week 11: medical management and differential dx

what med for vestibular attacks longer than 2 hours

meclizine

What do vestibular suppressants impede

normal healing and compensation that the CNS can do after a vestibular lesion

what med for nausea and vomitting

anti-emetic drugs like compazine

Endolymphatic sac surgery is used for

menieres disease

Endolymphatic sac surgery function

reestablish function of sac as resorptive organ for endolymph by draining extra info mastoid cavity

how to compensate for loss of vestibular function on one side

intact labyrinth on opp side if CNS is intact

vestibular neurectomy

vestibular nerve is cut

labyrinthectomy

SCC and otolithic organs are removed, no info into vestibulocochlear nerve

chemical labyrinthectomy

gentamicin is used to destroy hair cells of inner ear

peripheral vs central: ataxia

P: mild

C: severe

peripheral vs central: smooth pursuits/saccadic eye movements

p: normal

c: abnormal

peripheral vs central: hearing

P: hearing loss, tinnitus, fullness

c: no hearing logg

peripheral vs central: nystagmus

p: suppressed with visual fixation

c: not suppressed

red flags

horizontal or vertical diplopia (Double vision) lasting more than 2 weeks, persistent pure vertical positional nystagmus, spontaneous upbeating nystagmus

contraindications

risk of bleeding/CSF leak, menieres, cognitive/general mobility deficits

what 4 things for vestibular treatment

habituation, adaptation, substitution, repositioning

habituation

repeated exposure

(for CNS lesions)

adaptation

improve gaze stability by working on VOR (for unilateral vestibular loss, unilateral/bilateral paresis)

substituation

sub with other sensory systems (for bilateral vestibular loss)

repositioning

maneuvers (for bppv)