vestibular audiology conditions

1. Audiology Presentation
28 March 2017
Themba Hospital
WARD 8 SPEECH AND AUDIOLOGY DEPARTMENT

2. Speech and Audiology Team
Head of Department
 Zodwa
Grade 1 staff members
 Katlego Nkuna: Speech and Audiologist
 Gabby: Speech
 Anja: Speech Therapist
 Monique: Audiologist
Community Service:
Danielle van der Merwe: Speech and Audiologist
Simphiwe Ngwenya:

3. Scope of Audiology in a Hospital setting
Electrophysiological
Ax:
Objectives Axs such as
ABR, OAE
Geriatric Audiology
Disorders& pathologies
caused by aging such as
Presbycusis
Diagnostic Audiology:
Assess the hearing status
Conductive vs
sensorineural
pathologies
Paediatric Audiology:
Neonatal screening
Management of CSOM,
EARLY DIAGNOSIS AND
Mx
Educational Audiology:
Type of audio that affects
child in educational
setting such as processing
disorders
Vestibular Audiology
Assesses functioning of
vestibular system(balance)
Audiology Scope

4. What is Vestibular Audiology?
Part of audiology that assess functioning of vestibular system
Function of Vestibular system
1. Equilibruim( Balance)
2. Spatial Awareness
3. Rotation
4. Linear Movement

5. BALANCE
=
+
+ + + +
Vestibular system Visual Input Proprioceptive Cerebellum, Cerebral
Cortex& Brainstem

6. How we maintain focus on object/image
during head movement
 VOR signals to eyes to move opposite
Direction of head movement
 with same velocity and
 Amplitude

7. Prior to assessing pt in Vestibular Clinic
 Diagnostic Audiological Assessment
 In depth medical history
 Comprehensive Case History
 TTTA= differentitial diagnosis in 10 min
****NB Differentiate between True Vertigo and Dizziness
IF pt describes DIZZINESS, REFER cause not vestibular case
DIZZY VERTIGO
VS

8. The BIG 5 of Vestibular Disorders
1. Benign Positional Posterior Vertigo(BPPV)
2. Menieres Disease
3. Vestibular Neuritis
a. Inferior VN
b. Superior VN
4. Bilateral Vestibular Hypofunction
5. Persistent postural-perceptual dizziness(PPPD)

9. Benign Positional Posterior Vertigo(BPPV)
 Most common Vestibular Disorder
 Brief spells of false sensation of head movement triggered by head movements
 More prevalent in females over 50
 Has 3,2% lifetime Prevalence in females as compared to 1,6% in males
Typical Symptoms: experiences Vertigo if:
 Sitting from supine INCREASED RISK OF
 Lying or turning over in bed FALLING/ PT REPORTS
 Flexing neck or bending over
 Nystagmus FALLS DUE TO LOSS
“BALANCE”

10. Physiology and diagnosing BPPV
Types of BPPV Diagnosing:
Canalithiasis vs Cupulolithiasis Dix- Hallpixke

11. Management of BPPV
 BPPV is a mechanical disorder, therefore mechanical repositioning manoeuvre is
gold standard, not vestibular suppressants
CRP manoeuvre to reposition crystals
Back to Utricle
 Cost effective
 Can teach pt to do at home when
Symptoms return

12. 2. Meniere’s Disease
 Inner ear disease caused by
“ excessive endolymphatic fluid pressure in the endolymphatic membranous Labyrinth”
 Overly diagnosed especially in geriatric community
Symptoms:
 20 minutes to hours attack of:
 Vertigo
 Hearing Loss
 Low pitched roaring Tinnitus
 A feeling of fullness or blocked ears
 Postural Imbalance
 Nystagmus beating to the opposite site of the lesion

13. Categorising Meniere’s
 “Certain” on histopathologic confirmation
 “Definite” two or more attacks >20 mins; documented HL, tinnitus and fullness, other causes
excluded
 “Probable” as above, only 1 attack needed
 “Possible” episodic vertigo without HL

14. Meniere’s: Management
Medical:
 Long term options:
 Lifestyle advice (triggers, salt)
 Devices such as Meniett
 Meds: diuretics, vasodilators, steroids, aminoglycoside ablation
 For all options – strong evidence lacking
Audiological:
 Vestibular Rehabilitation Therapy
 Tinnitus therapy
 Hearing rehabilitation

