Vestibular Disorders — MCQs

Vestibular Disorders Indian Medical PG Practice Questions and MCQs

Question 61: All are characteristic features of superior semicircular canal dehiscence except?

A. Tullio's phenomenon
B. SNHL (Correct Answer)
C. Third window phenomenon
D. Abnormal vestibular evoked myogenic potentials

Explanation: ***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.

Question 62: Hallpike test is done for

A. Vestibular function (Correct Answer)
B. Cochlear function
C. Audiometry
D. Eustachian tube function

Explanation: ***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.

Question 63: Triad of Meniere’s disease includes all except?

A. Tinnitus
B. Vertigo
C. Migraine (Correct Answer)
D. Hearing loss

Explanation: ***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.

Question 64: Surgeries used in management of Meniere's disease are all Except

A. Sacculotomy
B. Endolymphatic shunt operation
C. Stapedectomy (Correct Answer)
D. Labyrinthectomy

Explanation: ***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.

Question 65: 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?

A. Congenital syphilis
B. Cholesteatoma
C. Stapedectomy
D. Meniere’s disease (Correct Answer)

Explanation: ***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.

Question 66: Vestibular evoked myogenic potential (VEMP) is a tool for evaluating which of the following?

A. Superior vestibular nerve disorders
B. Cochlear nerve lesions
C. Auditory nerve function
D. Inferior vestibular nerve disorders (Correct Answer)

Explanation: ***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.

Question 67: Bithermal caloric test stimulates which of the following?

A. Superior semicircular canal
B. Horizontal semicircular canal (Correct Answer)
C. Posterior semicircular canal
D. All of the options

Explanation: ***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.

Question 68: Differential diagnosis of Meniere's disease includes all except -

A. Acoustic neuroma
B. Suppurative otitis media (Correct Answer)
C. CNS disease
D. Labyrinthitis

Explanation: ***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.

Question 69: If a patient gets an attack of vertigo/dizziness triggered by loud noise, this indicates?

A. Dysplacusis
B. Tullio phenomenon (Correct Answer)
C. Paracusis
D. Hyperacusis

Explanation: **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.

Question 70: In Fitzgerald-Hallpike caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will induce -

A. Nystagmus to the left side
B. Positional nystagmus
C. Direction changing nystagmus
D. Nystagmus to the right side (Correct Answer)

Explanation: ***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**.

Practice by Chapter

Anatomy and Physiology of Balance

Practice Questions

Vestibular Testing Methods

Practice Questions

Videonystagmography

Practice Questions

Rotational Chair Testing

Practice Questions

Vestibular Evoked Myogenic Potentials

Practice Questions

Video Head Impulse Test

Practice Questions

Benign Paroxysmal Positional Vertigo

Practice Questions

Vestibular Neuritis

Practice Questions

Ménière's Disease

Practice Questions

Vestibular Migraine

Practice Questions

Central Vertigo

Practice Questions

Vestibular Rehabilitation

Practice Questions

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