Vestibular disorders are common in the elderly population and a leading cause of falls. Common vestibular disorders in the elderly include benign paroxysmal positional vertigo (BPPV), Meniere's disease, and vestibular neuritis. BPPV is often caused by calcium crystals in the inner ear and its symptoms are triggered by changes in head position. Meniere's disease causes episodes of vertigo, hearing loss, and tinnitus. Vestibular neuritis presents with sudden onset vertigo, nausea, and imbalance. Central vestibular disorders can also occur and are caused by lesions along the vestibular pathway in the brain. Proper diagnosis and management of vestibular disorders

1. VESTIBULAR
DISORDER IN
THE ELDERLY

2. 01 02
CONCLUSION
03
DISCUSSION
04
INTRODUCTION
REFERENCES

3. INTRODUCTION
● Clinicians are sometimes confronted with patients who complain about inability to maintain their
balance
● The prevalence of vertigo and dizziness in people aged>60 years reaches 30%, and due to aging of
world population, the number of patients is rapidly increasing (Fernández et.al, 2015)
● Dizziness is a general term for a sense of imbalance or disequilibrium and it affects approximately
20% to 30% of the general population and it is a strong predictor of falls, which is the leading cause
of accidental death in people older than 65 years
● Common causes of dizziness are peripheral vestibular disorders, but complaint of dizziness may be
due to non-specific ranging from disequilibrium, presyncope, lightheadedness, giddiness, fainting
attacks, to central nervous system disorders.
● The effects of dizziness in the elderly can be particularly disturbing, as it has been associated with
depressive symptoms, perceived fatigue, excessive drowsiness, recurring falls and fall-related
injuries such as fractures of long bones (Moraes et. al, 2013)
● Thus,this study aimed to explore the clinical causes of vestibular disorder among elderly patients

4. DISCUSSION
Benign Paroxysmal
Positional Vertigo
Causes of Vestibular Disorders in the Elderly
Meniere’s Disease
Vestibular Neuritis
Central Vestibular disorder
Acoustic Neuroma
Cerebellar infarct
Disequilibrium
Progressive
supranuclear palsy
Postural orthostatic
tachycardia syndrome
Peripheral Vestibular disorder

5. SATURN
● Most common, estimated lifetime prevalence of 2.4%
(Von Brevern et. al, 2007)
● Prevalent in individuals between the ages 50 - 70
years old (Baloh et. al, 1987)
● precipitated by a change in head
position (i.e: getting out of bed,
rolling over in bed) (Yeolekar,2015)
Benign Paroxysmal Positional Vertigo
Pathophysiology:
● Caused by calcium crystals (otoconia) that fall into
posterior or lateral semicircular canals after detaching
from ampulla of the utricle (Schuknecht, 2009)
● Detachment occur secondary to trauma, infection,
aging, vestibular neuritis, and
labyrinthitis (Schuknecht, 2009)
Management:
● Particle repositioning maneuvers or
canalith repositioning procedures,
has an efficacy of 75 - 100% in lateral
semicircular canal BPPV (Lea et. al, 2019)
● The Epley or Semont maneuvers for posterior
semicircular canal BPPV (Casani et. al, 2002)
Diagnosis:
Dix-Hallpike maneuver for the
posterior semicircular canal and
head rotation to the side in a
supine position for the horizontal semicircular canal,
should be conducted in vertigo and balance impairments,
despite a negative history as in elderly, the disorder
may present atypically (Furman et. al, 2010; Jahn et. al, 2015)

6. ● Most frequent causes of dizziness of the
inner ear seen in dizziness clinics (Alexander
& Harris, 2010)
● Patients generally present in the third to
seventh decades . (Patel & Isildak, 2016)
● Slight female predominance (Patel & Isildak,
2016)
● Low salt diet, avoidance of caffeine derivatives and
alcohol, diuretics, vasodilators, oral steroids, and
intratympanic injection of low-dose gentamycin or
dexamethasone. (Santos,1993)
● Surgical therapy should be considered if there is no
improvement with noninvasive therapy after 3-6
months. (Pullens,2013)
● According to Patel and Isildak (2016) It is
characterized by the disease is characterized by
recurrent attacks of : aural fullness, tinnitus,
vertigo and associated with a progressive hearing
loss over time.
Clinical manifestation
Meniere’s Disease
Management
Pathophysiology

