP DOWNACCELERATION:SACCULE
17. ACOUSTIC NEUROMA
Also k/a vestibular schwanomma
Benign tumor located on cranial nerve 8
Features
Progressive hearing loss
Tinnitus
disequilibrium
Treatment
Surgical excision of tumor
Preoperative complication
Vertigo ( sacrificing all / part of the vestibular nerve)
18.
19. MENIERE'S DISEASE
Diagnosed by a documented
Low Frequency Hearing Loss
EpisodicVertigo
Sense Of Fullness InTheEar
Tinnitus
The symptoms gradually increase in severity &
then last 1 to 2 hrs / episode
Pathophysiology
Increase in endolymphatic fluid cuasing
distension of the membranous tissues
20.
21.
22. TRIGGERS
Stress, Overwork, Fatigue, Emotional Distress,
Additional Illnesses, Pressure Changes, Certain
Foods,AndToo Much Salt InThe Diet.
Medical treatment
Diuretics [to control the amount of water in the
body]
Reducing/preventing fluid buidup
Diet
Reduced sodium diet ( 2g/day or less)
Avoid caffeine & alcohol
24. MIGRAINE-RELATED DIZZINESS
Vestibular migraine (VM) is vertigo
associated with a migraine’ either as a symptom
of migraine or as a related but neurological
disorder
Also k/n as
Migraine-associatedVertigo(MAV)
MigrainousVertigo
Migraine-relatedVestibulopathy
25. Signs and symptoms
Vertigo
Motion sickness
Sensorineural Hearing Loss
MEDICALTREATMENT
Acetazolamide
Calcium Channel
26. CERVICOGENIC DIZZINESS
Cervicogenic dizziness is a syndrome of neck pain
accompanied by an illusory sense of motion and
disequilibrium
Neck pain often accompanies dizziness
Causes
Result of whiplash/head injury
Brain injury
Inner ear injury
27.
28. Pathophysiology
The upper cervicle spine sends proprioceptive input to
the contralateral vestibular nucleus
Symptoms
Dizziness worse during head movement
Dizziness worse after maintaining one head position
Dizziness occurs after neck pain & accompanied by a
headache
[Dizziness usually present last minutes to hours]
Imbalance increase with head movement / movement
of environment
29. VERTEBROBASILAR INSUFFICIENCY
Dizziness due to vascular compromise
Causes
•Result of whiplash
/head injury
•Brain injury
•Inner ear injury
Symptoms
•Diplopia
•Dysarthria
•Syncope
•Headache
•Visual field deficit
•Vertigo
•nystagmus
30.
31.
32. Test
Pt position:sitting
Procedure: pt leans forward & extends the neck
than rotated 450. check these symptoms
Diplopia
Dysarthria
Syncope
Headache
Visual field dificit
Vertigo
nystagmus
33.
34. AUTOIMMUNE INNER EAR DISEASE
Immune system runs amok,self-attack of antigen-
antibody is referred to as an autoimmune
reaction.
The immune system can attack the ear and some
other body parts (eye / attack the entire body)
Autoimmune reaction creates a debris
If the ear is not being directly attacked, it can end
up with debris transported from distant locations
and deposited by the circulation.
35. Symptoms
Hearing loss
Vestibular symptoms
More frequently in women than men and less
frequently in children and the elderly
Medical treatment
Immuno suppression
Steroids
36. AGE RELATED DIZZINESS AND IMBALANCE
The body has three primary sensory systems
that work together to create postural
stability.
With normal brain function, the vestibular
system of the inner ear coordinates with the
visual system and proprioceptors.
37. Pathological changes
Number of nerve cells in the vestibular system
decreases after about age 55.
Blood flow to the inner ear also decreases with
age.
When the vestibular system is damaged, an
individual may experience dizziness and balance
problems
38. CAUSES
Impaired Inner Ear Function
Cardiovascular Health
Neurological Disease
Arthritis
Mental Status
Nutrition
ImpairedVision
Lifestyle and Environmental factors
39. PEDIATRIC VESTIBULAR DISORDER
It is due to disruption of vestibular system.
Symptoms
Vertigo
Dizziness
Oscillopsia
Gaze instability
Delayed development
Diminished balance
Other motor disabilities
41. BENIGN PAROXYSMAL POSITIONAL
VERTIGO (BPPV)
Benign – it is not life-threatening
Paroxysmal – it comes in sudden, brief spells
Positional – it gets triggered by certain head positions
or movements
Vertigo – a sense of rotational movement
Benign paroxysmal positional vertigo (BPPV) is a
disorder of the inner ear characterized by episodes
of vertigo triggered by changes in head position.
Incidence of 107 per 100,000 per year.
42. INCIDENT
Accounts for 20% of dizziness cases presenting to
ENT office
Frequently seen in elderly
50% of all dizziness in elderly is due to BPPV
43. TYPICAL PRESENTATION
Transient episodes of vertigo (<1 minute)
Initiated by position change
Characterized by periods of exacerbation
and remission
Usually unilateral
Symptoms include dizziness,imbalance,
difficulty concentrating & nausea
44. PATHOLOGY
Semicircular Canals (SCC)Filled with endolymph
Detect rotational movement
Endolymph exerts pressure on Cupula (sensory
receptor at SCC base) & sends impulses to brain
Otolith in the semicircular canals shift causing
the cupula to send false positional signals to the
brain
45.
46. ETIOLOGY
Idiopathic (unknown causes)
Natural age-related degeneration of otolithic
membrane
Head injuries (concussions,whiplash)
Other possible causes
Ear viruses, migraine, earsurgery
47. It is very commonly triggered by things like
Rolling over in bed
Getting in and out of bed
Tipping the head to look upward
Bending over
Quick head movements
48. Mechanism of BPPV based on location of
SCC & types of nystagmus
SCC CUPULOLITHIASIS CANALITHIASIS
RIGHT
POSTERIOR
PERSISTENCE UBN &
RIGHT TORSION
TRANSIENT UBN &
RIGHT TORSION
LEFT
POSTERIOR
PERSISTENCE UBN &
LEFT TORSION
TRANSIENT UBN &
LEFT TORSION
RIGHT
ANTERIOR
PERSISTENCE DBN &
RIGHT TORSION
TRANSIENT DBN &
RIGHT TORSION
LEFT ANTERIOR PERSISTENCE DBN &
LEFT TORSION
TRANSIENT DBN &
LEFT TORSION
HORIZONTAL PERSISTENCE
AGEOTROPIC
TRANSIENT
GEOTROPIC
49. Special tests
Hallpic dix test ( post scc)
Side lying test
Hallpike & roll test ( horizontal scc)