Peripheral Vestibular Disorders.pptVIP

Treatment Vestibulosppressive medication Ablative surgery Chemical labyrinthectomy Rehabilitation Emergency operative intervention and antibiotic therapy are considered when chronic infection causes vertigo Diazepam 5~10mg iv slowly will reduce vertigo, nausea and vomiting of severe unilateral loss of vestibular function Use for vestibular neuronitis, posttraumatic loss of vestibular function, labyrinthitis, severe episodic vertigo Rehabilitation Promote compensation and develop substitution strategies to maintain balance Effective vestibular rehabilitation requires early initiation of active head movement with visual stimulation Vestibulosuppressive Medications Meclizine or Transdermal scopolamine is useful during acute attacks, but doses are reduced and discontinued as soon as posible to minimize suppression of compensation. Episodic Vertigo of Vestibular Hydrops Decrease dietary sale intake for Meniere disease and diuretics use. It is to reduce endolymph pressure If the hydrops can’t be controlled, then use intratympanic gentamicin Surgery Shunting Vestibular neurectomy Ablation of labyrinthine function A high successful rate in relieving symptoms of episodic vertigo Streptomycin Indications: A chemical labyrinthectomy for bilateral Meniere disease Disease in an only hearing ear Poor surgical candidates Streptomycin It appears to ablate low frequency and spare high frequency. Caloric response is used to measure low-frequency. When caloric responses decrease, treatment is stopped. Surgical Labyrinthectomy Indication: Who has incapacitating episodic vertigo but no useful hearing in the affected ear The results Loss of vestibular function Destruction of any residual hearing Superior Canal Dehiscence Surgery to expose by a middle cranial fossa approach. Either occluded with bone dust or resurfaced using fascia and bone. BPPV Partical repositioning manuever is highly successful If unresponsive, occlusion of the posterior semicircular canal lumen with bone dust or