Julie A. Honaker - Diagnostic Vestibular Pocket Guide: Evaluation of Dizziness, Vertigo, and Imbalance

DIAGNOSTIC VESTIBULAR POCKET GUIDE

Evaluation of Dizziness, Vertigo, and Imbalance

Editor-in-Chief for Audiology

Brad A. Stach, PhD

DIAGNOSTIC VESTIBULAR POCKET GUIDE

Evaluation of Dizziness, Vertigo, and Imbalance

Julie A. Honaker, PhD, CCC-A

5521 Ruffin Road

San Diego, CA 92123

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Website: https://www.pluralpublishing.com

Copyright 2021 by Plural Publishing, Inc.

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Library of Congress Cataloging-in-Publication Data:

Names: Honaker, Julie A., author.

Title: Diagnostic vestibular pocket guide : evaluation of dizziness, vertigo, and imbalance / Julie A. Honaker.

Description: San Diego, CA : Plural, [2021] | Includes bibliographical references and index.

Identifiers: LCCN 2020027362 | ISBN 9781635503128 (paperback) | ISBN 1635503124 (paperback)

Subjects: MESH: Dizzinessdiagnosis | Vertigodiagnosis | Handbook

Classification: LCC RB150.V4 | NLM WL 39 | DDC 616.8/41dc23

LC record available at https://lccn.loc.gov/2020027362

Contents

The goal of the Diagnostic Vestibular Pocket Guide is to provide hands-on, evidence-based material for students and clinicians in the trenches of vestibular evaluation. This quick reference evolved from experiences teaching vestibular assessment in both academic and clinical settings. The book is designed for patient care and complements core theories provided in comprehensive texts dedicated to balance assessment and management. The reader should be familiar with vestibular anatomy and physiology, along with a basic understanding of key concepts. The pocket guide is organized and condensed to encompass all facets of the clinical evaluation: appointment preparation, formulating the clinical question(s), vestibular screening measures, and appropriate objective testing. The work is innovative as specific chapters target common disorders and evaluation, modifications to vestibular evaluation for both ends of the lifespan, the vestibular care path, the framing of clinical impressions, and medical referral criteria. Well-known treatments are briefly discussed concerning appropriate usage and based on accurate diagnosis. Emphasis is placed on the availability of a portable reference (pocket) guide to carry throughout the clinical appointmentan invaluable resource for students and providers in the clinical setting.

First and foremost, I am sincerely appreciative of my students for inspiring and encouraging me to write this book. I also wish to thank my friends and colleagues for their interest and support in this venture. Thank you to Ross Papalardo and Jeffrey Mobley for their assistance with the BPPV maneuvers illustrations in . A special thanks to my dear friend Jane Gilbert, retired AuD, for her invaluable editing and suggestions. Lastly, I would like to recognize my family. Thank you to my parents for teaching me the importance of effort and perseverance. To my husband Duane and daughter Vivian, thank you for being my cheerleaders and welcome distractions when I needed it most.

Plural Publishing, Inc. and the author would like to thank the following reviewers for taking the time to provide their valuable feedback during the development process:

Rachel D. Craig, AuD, CCC-A

Assistant Professor of Audiology

University of Wisconsin

Madison, Wisconsin

Robin Criter, AuD, PhD

Western Michigan University

Kalamazoo, Michigan

Steven M. Doettl, AuD

University of Tennessee Health Science Center

Memphis, Tennessee

Lilian Felipe

Post-Doctoral in Otoneurology and PhD in Health Sciences

Professor

Lamar University

Beaumont, Texas

Patricia Gaffney, AuD

Professor

Department of Audiology

Nova Southeastern University

Fort Lauderdale, Florida

Barbara Grossman, AuD

Clinical Audiologist

New York City Private Practice

Troy D. Hale, AuD

Assistant Professor

A.T. Still University

Audiologist

Barrow Neurological Institute/St. Josephs Hospital

Mesa, Arizona

Lauren L. Pasquesi, AuD

Senior Audiologist/Lead Vestibular Audiologist

University of California San Francisco Medical Center

Adjunct Faculty

University of the Pacific

San Francisco, California

SENSORY MODALITIES OF BALANCE CONTROL

The balance system coordinates compensatory eye, head, and body movements allowing for clear vision with head and body activities, perception of movement and direction, and postural control. The three primary systems that contribute to balance control include vestibular, visual, and somatosensory.

The vestibular system is an internal sensory reference that provides cues of space perception and both direction and velocity of movement. A central role of this system is to stabilize retinal images during head movements.

The visual system is an external sensory reference that indicates environmental movement and position.

The somatosensory system is also an external sensory reference, including both proprioception and kinesthetics that detect changes in the support surface.

ANATOMY AND PHYSIOLOGY OF THE VESTIBULAR SYSTEM

Located within the petrous portion of the temporal bone, two labyrinths (bony and membranous) comprises the vestibule, semicircular canals, and cochlea (Baloh & Honrubia, 2001). The bony labyrinth is a hollow chamber that houses the sensory organs for hearing (anterior part) and balance (posterior part). Perilymph fluid fills the space.

The membranous labyrinths (right and left) contain the cochlea and five vestibular organs: the utricle and saccule (otolith organs), and the three semicircular canals (horizontal, anterior/superior, and posterior; ). The vestibular organs contain receptors responsible for sensing both linear (otolith organs) and angular (semicircular canals) acceleration and deceleration. The membranous labyrinth is suspended within the bony labyrinth but is adhered to ligaments, so only the fluid within the membranous labyrinth moves with head and body movements. Endolymph fluid fills the membranous labyrinth. The membranous labyrinth also contains the endolymphatic duct and sac.