except bppv,meniere

1. PERIPHERAL VESTIBULAR
DISORDERS
Dr Tess Jose
Intern

2. • . The peripheral vestibular system includes
Vestibular end organs
First order neuron VIII CN

3. • VESTIBULAR END ORGAN INCLUDE
3 semicircular canal(sensitive head rotation)
2 otoloth (sensitive to linear acceleration)

4. Semi-circular canal
 3 in number-lateral post, superior
 Respond to angular acceleration and
deceleration
 Right angle to each other
 Stimulation of canal produce nystagmus
 Horizontal nystagmus –horizontal canal
 Rotatory- superior
 Vertical -posterior

5. Peripheral vestibular disorders
1. Meniere disease
2. BPPV
3. Vestibular neuronitis
4. Labrynthits
5. Vestibulotoxic drugs
6. Head trauma
7. Perilymph fistula
8. Syphilis
9. Acoustic neuroma

6. 1.Vestibular neuronitis
• Inflammation of vestibular branch of VIIIth cranial nerve
• Affects balance >> hearing
• Infection often associated with systemic viral infection such as
influenza , EBV, herpes, measles, hepatitis
• Symptoms severe vertigo sudden onset with no cochlear symptoms
• Last for few days to 2 to 3 weeks.
• Tx –antihistaminics , anticholinergics, anti dopaminergic
• Self limiting

7. 2.Labyrinthitis
• Infection of labyrinth
• There are 3 stages
Fistula formation
Serous labryrinthitis
 diffuse suppurative labryrinthitis

8. Fistula formation
• Causes –csom ,neoplasm,trauma
• Dx FISTULA TEST
1. pressure on tragus
2. siegle’s speculum
• Mx – antibiotics , mastoid exploration
False negative: cholesteatoma
False positive :congential syphilis,Meniere’s d/s(25%)
Sudden inward pressure is
applied on tragus
Increases pressure in ear
canal stimulates labyrinth
Vertigo , nystagmus

9. Diffuse serous labyrinthitis
• Causes – pre existing fistula formation ,acute infection of middle ear
,following stapedectomy
• Cf –vertigo, vomiting , SNHL
• TX- antibiotics,
labyrinthine sedative
myringotomy
mastoidectomy

10. • Diffuse suppurative labyrinthitis
• Follows serous labyrinthitis
• Cf- severe vertigo , nausea , vomiting
Total loss of hearing
Tx-same as above

11. 3.Vestibulo toxic drugs
• Aminoglycosides (irreversible)
Streptomycin
Gentamycin
Kanamycin
Amikacin
• Cisplatin
• Furosemide
• Quinine
• NSAIDS(Naproxin,Ibuprofen)
• Macrolides (erythomicin)
Affects hair cell of crista ampuillaris

12. 4.Head trauma
• Can be due to:
 concussion of labyrinth
Disrupt bony labyrinth
VIII th CN
Disturb vestibular end organ

13. 5.Perilymph fistula
• A perilymph fistula (PLF) is an abnormal connection in one or both of
the oval window and the round window) that separate the air filled
middle ear and the fluid filled perilymphatic space of the inner ear.
• This small opening allows perilymph (fluid) to leak into the middle
ear.
• Causes : 1.stapectomy complication
2. barotrauma
3. raised ICT

14. 6.Syphillis
• Can be seen In patients with any stage .
1. hearing loss ,vertigo, tinnitus
2. Aural pressure
3. Loudness in tolerance
4. Displacusis(inter aural pitch difference
– single auditory stimulus as different
pitch in 2 ears )
5. Neurosyphilis – central type of
vestibular dysfunction )

15. 7.Acoustic neuroma
• Benign encapsulated tumor of VIII th nerve
• Clinical features
• Earliest symptoms
1. Cochleovestibular symptoms(deafness,tinnitus)as tumour arises
from IAC)
2. Tinnitus, Vertigo (COCHLEAR SYMPTOMS)
3. Progressive unilateral SNHL

16. FEATURES DUE TO INVOLVEMENT OF OTHER
STRUCTURES
• CN VII
Hitzelberger’s sign :hypothesia in posterior meatal wall.
Loss of taste in ant 2/3of tongue
Schirmer’s test : reduced lacrimation
Delayed blink reflex
• CN V
Reduced corneal sensitivity
Numbness and parathesia of face

17. • CN IX &X
Dysphagia , hoarseness of face
• Brainstem involvement
Ataxia weakness, numbness of arms and legs
• Cerebellar involvement
• Raised IC T Features

18. MANAGEMENT
• SURGERY
• RADIOTHERAPY
• Conventional radiotherapy
• Gamma knife surgery {source of radiation Cobalt 60 )
• Cyber knife (robotic sx –done by computer controlled robots )

20. References
• Diseases of ear , nose, throat 5 th edition –PL dingra
• Self assessment and review ENT – Sakshi arora