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L'elaborato multimediale è stato realizzato dagli studenti dell'IIS Sandro Pertini di Alatri nell'ambito del progetto di monitoraggio civico di "A Scuola di open coesione".
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This powerpoint elaborates the mechanism of balance & anatomy of vestibular apparutus. It also depicts the anatomy & physiology of haircells in detail. I also explained the vestibular function tests used for diagnosis of various vestibular disorders.
Nystagmus: clinical implications in otorhinolaryngology.one should understand anatomy and physiology of semicircular canals and vestibuloocular reflex in order to understand pathophysiology of nystagmus
The use of voice is an integral part of communication; our voice is one of the defining features of our individuality, and it shares a lot of information about you, your voice tells others if you are happy or sad, healthy or unwell, young or old. Our voice can also reveal to others our background, such as the region of the world where we live, and even our social economic status, when a voice produced that perceived by others as unusual or strange and draws attention to the person who is speaking, it is quite likely the person is demonstrating a voice disorder.
So, I am happy to introduce this presentation about Pubertal voice disorders & Puberphonia, I would like this presentation to be useful and add a lot of information on this topic.
Vestibular function tests are essential tests in otorhinolaryngology examination, especially examination of ear.
This presentation explains about all the important vestibular function tests.
Fumetto "Cronaca "due" giornate molto particolariAcropolis2015
L'elaborato multimediale è stato realizzato dagli studenti dell'IIS Sandro Pertini di Alatri nell'ambito del progetto di monitoraggio civico di "A Scuola di open coesione".
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11. Endolymph : marginal cells of stria vascularis
( deeply invaginated,Free ribosomes, vesicles ,
Na+K+ ATPase , adenylate cyclase ,carbonic
anhydrase )
Dark cells of crista & macula have similar
characters.
Endolymphatic sac : columnar cells for
absorption
12. Perilymph : ultrafiltrate of either CSFCSF or bloodblood .
Reaches by vestibular aqueduct or preivascular
or perineural channels
Drainage is through venules & middle ear
mucosa
19. Crista : central & peripheral zone
Modified columnar epithelial cells
In horizontal canal kinocilium is
located towards utricle ,where as in
vertical canals the kinocilium is
placed away from the utricle
24. Vestibular - Holds images of the seen world steady on
the retina during brief head rotations
Optokinetic - Holds images of the seen world steady on
the retina during sustained head rotations
Smooth pursuit - Holds the image of a moving target
on the fovea
Nystagmus (quick phases) - Resets the eyes during
prolonged rotation and direct gaze toward the
oncoming visual scene
Saccades - Brings images of objects of interest onto the
fovea
Vergence - Moves the eyes in opposite directions so
that images of a single object are placed simultaneously
on both foveas
27. Semicircular Canals
are angular rate
sensors.
Otoliths (utricle and
saccule) are linear
accelerometers
28. Principle 1: The vestibular system primarily
drives reflexes to maintain stable vision and
posture
VOR / VCR / VSR
Input to autonomic centres
Cerebellum
Cortical areas
Vestibular deficit can thus be unmasked by
very dynamic head movements
29. Principle 2: By modulating the non-zero
baseline firing of vestibular afferent nerve
fibers, semicircular canals encode rotation of
the head, and otolith organs encode linear
acceleration and tilt.
30.
31. Principle 3: Stimulation of a semicircular canal
produces eye movements in the plane of that
canal. Ewald’s 1st
law.
33. B.P.P.V
Slow phase eye movement
downward in the plane of
affected pc.
34. Principle 4: A semicircular canal is normally
excited by rotation in the plane of the canal
bringing the head towards the ipsilateral side.
Horizontal : ampulopetal flow is excitatory
Vertical : ampullofugal flow is excitatory
35. Principle 5: Any stimulus that excites a
semicircular canal's afferents will be
interpreted as excitatory rotation in the plane
of that canal.
Vertigo
Nystagmus ( brief changes )
36. Pc- BPPV-Exitation of PC afferent
Superior canal dehiscence syndrome
Caloric testing :
COWS (cold opposite, warm same) – direction
of the nystagmus
37. Principle 6: High accelerations head rotation in
the excitatory direction of a canal elicits a
greater response than does the same rotation in
the inhibitory direction. Ewald’s 2nd
law.
Excitation inhibition asymmetry:
Hair cells asymmetry. Vest.aff. baseline firing
rate 50 – 100 spikes / sec. while they can be
increased they cannot be driven below 0.
38. Acceleration must be 3000 degrees/sec2 , and the peak velocity must be 150 to 300
degrees/sec, meaning that the rotation must be finished in 150 milliseconds , 10 to 15
degrees.
HEAD THRUST
TEST
39. Principle 7: The response to simultaneous canal
stimuli is approximately the sum of the
responses to each stimulus alone
RIGHT HAND
RULE
40.
41. Vestibular neuronitis : Fetter & Dieghan’s et al
proposed that vestibular neuritis is usually a
disorder of organs innervated by
sup.vestibular N. 21% occurrence of
ipsilateral Pc-BPPV.
42. Principle 8: Nystagmus due to dysfunction of
semicircular canals has a fixed axis and
direction with respect to the head
Central nystagmus direction may change with
direction of gaze , where as peripheral
nystagmus has a fixed axis & direction.
43. Principle 9: Brainstem circuitry boosts low-
frequency VOR performance through "velocity
storage" and "neural integration.“
In humans the time constant of the decay of
angular VOR for constant velocity of rotation is
about 20sec longer.
