Vestibular Disorders Practice Questions

Q: All are characteristic features of superior semicircular canal dehiscence except?

SNHL. ***SNHL*** - **Superior semicircular canal dehiscence (SSCD)** typically presents with conductive hearing loss or mixed hearing loss, not sensorineural hearing loss (**SNHL**), due to the "third window" effect. - The dehiscence allows sound energy to escape, primarily affecting sound transmission to the cochlea and ossicular chain mechanics, mimicking a **conductive hearing loss**. *Tullio's phenomenon* - This is a classic symptom of **SSCD**, characterized by **vertigo** and **nystagmus** induced by loud noises. - The dehiscence causes abnormal pressure changes in the inner ear in response to sound, stimulating the vestibular system. *Third window phenomenon* - The dehiscence itself creates an abnormal "third window" in the inner ear, altering the normal fluid dynamics. - This phenomenon is central to the pathophysiology of **SSCD**, causing symptoms like **autophony** and **pulsatile tinnitus**. *Abnormal vestibular evoked myogenic potentials* - **Vestibular evoked myogenic potentials (VEMPs)**, particularly **cervical VEMPs (cVEMPs)** and **ocular VEMPs (oVEMPs)**, are characteristic findings in **SSCD**. - They show **abnormally low thresholds** and **increased amplitudes** in response to sound or vibration due to the altered inner ear mechanics from the dehiscence.

Q: Hallpike test is done for

Vestibular function. ***Vestibular function*** - The **Dix-Hallpike maneuver** is a diagnostic test used to identify **benign paroxysmal positional vertigo (BPPV)**, a disorder of the vestibular system. - It involves specific head and body movements to provoke dizziness and **nystagmus**, indicating otolith displacement in the semicircular canals. *Cochlear function* - **Cochlear function** relates to hearing, which is evaluated by tests like **audiometry** or **otoacoustic emissions**. - The Hallpike test does not assess the ability to perceive sound or the health of the cochlea. *Audiometry* - **Audiometry** is a hearing test that measures a person's ability to hear sounds at different frequencies and intensities, assessing the **degree and type of hearing loss**. - It is unrelated to assessing vertigo or balance disorders caused by semicircular canal pathology. *Eustachian tube function* - **Eustachian tube function** is assessed by tests like **tympanometry** or the **Valsalva maneuver**, which evaluate middle ear pressure equalization. - The Hallpike test does not assess Eustachian tube patency or function.

Q: Triad of Meniere’s disease includes all except?

Migraine. ***Migraine*** - **Migraine** is not considered part of the classic triad of Meniere's disease. While some patients with Meniere's may experience migraines, it is not a diagnostic criterion. - The core symptoms of Meniere's disease relate specifically to inner ear dysfunction and are distinct from primary headache disorders. *Tinnitus* - **Tinnitus**, often described as ringing, buzzing, or roaring in the ear, is a hallmark symptom and a key component of the Meniere's disease triad. - It usually fluctuates in intensity and can precede or coincide with vertigo attacks. *Vertigo* - **Vertigo**, characterized by sudden, severe spinning sensations, is the most debilitating symptom and an essential part of the Meniere's triad. - These episodes can last from minutes to hours and are often accompanied by nausea and vomiting. *Hearing loss* - **Hearing loss**, typically fluctuating and affecting low frequencies initially, is a crucial diagnostic criterion and part of the Meniere's triad. - The hearing loss tends to progress over time, often becoming more permanent and affecting a broader range of frequencies.

Q: Surgeries used in management of Meniere's disease are all Except

Stapedectomy. ***Stapedectomy*** - **Stapedectomy** is a surgical procedure primarily used to treat **otosclerosis**, a condition causing conductive hearing loss due to abnormal bone growth in the middle ear. - It involves removing the stapes bone and replacing it with a prosthesis to restore sound conduction, which is not a treatment for **Meniere's disease**. *Sacculotomy* - This procedure involves making a small incision in the **saccule** (part of the labyrinth) to decompress the inner ear in Meniere's disease. - Its goal is to reduce inner ear pressure and improve symptoms like **vertigo**, but it carries a risk of hearing loss. *Endolymphatic shunt operation* - This surgery aims to create a drainage path for excess **endolymph** from the endolymphatic sac, reducing pressure in the inner ear. - It is a common surgical option for intractable Meniere's disease to control vertigo attacks while preserving hearing. *Labyrinthectomy* - **Labyrinthectomy** is a destructive surgical procedure where the entire **labyrinth**, including the vestibular and cochlear structures, is removed. - It is typically reserved for severe, intractable Meniere's disease in patients with **non-serviceable hearing** in the affected ear, as it results in complete hearing loss.

Q: Hennebert's sign is a false positive fistula test when there is no evidence of middle ear disease causing a fistula of the horizontal semicircular canal. It is seen in?

