3. According to the National Institute of
Health, 42% of the population is said to
suffer from balance problems some time
in their life.
4. Vertigo, imbalance, dizziness, disequilibrium –
these are all terms used by the pt. to describe
a sensation of altered orientation to the
environment.
Affects day to day life
Who to consult?
5. Challenging for the physician
Vague history
Vague complaints
Investigations ?
Etiology ?
7. • DURATION OF ILLNESS
• DURATION OF ATTACKS
• TRIGGERS
• ASSOCIATED SYMPTOMS
8.
9.
10. SECONDS – LATE OTOTOXICITY
MINUTES –BPPV, TIA
HOURS – MENIERE’S DISEASE ,
MIGRAINE
DAYS – VESTIBULAR NEURITIS
MONTHS TO YEARS- HYSTERICAL
11. CHANGE IN POSITION – BPPV
URI – VESTIBULAR NEURITIS
RAISED INTRATHORACIC
PRESSURE – PERILYMPH
FISTULA
12. AUDIOMETRY CRANIOCORPOGRAPHY
-HELPS IN
ELECTRONYSTAGMOGRAP DIFFERENTIATING
HY PERIPHERAL & CENTRAL
DISORDERS
13.
14. 28 YEAR OLD FEMALE
INTENSE SPINNING ON GETTING UP
IN MORNING LASTING SEVERAL HRS.
CANNOT GET UP FROM BED
N/V ++
NO HEARING LOSS
15. • TYMP. MEMBRANE – WNL
• NYSTAGMUS – LEFT BEATING SPONTANEOUS
• CRANIAL NERVES WNL
• GAIT –COULD NOT BE TESTED
• NO NEUROLOGICAL DEFICIT
16.
17.
18. Pathogenesis – viral infection of superior division of
vestibular N.
History – sudden onset of severe vertigo without hearing
loss. Usually preceded by URI.
Investigations
Audiometry – WNL
ENG – canal paresis
CCG – rotation to the affected side
19. • CONTROL OF SYMPTOMS
• INITIALLY STRONG VEST. SEDATIVES – MECLIZINE ,
PROCLOPERAZINE ,ALPRAZOLAM,
• ONDANSTERON – NOT MORE THAN 5 DAYS
• IF PT. SEEN WITHIN 2 DAYS OF ONSET – STEROIDS
• START VESTIBULAR REHABILITATION ASAP
20. 41 YR. OLD MALE
RECURRENT EPISODES OF VERTIGO
SINCE 4 MONTHS WHICH LAST FOR FEW
HRS.
N/V+
HEARING LOSS AND RINGING IN RT.EAR
DURING THE ATTACK
21. TM – N
NO NYSTAGMUS
STEPPING TEST – 90* ROTATION TO
RT
AUDIOMETRY – LOW FREQ.
HEARING LOSS RE
ENG – HYPERACTIVE CALORIC
RESPONSE ON RT
22.
23.
24. MENIERE’S DISEASE
Pathogenesis-
endolymphatic hydrops
Dilated membranous
Normal membranous labyrinth labyrinth in Meniere's
disease (Hydrops)
27. 23 YR. OLD FEMALE
PERSISTANT FEELING OF
UNSTEADINESS
OFTEN EPISODES OF SPINNING
FREQ. HEADACHES WITH SENSORY
AMPLIFICATION
NO AURAL SYMPTOMS
HIGH STRUNG PERSONALITY
37. 55 YR.OLD MALE
CHR. UNSTEADINESS SINCE SEVERAL MONTHS
INCREASED ON CHANGE OF POSITION
DECREASED HEARING BE
HYPERTENSIVE,DIABETIC
H/O ATT 10 YRS. AGO WITH STREPTOMYCIN