Arise from medial & descending vestibular
nucleus whose axons cross midline
44. Pre & post rotatory nystagmus (due to
exitation& inhibition asymmetry net result not
zero-sensed by brain stem)
Head –shake nystagmus
Alexander’s law -Amp of nystagmus
Video Frenzel Goggles
45. Principle 10: The utricle senses both head tilt
and translation, but loss of unilateral utricular
function is interpreted by the brain as a head
tilt toward the opposite side
47. Principle 11: Sudden changes in saccular activity
evoke changes in postural tone.
Activates the extensor muscles & relaxes the
flexors to restore postural tone
VEMP---short latency relaxation potential by
click or tone burst
48. Principle 12: The normal vestibular system can
rapidly adjust the vestibular reflexes according
to the context, but adaptation to unilateral loss
of vestibular function may be slow and
susceptible to decompensation
49. It is rhythmic repetitive oscillation of eye ,
initiated by a slow eye movement that drives
the eye off target , followed by a fast movement
that is corrective(jerky movement) or another
slow eye movement in the opposite direction.
(pendular nystagmus)
50. Jerky-direction, true , vestibular system
Pendular- direction ,not true , visual system
Irregular- jerky or pendular , cns leasion
51. Direction –detemined by direction of fast phase.
Horizontal plane- H nystagmus , V system
Vertical plane- vertical nystagmus ,CNS
53. Peripheral vestibular pathology-decrease on
optic fixation & increase on optic fixation
withdrawal(eye closed)
Central vestibular pathology-
54. Features peripheral central
Direction -fast phase away from
leasion
-unilateral disease of
vestibular organ or nerve
Labyrinthitis
Meniere’s disease
-changes with gaze
-disease of brain stem
Any cns disorder
Visual fixation Inhibit nystagmus
Always diminishes or
even disappear
Either no effect or
increase nystagmus
55. Peripheral Central
Latency + -
Duration < 1 min > 1 min
Fatigability Yes No
Reversal with upright
position
Yes No
61. A sensation of spinning or motion
Time course : helps to discriminate between
otologic and nonotologic causes of vertigo
Vertigo that lasts for less than 1 minute can
represent benign paroxysmal positional vertigo
Vertigo that is prolonged for hours is typical of
Ménière's disease or endolymphatic hydrops
65. most common infectious cause of acute
vertigo is viral labyrinthitis
Traumatic causes of vertigo include temporal
bone fractures, labyrinthine concussion, and
perilymphatic fistula
Systemic metabolic abnormalities that can
affect vestibular function include
hyperviscosity syndromes (hyperlipidemia,
polycythemia, macroglobulinemia,sickle cell
anemia), diabetes mellitus,
hyperlipoproteinemia, and hypothyroidism
66. A number of collagen vascular disorders have
been associated with vestibular dysfunction as
a form of autoimmune inner-ear disease.
Common disorders of this type include
rheumatoid arthritis, polyarteritis nodosa,
temporal arteritis,nonsyphilitic interstitial
keratitis, lupus, sarcoid, relapsing
polychondritis, dermatomyositis, and
scleroderma.
67. Ischemia of small labyrinthine vessels will
cause isolated infarction of the vestibular
labyrinth and vertigo; occlusion of larger
vessels anterior inferior cerebellar artery or its
branches will cause sudden and profound loss
of both auditory and vestibular function and
regional infarction of the brainstem.
68. . Endolymphatic hydrops or Ménière's disease is
defined by the well-recognized symptoms of
vertigo, hearing loss, tinnitus, and aural
fullness. The underlying mechanism(s) that
cause abnormal homeostasis of endolymph
resulting in distention and rupture of the
membranous labyrinth
. Histopathologic findings suggest that fibrosis
of the endolymphatic sac,
. Altered glycoprotein metabolism,
. viral infections may be pathogenic
69. Otoconia or calcium carbonate crystals
normally attached to the macula of the utricle
become free floating within the endolymph of
the posterior semicircular canal. These free-
floating particles become gravity sensitive and
cause a hydrodynamic shift in endolymph that
affects the posterior semicircular canal cupula
in response to provocative head movements,
resulting in positional vertigo.
70. The peripheral vestibular system includes : (1)
sensory receptor structures that are responsible
both for sensing the motion and position of the
head in space and converting (transducing) the
sensory stimulus into an electricalsignal;
(2) the vestibular portion of the eighth cranial
nerve that carries the encoded sensory
information from the receptors to the central
nervous system (CNS) in the form of neural
activity
71. Ménière's disease (idiopathic endolymphatic
hydrops) is a disorder of the inner ear
associated with a symptom complex consisting
of spontaneous, episodic attacks of vertigo;
sensorineural hearing loss that usually
fluctuates; tinnitus; and
often a sensation of aural fullness.
72. distortion of the membranous labyrinth
perisaccular ischemia and fibrosis(pathologic
study)
hypoplasia of the endolymphatic sac and
duct(imaging study)
Autoimmune processes
74. canalithiasis mechanism-latency
nystagmus duration ---lowest part of canal
the vertical (upbeating) and
torsional nystagmus
reversal of nystagmus
fatigability of the nystagmus(repeated Dix
Hallpike - dispersion of material with
in the canal)
75.
76.
77. syndrome of vertigo and oscillopsia induced by
loud noises or by stimuli that change middle
ear or intracranial pressure
Tullio phenomenon--- eye movement-- loud
noise
Hennebert's sign
"third mobile window
78. Loud sounds, positive pressure in the external
auditory canal, and the Valsalva maneuver against
pinched nostrils --- ampullofugal deflection
---nystagmus that has slow phase components that
are directed upward with torsional motion of the
superior pole of the eye away from the affected
ear.
Conversely, negative pressure in the external
canal, Valsalva against a closed glottis, and jugular
venous compression ----oppositelydirected eye
movements with slow phase components directed
downward with torsional motion of the superior
pole of the eye toward the affected ear.