Meniere’s disease. ***Meniere's disease*** - **Hennebert's sign** is a *false-positive fistula test* resulting from a hypermobile footplate or saccule, or a fibrous band between the stapes footplate and the utricle due to otolithic *hydrops*. - It indicates that changes in external ear canal pressure cause **nystagmus** and **vertigo** due to inner ear fluid displacement, even without a true fistula. - This is the **most common** cause of Hennebert's sign in clinical practice. *Congenital syphilis* - Congenital syphilis can also present with Hennebert's sign as a false-positive fistula test due to inner ear involvement. - However, the question context specifies Hennebert's sign in the absence of middle ear disease, making Meniere's disease the more typical answer. - Other features include **sensorineural hearing loss**, **vestibular dysfunction**, **interstitial keratitis**, and **Hutchinson's teeth**. *Cholesteatoma* - A cholesteatoma often erodes bone, leading to a **true fistula** in the horizontal semicircular canal, especially its lateral aspect. - This would result in a *true positive fistula test* rather than a false positive associated with Hennebert's sign. *Stapedectomy* - A stapedectomy is a surgical procedure to treat otosclerosis, involving the removal of the stapes and insertion of a prosthesis. - While it can lead to complications such as perilymph fistula, it is not directly associated with Hennebert's sign as a *pre-existing condition* causing a false-positive fistula test in the absence of middle ear disease.

Q: Vestibular evoked myogenic potential (VEMP) is a tool for evaluating which of the following?

Inferior vestibular nerve disorders. ***Inferior vestibular nerve disorders*** - **VEMP** uses **loud acoustic stimuli** or **bone vibration** to activate the **saccule**, with the response pathway: saccule → inferior vestibular nerve → vestibular nucleus → vestibulospinal tract → muscle response. - **Cervical VEMP (cVEMP)** is recorded from the **sternocleidomastoid muscle**, while **ocular VEMP (oVEMP)** is recorded from **extraocular muscles**; absent or delayed responses indicate **saccular or inferior vestibular nerve dysfunction**. *Superior vestibular nerve disorders* - The **superior vestibular nerve** innervates the **utricle** and **semicircular canals**, which are assessed by **head impulse test** and **caloric testing**, not VEMP. - **VEMP** is the only clinical test specifically assessing **otolith (saccule) function** and does not evaluate semicircular canal pathways. *Cochlear nerve lesions* - **Cochlear nerve** assessment requires **pure tone audiometry**, **auditory brainstem response (ABR)**, and **otoacoustic emissions**. - **VEMP** evaluates vestibular pathways through **muscle reflexes**, not auditory nerve conduction or cochlear function. *Auditory nerve function* - **VEMP** is a vestibular test that evaluates **otolith organs** and their neural pathways, not auditory function. - While VEMP uses **acoustic stimuli** to trigger the response, it measures **vestibulospinal or vestibulo-ocular reflexes**, not hearing or auditory nerve conduction.

Q: Bithermal caloric test stimulates which of the following?

Horizontal semicircular canal. ***Horizontal semicircular canal*** - The **bithermal caloric test** works by introducing temperature changes (warm or cool water/air) into the **external auditory canal**. - This temperature change creates an **endolymphatic current** primarily within the **horizontal semicircular canal**, stimulating the vestibular afferents and eliciting nystagmus. *Superior semicircular canal* - While all semicircular canals contribute to balance, the caloric test is **not designed to selectively stimulate** the superior canal. - The orientation and fluid dynamics of the superior canal make it less responsive to temperature changes introduced via the external ear canal. *Posterior semicircular canal* - Similar to the superior canal, the **posterior semicircular canal is not the primary target** of the caloric test. - Its anatomical position and fluid dynamics limit its significant stimulation by caloric irrigation, which mainly affects the horizontal canal. *All of the options* - The **caloric test specifically targets the horizontal semicircular canal** due to its orientation and proximity to the external ear canal. - Other canals are not significantly or specifically stimulated, making this option incorrect.

Q: Differential diagnosis of Meniere's disease includes all except -

Suppurative otitis media. ***Suppurative otitis media*** - **Suppurative otitis media** is an **infection of the middle ear** causing pus formation, earache, and hearing loss, which is distinctly different from the inner ear disorder seen in Meniere's disease. - Its clinical presentation, including visible **tympanic membrane perforation** and **otorrhea**, does not mimic the classic Meniere's triad of episodic vertigo, tinnitus, and fluctuating hearing loss. *Acoustic neuroma* - This is a **benign tumor** on the **vestibulocochlear nerve** that can cause progressive unilateral hearing loss, tinnitus, and balance issues, similar in some ways to Meniere's. - However, the hearing loss is typically **slowly progressive** and not fluctuating episodically like in Meniere's disease. *CNS disease* - Various **central nervous system (CNS) conditions**, such as **migraine-associated vertigo** or **vertebrobasilar insufficiency**, can present with dizziness, balance problems, and even tinnitus. - Unlike Meniere's, these conditions often have additional **neurological deficits** and typically lack the classic triad of episodic vertigo, fluctuating hearing loss, and aural fullness. *Labyrinthitis* - **Labyrinthitis** is an **inflammation of the inner ear** that causes sudden, severe vertigo, nausea, and hearing loss, which can initially resemble a Meniere's attack. - However, labyrinthitis is usually **self-limiting**, resolves over weeks, and does not involve the recurrent, fluctuating symptoms and aural fullness characteristic of Meniere's disease.

