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- 2. BALANCE Three sensors 1. Eyes 2.Vestibular apparatus (inner ear) 3. Proprioceptors muscles and joints Any problem in the inputs from these senses results in vertigo Central processing –Cerebral cortex Cortex then sends message to muscles regarding the tone and action one ofmostImpSensorforbalance inner ear organresponsibleforcoordination integrationofthisbalancein brain 27 cerebellum whichsendimpulsetocentralpartofbalancesystemin 17 Posterior cranial fos 27 cerebellum 37 Brainstem mostimp oronly informationaboutsurrounding
- 3. Inner ear Central proces sing in brain eye Proprioceptor sensation in muscles Muscle tone& action Balancesystem Peripheralcause ofVertigo according toinformation inBrainstem and cerebellum andintegration ofinformation ids 1 Ias I od di Idi Is WH E's to ow wsisms Itf correctivemovement
- 4. Definition VERTIGO “IMBALANCE”: isa subjective sensation of motion (rotation) Nystagmus : involuntary rhythmical movement “oscillation” of eyeballs, due to problem in vestibular function Disorderof Balance system inDT2 in CSSsuchas Vertigo Typeofdiziness 9 inabsenceofreal motion halucination ofmotion i i ios I Ign f Higo
- 5. Etiology of vertigo PERIPHERALCENTRAL Miscellaneous causes inIEor nerve inBrainstem orconnectionof them orcerebellumor
- 6. PERIPHERAL CAUSES 1. Meniere’sdisease 2. BPPV 3. Vestibular neuronitis 4. Labyrinithitis 5. Vestibulotoxic drugs 6. Head trauma 7. Perilymph fistula 8. Syphilis 9. Acoustic neuroma Benignparoxysmalpositionalvertigo or cochlear oto toxic orBoth acoustictrauma
- 7. CENTRAL VERTIGO 1. Vertebrobasilarinsufficiency 2. Posterior inferior Cerebellar Artery Syndrome (PICA Synd.) 3. Basilar Migraine 4. Cerebellar disease 5. Multiple sclerosis 6. Tumours of brainstem and IV ventricle 7. Epilepsy mostly problem inBlood supplyofPosterior cranial fossa Bloodinsufficiency
- 8. Miscellaneous causes 1. Psychogenicvertigo 2. Vertigo of old age 3. Motion sickness 4. Occular vertigo 5. Cervical vertigo Sea sickness
- 9. DIFFERENCES BETWEEN central& peripheral VERTIGO PERIPHERAL CENTRAL 1- Otologic features (e.g. HL & otorrhea,) + No loss of consciousness Neurological deficits (e.g. hemiplegia) +_ Loss of consciousness 2- Abrupt onset / fades off in week. May be recurrent (Compensation) Gradual / Sustains 3- Balance impaired, but still can walk Cannot stand or walk without falling 4- Nausea and vomiting severe at onset Not severe epilepsy Discharge TinnitusPain Gigs a sudden 6 prolonged for years notcontinues gaitnotimpaired end impaired gait
- 10. DIFFERENCES BETWEEN central& peripheral VERTIGO PERIPHERAL CENTRAL 5- Nystagmus-inhibited by fixation Cannot be fixated 6-Severity of nystagmus proportionate to vertigo Not proportionate 7- Nystagmus =directional (horizontal ) Nystagmus= Any type 8- Latency present No latency 9- Nystagmus-fatigable Not fatigable i.ba fsosoI.eI ow plane vertical anorizontai accordingtoeyemovement Planeand speed arotatory Two face equal to eachother pendolar nystagmus onefastandoneslow directional nystagmus
- 11. MENIERE’S DISEASE (TRIAD ORTETRAD) OF symptoms: vertigo, SNHL, tinnitus and senses of pressure in ear. Vertigo: sudden in onset. lasts minutes up to 24 hours. SNHL: fluctuating. Investigations: - PTA - Glycerol test. -E.cochleo.G. Classic 3 or 4symptoms syndrome omeinattacknotpersistent Pressurein ear orhead orneck nausaeandvomiting inattack not second andnot 724hr ofclassic meniere I Diagnosis Sensorineural 90 byhistory main histopatholgic excess endolymph
- 12. The main histopathologyin meniere’ is: endolymphatic hydrop. eddolymphatic hydrop
- 13.
