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832 Week Five and Six Review

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Lisa Koch

on 10 June 2014

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Transcript of 832 Week Five and Six Review

Week 5-6 Review
Be able to give one example - describing a case where BPPV was self-limiting for the patient.

How would you treat a patient that presents with BPPV that was self-limiting?

Endolymphatic Sac Decompression a patient with fluctuating hearing loss and does not experience drop attacks.

Vestibular Nerve Section a patient that suffers drop attacks due to Meniere's Disease and is in a "high risk" occupation.

Labyrinthectomy a patient with no usable hearing.

Cochleo-Sacculotomy an elderly patient with poor hearing.

Intratympanic gentamycin treatment is effective for inner ear dysfunction as long as pre-treatment testing shows residual vestibular function.
Neurotransmitters are targeted by different vestibular suppressant medications.

GABA transmitters - targeted with Lorazepam or Valium.
Cholinergics - targeted with Scopolamine or Meclizine.
Dopaminergic transmitters - targeted with Droperidol.
When treating the right ear with the Semont, turn the patient's head toward the left side and then quickly move the patient onto their right side.

When treating the left ear with the Semont, turn the patient's head toward the right side and then quickly move the patient onto their left side.
A single maneuver is effective more than 75% of the time in treating BPPV.

28% of patients have spontaneous resolution of symptoms after 1 month.
30% still have symptoms after 1 year.
Following the acute phase of a vestibular lesion, appropriate treatment should encourage physical activity to promote central compensation, rather than suppression of stimulation with medication.

Vestibular suppressants should be used only during the acute stage following vestibular insult.
Essential information that is necessary to obtain to ensure the effective treatment of BPPV include:
Determine which ear is affected
Know if the patient has true rotary nystagmus or a central lesion that is mimicking BPPV
Determine which semicircular canal is involved
Know the mechanism of the BPPV (canalithiasis vs. cupulolithiasis.)

A patient reports typical symptoms of BPPV during case history. During testing, the Dix Hallpike test is negative for torsional nystagmus on both sides. The side lying test does show geotropic horizontal nystagmus that lasts just less than 60 seconds when the patient is rolled onto their right side (a right horizontal (lateral) canal canalithiasis.) According to our text, this patient should be treated in the office with a log roll treatment.
The principle behind the use of the Meniett Device to alleviate the symptoms of Ménière's Disease is to restore the balance in the hydrodynamic system of the inner ear by applying
-pressure pulses to the middle ear. The pressure pulses generated by the Meniett device are weak, they do not cause any discomfort. Natural pressure changes to the inner ear, caused by normal sneezing, for example, are several times stronger.
The vestibular disorder that requires surgery most often to relieve vertigo is Menière’s disease.
A patient that returns for treatment of BPPV with canalith repositioning reports that their symptoms have resolved since VNG testing.
There is no evidence of BPPV and treatment will not be successful in moving the otoliths.
The intratympanic steroid perfusion procedure for treatment of Meniere's Disease delivers higher levels of the medication to the inner ear end organ than oral steroids.
Groups of medications that are considered to be vestibular suppressants include anticholinergic medications, antidopaminergic medications and benzodiazepan medication.
The most common risk a patient may experience after a singular neurectomy or section of the posterior ampullary nerve procedure is sensorineural hearing loss
Patients may exhibit postoperative imbalance and disequilibrium following posterior semicircular canal plugging because the occlusion impaired the normal inner ear physiology.
In cases of bilateral BPPV where the patient reports greater symptoms of vertigo in one ear, treat the "worse" ear first.
In cases when a patient is treated for BPPV several times, symptoms worsen dramatically and tinnitus is noted: the correct patient management should be to refer for a medical consult.
When teaching the patient how to perform the Brandt–Daroff exercises, is it important to have the patient demonstrate the entire sequence on their own because the patient might position their body incorrectly by turning their head to look down toward the table as they lie down or turn their head to look up as they return to a sitting position.
BPPV patients historically have been told to restrict their head movement for up to 48 hours and to avoid lying on the affected ear after treatment.
According to Richard Gans, there is little evidence that post-treatment restrictions are necessary.
Some cases of BPPV may need to be treated a second time due to the fact that the recurrence rate of BPPV within one year of treatment is 30%.
The labyrinthectomy procedure is considered as a "last resort" for dizzy patients.
Vestibular nerve section surgery generally eliminates more of the normal vestibular system than is necessary.
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