Balance and Vertigo

By
Sahr Kortequee FRCS(ORL-HNS)

Aims

Basic balance anatomy and physiology

Appreciate its complexity
Appreciate its importance
Common peripheral problems and Mx
Stimulate interest to learn more

Definitions

Vertigo: The illusion of movement

Lightheadedness
Disequilibrium
Drop attacks
Nystagmus: an involuntary, rhythmical
oscillation of the eyes away from the direction
of gaze, followed by a return of the eyes to
their original position.

Vestibular system
Found in the inner ear
Developed very early in mammals

Anatomy
Vestibule
3 semi-circular canals
Otolith organs: utricle
and saccule

Physiology
Receptor for gravity and linear acceleration
Receptor for angular acceleration
Regulates muscle tone

Vestibular system interactions

VOR
VCR
VSR
Autonomic centers
Cerebellum
Cerebral cortex

Other sensory systems

Smooth pursuit: reflexive eye movement
tracking object on retinal fovea
Optokinetic nystagmus:reflexive eye
movement tracking object outside retinal
fovea
COR: Propioceptors in neck augment the VOR
Limb proprioceptors
Graviceptors: major blood vessels and
abdominal viscera

Evaluation of Vestibular Pathology

History
Vertigo
Episodic or continous
Localising symptoms
Other medical pathology
Are they mad??
Precipitating factors
Relieving factors
Associated symptoms

Evaluation of Vestibular Pathology

Examination
H&N including CN
Smooth pursuit
Saccades
Head thrust
Positional testing
Cerebellar testing
Rombergs/Unterbergers
Head shaking nystagmus

Testing the Vestibular system

Audiograms
Caloric testing
Nystagmography
Rotational chair testing
Posturagraphy
CT/MRI Scans

Specific Disorders

BPPV
BPPV
Sudden rotational vertigo lasting seconds
No hearing loss
+ve Dix-Hallpike test

Treatment
Epleys Manoeuvre
Surgery

Menieres Disease
Essentials for diagnosis
Episodic vertigo lasting hours
Fluctuating hearing loss
Tinnitus
Aural pressure

Treatment
Dietary
Medical
Surgical

Vestibular Neuronitis
Essentials for diagnosis
Vertigo lasting days after a URTI
No hearing loss
No other focal neurological signs

Treatment
Mainly symptomatic
Avoid prolonged vestibular sedatives

Presbystasis
Disorder of balance related to aging