Introduction to Dizziness and the Vestibular System
Transcript of Introduction to Dizziness and the Vestibular System
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Introduction to Dizziness and the Vestibular System David R Friedland, MD, PhD
Professor and Vice-Chairman Chief, Division of Otology and Neuro-otologic Skull Base Surgery
Chief, Division of Research Department of Otolaryngology and Communication Sciences
Medical College of Wisconsin, Milwaukee, WI
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8:30 am – 9:00 am Introduction to Dizziness and the Vestibular System David Friedland, MD, PhD, Professor & Vice-Chair of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee.
9:00 am – 9:30 am Clinical Exam for Dizziness Dennis Moore, MD, Otolaryngologist at Lutheran General Hospital, Park Ridge, IL
9:45 am – 10:30 am Vestibular Tests and Diagnosis Marcello Cherchi, MD, PhD, Assistant Professor of Neurology, Northwestern University, Chicago
10:30 am – 11:00 am Benign Paroxysmal Positional Vertigo (BPPV) Miriam Redleaf, MD, Chief of Otology/ Neurotology/ Skull Base Surgery Services, University of Illinois, Chicago
1:00 pm – 1:30 pm Meniere’s Disease Richard Wiet, MD, Ear Institute of Chicago, Professor of Clinical Otolaryngology & Neurosurgery, Northwestern University Medical School, Chicago
1:30 pm – 2:00 pm Migraine-Associated Vertigo Robert Battista, MD, Ear Insitute of Chicago, Assistant Professor in Clinical Otolaryngology at Northwestern University, Chicago
2:15 pm – 2:45 p Vestibular Physical Therapy Janet Helminski, PhD, PT, Vestibular Therapist, Professor of Physical Therapy, Midwestern University, Downers Grove, IL
2:45 pm – 3:15 pm Intra-Tympanic Therapy Alan Micco, MD, Associate Professor of Otolaryngology and Neurological Surgery, Northwestern Medical Faculty Foundation, Chicago
3:15 pm – 3:45 pm Future Therapies- gene/stem cells/implants Hinrich Staecker, MD, PhD, Professor of Otolaryngology – Head & Neck Surgery, University of Kansas, Kansas City, MO
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Goals and Objective • Understand the complexity of the vestibular
system and that dizziness can come from a number of different sources
• Recognize features of dizziness that come from ear-related disorders
• Recognize the association of dizziness with migraine
• Learn about new treatments and potential therapies
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Balance System
www.resourcesonbalance.com
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Descriptions of Dizziness • Vertigo
– Sensation of inappropriate movement – Spinning
• Disequilibrium / Imbalance – Unsteadiness; listing to one side – Drunk feeling
• Lightheadedness / Giddiness – Woozy, disorientation, feeling “off” – Faint
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Descriptions of Dizziness
• Acute • Chronic • Wax and wane • Episodic
– Seconds – Minutes – Hours – Days
• Spontaneous • Provoked
– Position change – Visual stimuli – Foods – Stress – Sound / pressure
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The Vestibular System
Anatomy
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The Vestibular System Inner Ear
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The Vestibular System Fluid Filled Compartments
Hearing Balance
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Semicircular Canals Angular Acceleration
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Otolith Organs Linear Acceleration
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Ross et al, Histology, 1995
The Vestibular System Passing Information to the Brain
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www.resourcesonbalance.com
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The Vestibular System
Functions
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Vestibular System Sense of Movement
• Linear acceleration • up/down; front/back; left/right (i.e., elevator,
airport conveyor)
• Angular acceleration: • Pitch: head shake “yes” • Yaw: head shake “no” • Roll: head shake “na-na-nah-nah-nah-nah”
• Sends this information to the brain, eyes, neck, spine, extremities, etc.
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Central Integration
• Both ears send signals to the brain
• The brain compares both sides and determines plane, speed and degree of movement
• The brain tells the eyes how to adjust
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Balance = Balance
Put in slide with brain in the middle of a see-saw. The inner ears are on either side
baseline
high
low
Activity
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Sensing Motion: Comparing signals
Slide showing turning head to one side with the see saw going up on the activated side and down on the other
omparing
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Vestibular Ocular Reflex VOR
• Most important vestibular reflex • Maintains eye position during motion • Extremely fast responses • Disturbances are demonstrated by eye
examination • Eye movements that are inappropriate
cause sensations of dizziness
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Loss of VOR on Left Side
Zee and Minor, 2002
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Vestibular Physiology
Laws to Live By
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Ewald’s First Law
Stimulation of a semicircular canal generates eye movements in the plane of that canal
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L. Minor, 2001
Eye Movements Evoked by Stimulation of Individual Semicircular Canals
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Nystagmus • Opposite the direction evoked by canal
excitation • Corrective mechanism
– Rapidly bring eyes back to where they belong
• Named for the fast direction of motion – Left / right; up / down – Rotary: clockwise / counterclockwise
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Nystagmus Directions
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Nystagmus
nystagmus
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Dizziness – Ear Disease • Ear diseases
– can cause • Inappropriate signals from the
semicircular canals – which causes
• Inappropriate eye movements – which causes
• A sensation of dizziness
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Dizziness – Non Ear Disease • Other diseases
– do not cause • Inappropriate signals from a
semicircular canal – so they do not cause
• Inappropriate eye movements – but there can be
• A sensation of dizziness
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Ear vs. Non-Ear
• Clinical examination • Vestibular Testing • Ear Diseases
– BPPV – Meniere’s Disease
• Non Ear Disease – Migraine
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8:30 am – 9:00 am Introduction to Dizziness and the Vestibular System David Friedland, MD, PhD, Professor & Vice-Chair of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee.
9:00 am – 9:30 am Clinical Exam for Dizziness Dennis Moore, MD, Otolaryngologist at Lutheran General Hospital, Park Ridge, IL
9:45 am – 10:30 am Vestibular Tests and Diagnosis Marcello Cherchi, MD, PhD, Assistant Professor of Neurology, Northwestern University, Chicago
10:30 am – 11:00 am Benign Paroxysmal Positional Vertigo (BPPV) Miriam Redleaf, MD, Chief of Otology/ Neurotology/ Skull Base Surgery Services, University of Illinois, Chicago
1:00 pm – 1:30 pm Meniere’s Disease Richard Wiet, MD, Ear Institute of Chicago, Professor of Clinical Otolaryngology & Neurosurgery, Northwestern University Medical School, Chicago
1:30 pm – 2:00 pm Migraine-Associated Vertigo Robert Battista, MD, Ear Insitute of Chicago, Assistant Professor in Clinical Otolaryngology at Northwestern University, Chicago
2:15 pm – 2:45 p Vestibular Physical Therapy Janet Helminski, PhD, PT, Vestibular Therapist, Professor of Physical Therapy, Midwestern University, Downers Grove, IL
2:45 pm – 3:15 pm Intra-Tympanic Therapy Alan Micco, MD, Associate Professor of Otolaryngology and Neurological Surgery, Northwestern Medical Faculty Foundation, Chicago
3:15 pm – 3:45 pm Future Therapies- gene/stem cells/implants Hinrich Staecker, MD, PhD, Professor of Otolaryngology – Head & Neck Surgery, University of Kansas, Kansas City, MO