Vestibular System. BAA Conference 2014 Assistant Audiologist Workshop
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1 Vestibular System BAA Conference 2014 Assistant Audiologist Workshop
2 Balance testing - why do we do it? Dizziness / vertigo / unsteadiness / light-headedness Very common Very distressing Nausea / vomiting Impact on daily life Time off work Injuries / falls
3 Simplified model of balance Output Postural control Eye movements Central processing Brain Senses Vision Proprioception Vestibular
4 Vestibular system Picture taken and adapted from:
5 Types of dizziness Ear related examples: Labyrinthitis Menieres disease BPPV (Benign Paroxysmal Positional Vertigo) Non-ear related examples: Medical Neurological dizziness (central/brain) Undiagnosed dizziness
6 History very important A patient reports dizziness / balance problems. What would you ask? Do you sense movement? Is it recurrent or one-off or constant? What does it feel like? When did it start? How long does it last? Advise to see GP / refer to ENT (If not already being investigated)
7 Balance history - Red flags From: British Academy of Audiology Guidelines for Referral to Audiology of Adults with Hearing Difficulties (2009) Vertigo Also: a hallucination of movement, including dizziness, swaying or floating sensations (frequently associated with unsteadiness) that may indicate otological, neurological or medical conditions Any extra red flags agreed locally.
8 How do we test it? Eye movement recordings Picture taken from: d=view_subsection§ion_id=3&subsectio n_id= Postural movement recordings Picture taken from: hearingbalance/balance/pages/diagnostict esting.aspx
9 Simplified model of balance Output Postural control Eye movements Central processing Senses Vision Proprioception Vestibular
10 Eye movement recordings Nystagmus Repetitive involuntary eye movement Side/side, rotatory, up/down, pendular
11 Nystagmus video Right Left
12 Range of tests in audiology Hearing tests Videonystagmography Caloric (water) test Rotatory chair Positional testing Posturography VEMPs Bedside tests Bottom right picture taken from:
13 Video of basic balance testing
14 Rotatory chair testing video
15 Sway pen testing video
16 Management for dizziness Medical Surgical Dietary changes Occupational Therapy In Audiology. Balance Rehabilitation Relaxation Physiotherapy
17 Treatment (Balance Rehabilitation) Cooksey Cawthorne exercises Head / eye movements (slow/fast) whilst sitting, standing Throwing a ball Moving around Customised exercises Stress / relaxation therapy Groups e.g. Tai Chi Virtual reality Visual stimulation Tai Chi photograph removed Photographs removed Photographs removed
18 Role of the assistant Always under the supervision of Senior Audiologist Complex testing support second tester Supportive to patients, often very anxious, feeling nauseous, dizzy, wobbly for years, patients need reassurance Explanation of rehab and progression, use of diary sheets, questionnaires See in daily hearing aid or repair appointments. If a patient reports dizziness signpost / onward referrals
19 Practical time 5 bedside tests in 5 minutes 1. Saccades 2. Smooth pursuit 3. Romberg 4. Sharpened Romberg 5. Unterbergers
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22 Practical time 5 bedside tests in 5 minutes 1. Saccades 2. Smooth pursuit 3. Romberg 4. Sharpened Romberg 5. Unterbergers
23 For more information: NHS website Meniere s society BSA Recommended Procedures for Vestibular Assessment, Hallpike Manoeuvre, Caloric Test, VR on a shoestring. Local protocols Find out what you do in your department
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