Vestibular Foundations - Session 3: History Taking and Balance Part 2

• Sudden, severe vertigo (spinning/swaying sensation)

• Vertigo can last up from a several days to a couple of weeks. and they can make a full recovery or even have symptoms for months.

• Random attacks of dizziness

• Balance difficulties

• Nausea, vomiting

• Concentration difficulties

Labyrinthitis (same symptoms as above) but also

• Hearing loss

• Tinnitus

• Unknown- in many cases, no definitive cause can be identified for an individual

*the following are some of the well recognised causes:

• Viral infection of the inner ear

• Viral infection which has occurred somewhere else in the body.
  Example: Herpes virus, measles, common flu.

• Medication

• Vestibular suppressants – Betahistine - Stop the incorrect balance
  information

• Anti – emetics (used for nausea)

• Treating the virus – Antiviral medicine - Acyclovir

• Vestibular rehabilitation

age 40-60 but can affect anyone

quite rare condition- 1 in 1000

• Dizziness or vertigo (attacks of a spinning sensation)

• Hearing loss- intermittent mainly at the times of vertigo. loud sounds may sound distorted and may cause discomfort. Usually the HL involves the lower frequencies but eventually also the higher. Whilst HL fluctuates, it becomes more permanent as the disease progresses.

• Tinnitus (a roaring, buzzing, or ringing sound in the ear)

• Sensation of fullness in the affected ear

• Symptoms tend to come and go together with episode lasting from 20 mins to 8-12 hours

-unknown
-- Research suggest: Too much endolymph being produced, blocked
endolymphatic duct resulting in inefficient drainage of the
endolymph

reduces vertigo in Ménière’s disease by decompressing the endolymphatic sac and, in some cases, inserting a shunt to drain excess inner ear fluidMedications: Vestibular Suppressants, Anti- Emetics, Diuretics (to control fluid balance)

• Diet control may also reduce the amount of fluid in the inner ear and ease symptoms. avoid foods like salt, chocolate, caffeine and alcohol.

• VR to control symptoms in between attacks

• Hearing aid

• Intratympanic Gentamicin- Gentamicin selectively damages the vestibular hair cells in the affected ear, reducing vestibular function and suppressing vertigo.

• Surgical intervention:
  Labyrinthectomy – Destruction of the labyrinth-- removing the balance portion of the inner ear thereby removing balance and hearing function of the effected ear. This procedure is only performed if you have near total/ total HL in affected ear.

Endolymphatic Shunt (endolymphatic sac procedure as the endolymphatic save plays a role in regulating inner ear fluid levels and during the procedure the sac is decompressed which can elevate excess fluid levels. in some cases this procedure is coupled with a shunt which drains excess fluid from your ear. )

• Grommet insertion- ventilating the middle ear, reducing fluid buildup, and relieving pressure, which improves hearing and reduces infections

-Tear or defect in the bony capsule of the labyrinth or in the round or oval windows. This small opening allows perilymph fluid to leak into the middle ear.

• Changes in air pressure occurring the middle ear, like ears popping in plane, do not effect the inner ear but with PF, changes in middle ear pressure directly effect inner ear, stimulating balance or hearing structures within.

• Ear fullness, - Fluctuating or ‘sensitive’ hearing, -- - Vertigo (without the spinning), motion intolerance,

• Hearing loss, symptoms get worse with changes in altitude.

An opening in the bone that covers one of the semicircular canals, leading to abnormal fluid movement and causing vertigo, hearing issues, and heightened sensitivity to internal sounds.

• True cause of SSCD is unknown: Congenital or may have occurred during the development of the
  inner ear.

• Ear infections or head trauma.

• Head trauma.

• Rapid and intense changes in intracranial or atmospheric pressure such as SCUBA
  diving, weightlifting or childbirth.

• surgery

"LOUD PRESSURE TRIGGERS VERTIGO AND MOVES OBJECTS"

• LOUD: Sensitivity to loud sounds.

• PRESSURE: Fullness/pressure in the ears.

• TRIGGERS: Symptoms triggered by pressure changes (e.g., coughing, sneezing, straining).

• VERTIGO: Dizziness or vertigo.

• AND: Autophony (hearing your own voice or internal sounds loudly).

• MOVES OBJECTS: Oscillopsia (stationary objects appear to move).

surgery- plugging the dehiscence

-there's lots of different causes including:
-ageing
-cardiovascular
-neurological
-vestibular etc

History taking is crucial because it can help diagnose the condition. About 80% of the diagnosis comes from the patient's history.

The answers provided during history taking help decide which assessments and tests to use.

It serves as a diagnostic factor and helps distinguish between different diagnoses.

Instead of using the term ‘dizzy,’ more specific symptoms and descriptions are used to accurately understand the patient's condition.

The term ‘dizzy’ is very vague and non-specific, making it less useful for accurate diagnosis.

 Walking on cotton wool
 Sinking into the floor
 Eyes are playing catch up (image is moving)
 Spinning
 Disorientated and imbalance
 Struggles to walk in the dark
 Veering off to one side – Unable to walk in a straight line
 Sensitive to light
 Unable to look over my right/left shoulder

Extreme symptoms: BLACKOUTS (This should be referred)

• Open-ended questions

• Accurate timeline

• Pay attention to off the cuff comments

• Be patient (symptoms can be difficult to describe)

• Summarize and confirm understanding

• Onset: How long ago, any colds or accidents?

• Presenting features: Headaches, nausea

• Frequency: How often does it occur?

• Triggers: What causes it (e.g., looking up, rolling over in bed)?

• Duration: How long does it last (seconds, minutes)?

• Sensation: Type of sensation (spinning, swaying)

• Coinciding factors: Tinnitus, changes in hearing

• Medical conditions and medications

• (8)

• Write it down and use prompts

• Keep an accurate record

• Stay on topic and check understanding

• Identify contra-indications

• Have good knowledge of key vestibular conditions

Vestibular Neuritis is a peripheral vestibular disorder, not a central one, as it affects the vestibular nerve.