15. Vestibular Neuritis
 Inflammation of the Vestibular Nerve
 Most likely ganglion cells are affected
2 Types of Vestibular Neuritis
 Superior Vestibular Neuritis
(more prevalent)
 Inferior Vestibular Neuritis
(symptoms more severe)

16. Symptoms
 prolonged vertigo, N & V, slow improvement over weeks
 May have high frequency SNHL
 Followed by recurrent episodes of severe vertigo
 Spontaneous nystagmus
 Usually no auditory symptoms
 Commonly preceded by URTI
 Viruses include rubeola, reovirus, CMV and neurotropic strains of flu

17. Management
 Vestibular suppressants in acute stage
 Diazapam, Meclizine
 NB Withdraw asap
 Steroids helpful, acyclovir not
 Physio – strategies of substitution; habituation, balance and gait training
 Long term resolution can be very poor if not properly managed

18. Bilateral Vestibular Hypofunction
 Can be sequential or spontaneous
 Most commonly on ototoxic basis
 Has acute, chronic and compensatory stages
 Primary feature is oscillopsia
 Major issue is the loss of the VOR

19. Risk factors for Vestibular ototoxicity
 Drug variables: type, dosage, synergy
 Patient variables: age, genetics, renal status, previous Rx
 Clinician variables: awareness, ability to recognise symptoms, knowledge of vestibular otoxicity
Symptoms:
 Increased risk of falling
 Oscillopsia
 Imbalance
 Sense of disequilibrium and dizziness

20. Management
 physio
 Withdraw all vestibular sedatives and psychotropic drugs
 Prognosis variable and often poor
 Patients often severely disabled
 Compensatory strategies
 “Golden period” for Rx 6 months

21. Persistent postural-perceptual dizziness(PPPD)
 Somatoform disorder
 Disorders with symptoms that cannot be attributed
to medical condition and
there’s presence of psychological factors
 Represent a health practitioner’s
 diagnostic assessment rather
 than a patient’s self-observation.
Negative
reaction to
symptoms
Avoidance
behaviour
Anxiety
response
ANS
activation
and panic
Fear of
episode/
attack
Delayed
compensation

22. Persistent postural-perceptual dizziness(PPPD)
 Chronic hypersensitivity to own movements
 Fear of places where
there a lot of visual noise
 Light-headedness
 Non-vertiginous dizziness
 Anxiety attacks
 Usually a stress trigger in pts life
(psychological)
Psychogenic
Chronic
Subjective
Dizziness

23. PPPD: Management
 Psychology referral(Not always but often)
 Little evidence, but
 Selective Serotonin Reuptake Inhibitors(SSRI)
 combined with vestibular therapy looks the most promising
 Good explanation to patient essential with stress on management rather than
continued help-seeking behaviours

24. References
 Ariano, R. E., Zelenitsky, S. A., & Kassum, D. A. (2008). Aminoglycoside-induced vestibular injury:
maintaining a sense of balance. The Annals of Pharmacotherapy, 42, 1282 – 1289.
 Coelho, D. H. & Lalwani, A. K. (2008). Medical treatment of Ménière’s Disease. The Laryngoscope,
118, 1099 – 1108.
 Chalwa, N. & Olshaker, J. S. (2006). Diagnosis and management of dizziness. Medical Clinics of
North America, 90, 291 – 304.
 Schwaber, M. K. (2008). Vestibular disorders. In G. B. Hughes & M. L. Pensack (Eds.), Clinical
Otology (3rd Ed.), 355 – 374. New York: Thieme.
 Schwade, N. D. (2000). Pharmacology in audiology practice. In R.J. Roeser, M. Valente & H.
Hosford Dunn, (Eds.) Audiology Diagnosis, 139 – 152. New York: Thieme.
 Staab, J. P. (2006). Chronic dizziness: the interface between psychiatry and neurotology. Current
Opinion in Neurology, 19, 41 – 48.
 Staab, J. P. & Ruckenstein, M. J. (2007). Expanding the differential diagnosis of chronic dizziness.
Archives of Otolaryngology Head and Neck Surgery, 133, 170 – 176.

25. Questions???