Vestibular function tests are essential tests in otorhinolaryngology examination, especially examination of ear.
This presentation explains about all the important vestibular function tests.
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
Mechanism of balance & vestibular function test Dr Utkal MishraDr Utkal Mishra
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.
A detailed description of benign paroxysmal positional vertigo (BPPV): the symptoms, causes, diagnosis, and treatment methods.For more information, please visit www.everydayhearing.com
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
Mechanism of balance & vestibular function test Dr Utkal MishraDr Utkal Mishra
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.
A detailed description of benign paroxysmal positional vertigo (BPPV): the symptoms, causes, diagnosis, and treatment methods.For more information, please visit www.everydayhearing.com
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
A concise presentation about BPPV and Ménière's disease and other causes of vertigo, the difference between central and peripheral vertigo, symptoms and etiology and approach to physical examination and treatment.
Nasal Polyps are defined as pale, polypoidal, pedunculated , prolapsed sinus mucosa into the nose.
They cause nasal obstruction. Nasal allergy and infecions are proposed to be the most common etiological factors for nasal polyps.
This presentation explains in detail about every aspect of nasal polyps.
Allergic rhinitis is a very much prevalent condition in the community. This presentation hopes to spread a ray of hope in treating allergic and intrinsic rhinitis.
CSOM may lead to different complications. Although less common in developed countries, CSOM is common in developing and underdeveloped countries.
This presentation explains the complications of CSOM in details.
Facial nerve is the nerve of facial expression. Facial nerve disorders can lead to ugly face. This presentation explains the facial nerve disorders in details.
CSOM AA might present with both intracranial and extracranial complications. Extracranial complications might again be divided into Intratemporal and extratemporal extracranial.
This presentation explains you about different complications of CSOM in details.
Multiple choice Questions in Otorhinolaryngology with explanations module 2 ...Dr Krishna Koirala
In our part of world, final university examination in otorhinolaryngology carries 80 marks in theory. Out of that there shall be 30 MCQ questions each carrying 1 mark.
So I request you all to go through this presentation.
Audiometry for Undergraduate and postgraduate ENT students Dr Krishna Koirala
Audiometry is one of the essential topic in MBBS.
This presentation helps students to learn about basic audiometry for MBBS level and shall equally be useful for postgraduate ENT students, too.
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Tonsils and adenoids
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2. Nystagmus
• Rhythmic, involuntary, oscillatory movement of
eyeball
• Vestibular disorders cause nystagmus with slow and
fast phases
– The slow phase of the nystagmus is the direction of
flow of endolymph and is vestibular in origin
– The fast phase is most likely initiated by the
reticular formation as a compensatory mechanism
3. Intensity grading of Nystagmus
• First Degree
– Only present when gazing towards the direction of
fast phase
• Second degree
– Seen when gazing towards the fast phase and
straight gaze
• Third degree
– Seen even when looking towards the slow phase
4. • Vestibular nystagmus
– Suppressed by optic fixation
– Enhanced with use of Frenzel glasses (remove
optic fixation)
• Irritative vestibular labyrinthine lesion causes
ipsilateral nystagmus
• Paralytic vestibular labyrinthine lesion gives rise to
contralateral nystagmus
6. Test for gaze evoked nystagmus
• Examiner’s finger / pointed objects
kept 30 cm away from pt's eyes in
centre and moved in horizontal and
vertical planes not exceeding 30°
(to avoid physiological end-point
nystagmus)
• Pt is asked to follow it with his eyes
• Examiner looks for nystagmus
7. Fistula test
• Transmission of increased air pressure into
inner ear through a labyrinthine fistula
causes vertigo and nystagmus towards the
affected ear
• E.A.C. pressure is increased by intermittent
