Introduction: The Balance System

1
Introduction The Balance System

• Integration of Multiple Cues
• To facilitate orientation navigation
• To maintain
• upright posture
• visual focus
• Through stimulation of
• postural muscles
• eye muscles

2
Balance Is

• the ability to control the
• center of gravity
• over the
• base of support
• in any given
• sensory environment

3
Disorders of the Balance System

• Can Produce
• dizziness, vertigo, lightheadedness,
  presyncope, nausea, unsteadiness, vexion,
  pulsion, ataxia, diplopia, oscillopsia, ...
• With varying degrees of influence on functional
  health and lifestyle.

4
Disorders of Balance

• Benign Paroxysmal Positional Vertigo
• Menieres Disease
• Vestibular Neuronitis
• Autoimmune Inner Ear Disease
• Trauma
• Toxic Substances/Medications

5
Disorders of Balance

• Migraine
• Acoustic Neuroma
• Vascular Disorders
• Multiple Sclerosis
• Cervical Vertigo

6
The Audiologists Role

• Detection
• Assessment
• Rehabilitation
• Referral

7
Case History

• Nature of the dizziness (true vertigo, imbalance,
  presyncope)
• Timing/Duration of Spells
• What triggers spells?
• Other otologic symptoms
• General Health issues
• Neurologic symptoms

8
Electronystagmography

• Recording eye movements (nystagmus)
• Using electrodes to measure
• the Corneo-retinal potential

9
Video-nystagmography
10
The ENG/VNG Battery

• Gaze Testing
• Visual Tracking/Oculomotor Testing
• Dix-Hallpike Maneuver
• Positional Testing
• Caloric Testing

11
The Dix-Hallpike Maneuver
12
Rotary Testing

• Rotary Chair
• Vestibular Autorotation Test (VAT)

13
VAT Results
14
Dynamic Posturography

• Analysis of Sway under conditions which remove or
  attenuate
• Visual Cuesand/orProprioceptive Cues

15
CDP Sensory Organization Test
16
Medical Management

• Vestibular Suppressants benzodiazepenes,
  antihistimines, anticholinergics
• Steroids, Glucocorticoids
• Calcium channel blockers
• Beta blockers
• Diuretics
• Dietary changes

17
Surgical Management

• Endolymphatic Sac decompression/shunt
• Labyrinthectomy
• Gentamycin/Streptomycin Perfusion
• Vestibular nerve section
• Posterior Canal Occlusion
• Perilymph Fistula Exploration

18
Vestibular Rehabilitation

• Habituation
• Adaptation
• Substitution

19
BPPV Management

• Canalith Repositioning
• Epley,
• Semont
• Horizontal Canal Procedures
• Barbecue Roll
• Appiani
• Casani

20
Brandt-Daroff
21
Cawthorne-Cooksey Exercises

• Regime of movements
• Graded in difficulty/challenge
• Eye
• Head
• Shoulder Trunk
• Sit to Stand
• Walking up and down slope/steps

(Lying in bed, sitting, then standing)