Vestibular System Assessment Quiz

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Questions and Answers

What is one of the main roles of an audiologist in vestibular assessment?

Conducting purely auditory tests without considering balance

Focusing solely on hearing rehabilitation

Screening, assessment, diagnosis, and management of balance system disorders (correct)

Managing balance system disorders in isolation

Which vestibular assessment tool involves analyzing the response of the vestibular system to caloric stimulation?

Pure Tone Audiometry (PTA)

Vestibular Evoked Myogenic Potentials (VEMP)

Video Nystagmography (VNG)

Caloric test (correct)

What is the resting potential rate of vestibular hair cells?

50-60 spikes/sec

100-120 spikes/sec

70-100 spikes/sec (correct)

30-50 spikes/sec

Which assessment tool directly evaluates the granular movements of the head?

Video Head Impulse Test Signup and view all the answers

What characteristic is true about vestibular organs in the context of their function?

They work in pairs to maintain balance and spatial orientation Signup and view all the answers

What is the purpose of vestibular compensation?

To adjust for the loss of peripheral vestibular function Signup and view all the answers

Which of the following is a critical factor for effective VOR adaptation?

Encouragement to move in well-lit environments Signup and view all the answers

What differentiates one vestibular pathology from another?

Time course and associated symptoms Signup and view all the answers

In cases of bilateral vestibular loss, what is a key characteristic observed?

Inability to recalibrate the vestibulo-ocular reflex (VOR) Signup and view all the answers

How can a good history-taking contribute to vestibular disorder management?

By guiding which tests and management recommendations are most important Signup and view all the answers

When describing dizziness, which of the following is likely to indicate a vestibular origin?

Nausea and vomiting Signup and view all the answers

What aspect of vestibular disorders is often assessed by analyzing the time course of symptoms?

The duration and frequency of dizziness episodes Signup and view all the answers

Which associated symptom could suggest a vestibular pathology?

Consistent hearing loss Signup and view all the answers

Which of the following pathologies is characterized by an association with sudden onset vertigo without hearing loss?

Vestibular neuronitis Signup and view all the answers

What is a common trigger specifically associated with BPPV?

Quick head movements Signup and view all the answers

Which symptom is not associated with Menière's disease?

Facial palsy Signup and view all the answers

What is a possible cause of BPPV?

Head trauma Signup and view all the answers

In which scenario is balance likely to be worsened for individuals with vestibular dysfunction?

Balancing in the dark Signup and view all the answers

Which of the following is not a common associated symptom of labyrinthitis?

Loss of smell Signup and view all the answers

What type of episodic occurrence is Menière's disease known to involve?

Sudden episodic vertigo Signup and view all the answers

Which of these is a potential trigger for migraines that may relate to vestibular disorders?

Bright light Signup and view all the answers

Which symptom is commonly associated with Meniere's disease?

Paroxysmal attacks of vertigo Signup and view all the answers

What is the primary goal of acute treatment for vestibular neuritis?

To manage symptoms such as nausea and dizziness Signup and view all the answers

Which of the following lifestyle changes is recommended to manage Meniere's disease?

Avoid stress and overtiredness Signup and view all the answers

How does benign paroxysmal positional vertigo (BPPV) typically present?

Dizziness triggered by movement of the head Signup and view all the answers

What is a cause of Meniere's disease identified in the content?

