VESTIBULAR DISORDERS

Ashadi prasetyo

Bagian Ilmu Kesehatan Telinga Hidung Tenggorok-Kepala Leher Fakultas Kedokteran Universitas Gadjah Mada/RS Sardjito Yogyakarta

Interaksi Pada Sistem Vestibuler:

Fungsi sistem vestibuler:

1. Deteksi gerakan badan (aselerasi linier dan anguler) dimonitor oleh gerakan kepala. 2. Deteksi posisi kepala terhadap gravitasi (kemiringan). Integrasi informasi dengan input lain a. b. c. d. Menjaga fovea pada obyek fiksasi visual Menjaga keseimbangan Aktifitas sistem saraf otonom Tingkat mood dan arousal

BPPV
Benign Paroxysmal Positional Vertigo

 Most Common Cause of Vertigo

64/100,000/year 50% of those over 65yo will have at least 1 episode Usually self-limiting, but can persist for years

Etiology
Head Trauma, Inflammation, Aging, Spontaneous

Symptoms
Brief (<1min) intense spinning following a movement
Rolling over in bed Rising from Supine Head tilt up (top shelf vertigo)

No Crisis Event Hallpike Test Reproduces Symptoms

Diagnosis Hallpike Maneuver

Traditional No Neck Extension if Elderly-risk of basilar stroke No Neck Torsion if Cervical Problems Sit-to-side-lying if Back Problems

Torsional Nystagmus

Hallpike Maneuver

Management
Increase Activity Generic Vestibular Exercises Particle Repositioning Maneuver Vestibular Rehabilitation Therapy (VRT) Surgical
Posterior Semicircular Canal Occlusion

Particle Repositioning Maneuver

Management
Keep in Mind
Vertigo medications dont help and may hinder recovery Patients dont have to learn to live with it

Particle Repositioning Maneuver (PRM) and/or VRT

Combined have a 95% success rate PRM works best for most, VRT for others
VRT may also be used to resolve residual symptoms after PRM

Menieres Disease
Endolymphatic Hydrops

Mild Hydrops

Severe Hydrops

Symptoms
Episodic Severe Vertigo Lasting for Hours Fluctuating Low Frequency Hearing Loss Roaring Tinnitus Aural Fullness

Unstable Lesion

Medical Management
Sodium Restriction
1500 - 2000 mg per day

64 oz fresh water per day

Not just no salt shaker Must change eating habits

No Water Softener, which may add salt

Diuretic Avoid Caffeine, Sugar, Nutrasweet, Tobacco

Intratympanic Gentamicin
Advantages
70-90% Control of Vertigo Office Procedure

Disadvantages
Destructive Procedure Risk of Hearing Loss

Surgical Management
Endolymphatic Sac Shunt / Decompression
Advantages Non-Destructive Hearing Preservation Out - Patient Surgery Disadvantages Controversial ? 50% - 90% Effective Surgical Morbidity