tragal pressure or Siegelization
9. Hennebert’s sign
• False positive fistula sign in absence of
labyrinthine fistula
• Seen in
–Meniere's disease (fibrosis between stapes
footplate and utricle)
–Hyper mobile stapes footplate (congenital
syphilis, idiopathic)
10. False negative fistula sign
• Negative fistula sign in presence of labyrinthine
fistula
• Seen in
– Cholesteatoma / granulation covering the
labyrinthine fistula
– Dead Labyrinth
– Total E.A.C. obstruction
11. Romberg’s Test
• Test of vestibulospinal function
• Pt. is asked to stand with feet
together and arms by the side with
eyes first open ( can compensate the
balance) and then closed ( cannot
compensate the balance and sways
to side of lesion )
• Sharpened Romberg’s if Romberg is
negative
12. Fukuda Stepping Test (Unterberger’s
stepping test)
• Patient asked to make 90 steps
in one minute with eyes closed
and hands out in front in a circle
of 1 metre
• More than 30 degree deviation is
taken as positive
13. • Mechanism
– Convection current formation in endolymph due to
temperature gradient → ampullo-petal or ampullo-fugal
flow due to warm or cold water activation of Vestibulo-
Ocular Reflex → vertigo and horizontal nystagmus
• Contraindications
– E.A.C. obstruction, Ear infection, T.M. perforation,
Bradyarrythmias, Labyrinthine sedatives (for 24 hrs)
Fitzgerald - Hallpike Bithermal Caloric Test
14. Procedure
• Pt lies supine with 30° head elevation and each ear
is irrigated in turn for 40 sec with warm water at 44°C
& then cold water at 30°C after a gap of 8 mins
• Duration of nystagmus is counted from start of
irrigation to end point of nystagmus (Normal = 90–
140 sec)
– Direction of fast component
– Cold → Opposite ear
– Warm → Same ear
16. Canal Paresis
• Duration of nystagmus with both 44°C & 30°C
irrigations in one ear is 30 % less than opposite ear
• Seen in same sided peripheral vestibular lesion
• C. P. (%) = (R30 + R44) – (L30 + L44) X 100
R30 + R44 + L30 + L44
18. Directional Preponderance
• Duration of nystagmus in one direction is 30 % more
than opposite direction
• Seen in same sided central vestibular lesion &
opposite peripheral vestibular lesion
• D.P. (%) = (L30 + R44) – (R30 + L44) X 100
R30 + R44 + L30 + L44
20. Special cases
• Ipsilateral canal paresis and ipsilateral
directional preponderance
–Acoustic Neuroma
• Ipsilateral canal paresis and contralateral
directional preponderance
–Meniere’s disease
21. Modified Kobrak's Test
• E.A.C. irrigated for 60 sec with ice cold water in
increasing quantity (5, 10, 20 & 40 ml) till
nystagmus is noticed
• Nystagmus noticed with
–5 ml = Normal vestibular labyrinth
–10 / 20 / 40 ml = Hypoactive labyrinth
–No nystagmus in 40 ml = Dead labyrinth
22. Dundas Grant Cold Air Caloric Test
• Performed in T.M. perforation as water
syringing is contraindicated
• Air in coiled copper tube is cooled by pouring
ethyl chloride in it
• Effluent cold air is blown into E.A.C. to produce
vertigo + nystagmus
24. Used to provoke nystagmus and vertigo commonly
associated with BPPV
1. Pt in sitting position on a couch
2. Pt’s head turned 45° towards diseased ear to maximally
stimulate posterior semicircular canal
3. Pt moved rapidly into supine position with head hanging 30°
below couch. Pt’s eyes observed for nystagmus for 1 minute
(Frenzel glasses eliminate visual fixation suppression of response)
4. Pt moved rapidly back into sitting position
5. Maneuver repeated for the opposite ear
25.
26.
27. Nystagmus in B.P.P.V.
• Latent period (2–20 sec) before nystagmus
• Rotatory
• Fixed direction, towards ground (geotropic)
• Duration < 1 minute due to adaptation
• Direction reversal on return to sitting position
• Fatigues on repeating Hallpike maneuver
• Presence of associated vertigo and autonomic
symptoms
29. Epley’s Maneuver
1. Pt in sitting position on a couch
2. Pt’s head turned 45° towards diseased ear
3. Pt moved rapidly into supine position with head
hanging 30° below couch
4. Pt’s head rotated by 90° to opposite side
5. Further 90° head + trunk rotation
6. Pt moved rapidly back into sitting position
30. Epley’s Maneuver
7. Pt’s head brought in midline
8. Slight flexion of pt’s head
– Cervical collar applied for 48 hours
– Pt to sleep in 30o
head end elevation & avoid
violent head jerks
– Pt must have nystagmus at every step of Epley’s
maneuver if it is done properly