Q: If a patient gets an attack of vertigo/dizziness triggered by loud noise, this indicates?

Tullio phenomenon. **Tullio phenomenon** - **Tullio phenomenon** is characterized by the induction of **vertigo**, **dizziness**, nystagmus, or oscillopsia by **loud noises** or sound stimuli. - It is often associated with conditions causing a **dehiscence of the bone covering the superior semicircular canal** (e.g., superior semicircular canal dehiscence syndrome), leading to abnormal pressure transmission within the inner ear. *Dysplacusis* - **Dysplacusis** refers to a type of **recruitment** or **abnormal perception of pitch**, where the same sound is perceived differently in each ear or as distorted within one ear. - It is a symptom of **sensorineural hearing loss** but does not specifically involve sound-induced vertigo. *Paracusis* - **Paracusis** is a general term for **abnormal hearing**, often describing situations where hearing is better in noisy environments (e.g., **paracusis Willisiana** in otosclerosis) or other altered sound perceptions. - It does not specifically denote vertigo triggered by loud noises. *Hyperacusis* - **Hyperacusis** is a condition where everyday sounds are perceived as **abnormally loud**, annoying, painful, or even frightening. - While unpleasant, it typically involves **increased sensitivity to sound volume** rather than the induction of vertigo or dizziness by loud noises.

Q: In Fitzgerald-Hallpike caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will induce -

Nystagmus to the right side. ***Nystagmus to the right side*** - According to **COWS** (Cold Opposite, Warm Same) mnemonic, **cold-water irrigation** in the left ear inhibits the left horizontal semicircular canal. - This inhibition mimics a head turn to the right, causing nystagmus with the **fast phase to the opposite (right)** side. *Nystagmus to the left side* - This would occur with **warm-water irrigation** in the left ear, which excites the left horizontal semicircular canal. - Excitation would mimic a head turn to the left, causing nystagmus with the fast phase to the **same (left)** side. *Positional nystagmus* - This type of nystagmus is typically observed when the **head is moved into specific positions** and is indicative of benign paroxysmal positional vertigo (BPPV) or central lesions. - It is not the expected or primary response to a **caloric stimulus** in a normal individual. *Direction changing nystagmus* - This implies that the **direction of the nystagmus** changes depending on the gaze direction or with different stimuli, which can be a sign of a central vestibular lesion. - In a normal caloric test, the nystagmus direction following a specific stimulus (cold water in one ear) is **consistent**.

Question 1

All are characteristic features of superior semicircular canal dehiscence except?

Accepted Answer

SNHL

Answer

Tullio's phenomenon

Answer

Third window phenomenon

Answer

Abnormal vestibular evoked myogenic potentials

Question 2

Hallpike test is done for

Accepted Answer

Vestibular function

Answer

Cochlear function

Answer

Audiometry

Answer

Eustachian tube function

Question 3

Triad of Meniere’s disease includes all except?

Accepted Answer

Migraine

Answer

Tinnitus

Answer

Vertigo

Answer

Hearing loss

Question 4

Surgeries used in management of Meniere's disease are all Except

Accepted Answer

Stapedectomy

Answer

Sacculotomy

Answer

Endolymphatic shunt operation

Answer

Labyrinthectomy

Question 5

Hennebert's sign is a false positive fistula test when there is no evidence of middle ear disease causing a fistula of the horizontal semicircular canal. It is seen in?

Accepted Answer

Meniere’s disease

Answer

Congenital syphilis

Answer

Cholesteatoma

Answer

Stapedectomy

Question 6

Vestibular evoked myogenic potential (VEMP) is a tool for evaluating which of the following?

Accepted Answer

Inferior vestibular nerve disorders

Answer

Superior vestibular nerve disorders

Answer

Cochlear nerve lesions

Answer

Auditory nerve function

Question 7

Bithermal caloric test stimulates which of the following?

Accepted Answer

Horizontal semicircular canal

Answer

Superior semicircular canal

Answer

Posterior semicircular canal

Answer

All of the options

Question 8

Differential diagnosis of Meniere's disease includes all except -

Accepted Answer

Suppurative otitis media

Answer

Acoustic neuroma

Answer

CNS disease

Answer

Labyrinthitis

Question 9

If a patient gets an attack of vertigo/dizziness triggered by loud noise, this indicates?

Accepted Answer

Tullio phenomenon

Answer

Dysplacusis

Answer

Paracusis

Answer

Hyperacusis

Question 10

In Fitzgerald-Hallpike caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will induce -

Accepted Answer

Nystagmus to the right side

Answer

Nystagmus to the left side

Answer

Positional nystagmus

Answer

Direction changing nystagmus

Vestibular Disorders — MCQs

Vestibular Disorders — MCQs

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