Endolymphatic hydrops Signup and view all the answers

Study Notes

Vestibular System Assessment and Rehabilitation

Audiologists play a critical role in vestibular assessment and rehabilitation.
Audiologists are part of an interdisciplinary team and their role focuses on:
- Screening
- Assessment
- Diagnosis
- Management of individuals with balance system disorders.
Audiologists perform a variety of tests to evaluate vestibular function:
- Pure tone audiometry (PTA): Measures hearing sensitivity.
- Acoustic Brainstem Response (ABR): Evaluates the function of the auditory nerve and brainstem.
- Electrocochleography (ECochG): Measures the electrical activity of the cochlea.
- Video Nystagmography (VNG): Records eye movements to assess vestibular function.
- Caloric test: Evaluates the function of the semicircular canals.
- Vestibular Evoked Myogenic Potentials (VEMP): Tests the function of the saccule and utricle.
- Video Head Impulse Test: Assesses the vestibulo-ocular reflex (VOR).
Key learning issues in vestibular physiology:
- Vestibular hair cells have a high tonic firing rate (70-100 spikes/sec).
- Vestibular organs work in pairs.
- The VOR and vestibular spinal reflex (VSR) are closely related.
Vestibular compensation mechanisms:
- Adaptation: The brain adapts to changes in sensory input.
- Habituation: The brain learns to ignore repetitive stimuli.
- Substitution: The brain uses other sensory systems to compensate for lost vestibular function.
Critical periods in VOR adaptation:
- Recovery from unilateral vestibular lesions is faster with increased sensory input.
- Patients should be encouraged to move around in well-lit areas to engage their VOR and VSR.
Bilateral vestibular loss:
- Individuals with bilateral vestibular loss cannot recalibrate their VOR.
- They often rely on other sensory systems (proprioception and vision) for balance.
Differentiating vestibular disorders:
- Dizziness is a nonspecific term.
- Important to gather detailed information from patients:
  - Time course of dizziness
  - Associated symptoms
  - Triggers
A good history can help determine:
- Potential pathologies
- Potential problems during testing
- Necessary tests
- Management recommendations
Description of dizziness:
- Vertigo: A sense of spinning or rotation, likely of vestibular origin.
- Lightheadedness: A feeling of faintness, potentially related to anxiety or cardiac issues.
- Disequilibrium: A feeling of imbalance, potentially due to proprioceptive loss or vestibular problems.
Time course of dizziness:
- Different vestibular pathologies have different time courses.
- For example, Meniere’s attacks do not last for seconds, while BPPV does not last for hours.
Associated symptoms:
- Different pathologies have different associated symptoms.
- BPPV is not associated with fluctuating hearing loss, Meniere’s does not involve facial palsy, and SCD does not involve migraines.
Triggers for dizziness:
- Triggers can be pathology specific.
- BPPV can be triggered by head position changes, SCD by loud noise or pressure, and migraines by smell, light, food, or hormonal changes.
Co-morbidities:
- Stress and anxiety are highly associated with vestibular disorders.
- Quick head movement usually indicates a vestibular origin.
Causes of dizziness:
- Trauma, head colds, and viral infections can all cause vestibular disorders.
Impact of visual cues:
- Balance is often poorer in the dark due to the lack of visual cues.
Common vestibular disorders:
- Labyrinthitis: Inflammation of the inner ear, causing sudden onset vertigo, hearing loss, and tinnitus.
- Vestibular neuronitis: Inflammation of the vestibular nerve, causing sudden onset vertigo without hearing loss.
- Meniere’s disease: A condition that causes vertigo, hearing loss, and tinnitus.
- Benign Paroxysmal Positional Vertigo (BPPV): A condition caused by displaced otoconia in the inner ear, leading to brief spells of vertigo with head movements.
Labyrinthitis:
- Cause: Viral infections (e.g., herpes zoster oticus, influenzal otitis).
- Symptoms: Sudden onset vertigo, hearing loss, tinnitus.
- Recovery: Typically in three stages:
  - An acute period with severe vertigo and vomiting lasting 1-2 days.
  - A sub-acute period with less severe symptoms lasting 2 weeks.
  - A chronic compensation period lasting months or years.
Vestibular Neuronitis:
- Cause: Viral infection, often part of the herpes family.
- Symptoms: Sudden onset vertigo, nausea, vomiting, tinnitus.
- Recovery: Usually within a few days, but recurrent episodes are possible.
Treatment of labyrinthitis and vestibular neuritis:
- Symptomatic treatment with anti-emetics for nausea and vestibular suppressants to reduce dizziness.
- The use of vestibular retraining therapy.
Meniere’s disease:
- Characterized by paroxysmal attacks of vertigo.
- Often associated with hearing loss and tinnitus.
- Attacks last for a few hours and occur in clusters.
Diagnosis of Meniere’s disease:
- Definite Meniere’s disease: Two or more episodes of vertigo lasting 20 minutes to 12 hours, documented low-medium frequency sensorineural hearing loss (SNHL), and fluctuating aural symptoms (hearing, tinnitus, fullness) in the affected ear.
- Probable Meniere’s disease: Two or more episodes of vertigo lasting 20 minutes to 12 hours, fluctuating aural symptoms in the affected ear, and no better explanation by another diagnosis.
Cause of Meniere’s disease:
- Endolymphatic hydrops: Build-up of fluid in the inner ear.
Treatment of Meniere’s disease:
- Avoiding overtiredness, stress, coffee, tea, red wine, and cheese.
Benign Paroxysmal Positional Vertigo (BPPV):
- Described as a benign, paroxysmal, positional vertigo.
- Occurs with a change in head position.
- Characterized by sudden, brief spells of vertigo.

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Description

Explore the key roles and tests performed by audiologists in the assessment and rehabilitation of the vestibular system. This quiz covers essential screening, diagnosis, and management techniques for balance system disorders. Test your knowledge on various evaluation methods and their significance in vestibular function.