7. ● Peak age distribution for vestibular neuritis was between
30 and 50 years (Goddard & Fayad, 2011).
● Sekitani et al., approximately 12% of patients were over age
65.
● Primarily supportive – vestibular suppressants and antiemetics.
● Elderly and those with systemic disorders may require
intravenous hydration because they are more susceptible to
dehydration.
● Use of antiviral agents (acyclovir/valacyclovir) is also
recommended.
● Vestibular exercises can enhance ocular stability and improve
tolerance to various head and body movements.
● Characterized by acute onset of vertigo with associated
nausea, vomiting, and generalized imbalance. (Goddard &
Fayad, 2011).
● According to Sekitani et al., the initial symptoms of
vertigo will subside over a few days, the residual
imbalance might remain for longer.
● Tendency to fall on the affected side and spontaneous
nystagmus. Head or body movements will exacerbate the
symptoms.
Clinical manifestation
Vestibular Neuritis
Management
Researchers think the most likely cause is a
viral infection of the inner ear, swelling around
the vestibulocochlear nerve (caused by a
virus), or a viral infection that has occurred
somewhere else in the body.
Some examples of viral infections in other
areas of the body include herpes virus (causes
cold sores, shingles, chickenpox), measles, flu,
mumps, hepatitis and polio
(Strupp et al., 2014)

8. ● Is a noncancerous (benign) growth on the vestibular nerve.
Acoustic neuroma can be classified into two categories.
● One is rare and associated with neurofibromatosis type 2
(NF-2). In this rare, autosomal dominant disorder, the
acoustic neuromas are bilateral. It usually occurs among
teens or early adulthood.
● The more common type of acoustic neuroma occurs
sporadically [4]. This type is always unilateral and common
in elderly.
Treatment options depend on rate of growth of the lesion as
measured by serial MRIs and include wait and watch policy,
gamma-knife radiation, and surgical excision (Aditya,2015).
Symptoms of an acoustic neuroma generally include
unilateral progressive hearing loss and tinnitus on one
side rarely accompanied by dizziness or imbalance
(Aditya,2015).
Clinical Manifestation
Acoustic Neuroma
Management
(Ho & Kveton, 2002)

9. ● Presence of lesion along the vestibular pathway, extending to
brainstem,and eventually reach multisensory vestibular cortex areas
in the temporoparietal cortex. Dieterich, M. J Neurol (2007)
● The site of the lesion can be identified by analysis of nystagmus.
Dieterich, M. J Neurol (2007)
● In addition with age, the central nervous system capabilities become
impaired, affecting the signals from vestibular, visual, and
proprioceptive which is responsible for maintenance of body balance.
Teixeira, A. R., Wender, M. H., Gonçalves, A. K., Freitas, C. D. L. R., dos Santos, A. M. P. V., & Soldera, C. L. C.
(2016).
Central Vestibular disorder

10. Cerebellar infarct
● Manifested with dizziness with nausea and vomiting, unstable gait and sudden
headache.Yeolekar, A. M., & Yeolekar, M. E. (2016).
● The common cause of the instability is usually caused by multiple white matter lesions or also
known as periventricular leukomalacia. Yeolekar, A. M., & Yeolekar, M. E. (2016).
● However, vertigo and dizziness and dizziness are commonly caused by benign peripheral
vestibular disorders,Kerber, K. A., Brown, D. L., Lisabeth, L. D., Smith, M. A., & Morgenstern, L. B. (2006).
● Stroke can also manifest with Vertigo and dizziness, but the statistical association of instability
with stroke causing vertigo or dizziness is less compared with non stroke causes such as
peripheral vestibular disorders. Kerber, K. A., Brown, D. L., Lisabeth, L. D., Smith, M. A., & Morgenstern, L. B. (2006).
● conditions such as Parkinsonism is also common in older persons. Yeolekar, A. M., & Yeolekar, M. E.
(2016).
● Epileptic vertigo can also occur however it is uncommon as it responds well to treatment with
anticonvulsant medication.
Central Vestibular disorder

11. ● causes progressive deterioration in motor and subcortical
cognitive function.
● Is a degenerative movement disorder
● the clinical manifestation of vertical gaze palsy,
pseudobulbar palsy, axial rigidity, and cognitive impairment.
● One of the cardinal features of PSP are falls, where it
shows that the incidence of falls are associated with the
presence of gaze problems, axial rigidity, cognitive decline.
● Onset of PSP usually occurs among patients age range
from 50 to 70.
Egerton, Williams & Lansek (2012)
● Rare
● Idiopathic
● The slow loss of vestibular
function is distinguished with
difficulty in walking or
standing, especially in the
dark while on soft or uneven
surfaces.
Yeolekar, A. M., & Yeolekar, M. E. (2016).
Disequilibrium Progressive supranuclear palsy (PSP)
Central Vestibular disorder

12. ● Vestibular disorders require special care
● Vestibular disorders have various causes that need to be identified so that further assessment and
management plan for the elderly can be conducted
● More research are need on how the caregiver can handle these elderly patients in a more effective
way that may benefit both the patient and the caregiver
CONCLUSIONS

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