- 14. Managements • Medical: vestibularsedatives, diuretic & vasodilators • Surgery: according to hearing of the pt.: -destructive. -conservative:(E. sac decompression) -intra-tympanic gentamycin injection surfaceablehearing surgical 3 Tc l'd fortvertigo egentamycin injection I medical fills engolymphatic is lil surgery Is I'd WIG aminoglycosid medicaldestructionof haircellsCIE
- 15. BPPV • Vertigo whenhead is putted in a certain position. Lasts seconds – minutes. • Caused by disorder of SCC. • Treatment: EPLEY’s maneuver. Pathogenesis Shedding of Benign Paroxysmal Positional vertigo calciumcarbonate crystals cacoz ofutricle and saccule andadhere tocristi ofScc notassociated withany other symptoms noHLno Tinnitusno nausaenovomiting Recurrent If tis I W s W WI Is Iasi In os.es I d 61 d W 27 orSemon's reliefin morethan Tfreassurance it's benign 90 of
- 16. VESTIBULAR NEURONITIS • Severevertigo of sudden onset , with no hearing problem. • Lasts for days. • Due to viral infection • Self limiting. NanSae andvomiting non specific treatment normal investigation complete relifewithin 4days historyi Upper respiratorytractinfection eviralinflammation ofvestibular nerve 8th maincomplainissevereVertigo thausaet vomiting without othermanifestation
- 17. LABYRINTHITIS • caused by:biochemical toxins or bacteria or virus damaging the vestibular labyrinth. TREATMENT: – Treatment of the primary disease. – Treatment of inner ear complications anything cause HLcancauseverti secondarytootitismedia1meningitis or viral Labyrinthitisassociatedwith any encephalitis measis mumpsenve other viralinflammationwhich affect brain Ismeningoencephali Rubella Labrynthitis I catarrah recoverwithout permanantabnormality 27suppurative i completedestructionofIE hearingloss Vertigo d Profound ed i est w Brainadaptation
- 18. VESTIBULOTOXIC DRUGS ➢Certain drugsdamage the hair cells in vestibulococholear system eg; 1. Amino glycosides 2. Antihypertensive drugs 3. Oestrogen preparations 4. Diuretics 5. Antimalarials etc.
- 19. HEAD TRAUMA • Headinjury cause concussion of labyrinth, disrupt bony labyrinth or 8th nerve. • Operative trauma. • Severe acoustic trauma like explosion also cause vertigo Physical
- 20. ACOUSTIC NEUROMA • benigntumor (shawnnoma)of vestibular nerve • Vertigo rare & comes late due to adaptation • There are other neurological & otological findings. • The usual presenting symptom is unilateral hearing loss and tinnitus. youngadult unilateral HL 10 vertigo SNHL inSepangleandinternalauditorycanal slowlygrowing w's no vertigo oronly 10 Tinnitus mainsymptoms Ty 27 inadult 25
- 21. diagnosis A-history: 1.True vertigo 2.Duration 3.Associated nuasia&vomiting 4.Loss of conciousness 5.Symptom of ear diseases 6.Neurological Symptoms Complete CP investigation diagnosis onset course
- 22. Diagnosis B- examination: 1.General exam 2.Neurologicalexam 3.Cranial n exam 4.Vestibular exam 5.Exam of nystagmus; eye, Frenzil glass, ENG 6.Exam of balance: gait test, romberg test, test for dysmetria, Complete wholebodysystem Electro Nystagmo Direct graphy
- 23. diagnosis C- investigatios: 1. Vestibular.calorictest,rotation test, posturography, 2. Audiological: PTA, ABR, 3. Radiological:CT, MRI BRAIN & CPA 4. Laboratory: SUGAR, CBC, thyroid f, cholesterol,test for Syphilis. hypo
- 24. Treatment 1. Specific-Treatment ofcause 2. Symptomatic-Suppress vertigo, antiemetics, Betahistine 3. Rehabilitative-Specific exercise vestibularsediative dramamine pragodilation improvecirculation medizined of IE
- 25. Questions • Describe theanatomy of the inner ear? • Describe the main functions of the ear? • Describe the pathophysiological changes of balance disorder? • Describe the main treatment modality during vertigo?
- 26. Meniere's disease isa syndrome characterized by: A.Its attack is associated with loss of conscious. B.Its episode vertigo lasts for few weeks. C.Pathologically it is an perilymphatic hydrops. D.The attack of vertigo is rarely associated with nausea and vomiting. E.Triad of sensorineural hearing loss, vertigo and tinnitus.
- 27. 40 years oldfemale complains of episodic vertigo. Each attack lasts about 40 minutes and is associated with nausea, vomiting, tinnitus and ear fullness, without loss of conscious. PTA revealed fluctuating unilateral SNHL. The most probable diagnosis is: A.Acoustic neuroma. B.Basilar migraine. C.Benign paroxysmal positional vertigo (BPPV). D.Meniere's disease. E.Vestibular neuronitis.