Vestibular Disorders — MCQs

Vestibular Disorders Indian Medical PG Practice Questions and MCQs

Question 71: Caloric test assesses the function of ?

A. Posterior semicircular canal
B. Cochlea
C. Anterior semicircular canal
D. Horizontal semicircular canal (Correct Answer)

Explanation: ***Horizontal semicircular canal*** - The **caloric test** primarily assesses the function of the **horizontal (lateral) semicircular canal** by inducing temperature changes that stimulate or inhibit endolymph flow. - This test evaluates the **vestibulo-ocular reflex (VOR)**, which is crucial for maintaining gaze stability during head movements. *Posterior semicircular canal* - The **posterior semicircular canal** is mainly assessed by tests like the **Dix-Hallpike maneuver**, particularly for diagnosing **benign paroxysmal positional vertigo (BPPV)**. - It is responsible for detecting **head rotations in the sagittal plane**. *Cochlea* - The **cochlea** is the part of the inner ear responsible for **hearing**, converting sound vibrations into electrical signals. - Its function is assessed by **audiometry**, not the caloric test. *Anterior semicircular canal* - The **anterior (superior) semicircular canal** detects **head rotations in the sagittal plane**, similar to the posterior canal but in a different orientation. - While it contributes to overall vestibular function, the caloric test's thermal convection currents are most effective at stimulating the horizontally oriented canal.

Question 72: Epley's maneuver is used in the treatment of:

A. BPPV (Benign paroxysmal positional vertigo) (Correct Answer)
B. Infective labyrinthitis
C. Cervical spondylosis
D. Tinnitus

Explanation: ***BPPV (Benign paroxysmal positional vertigo)*** - The **Epley's maneuver** is a repositioning procedure specifically designed to treat **benign paroxysmal positional vertigo (BPPV)** by moving displaced otoconia out of the semicircular canals. - BPPV is characterized by brief episodes of **vertigo** triggered by specific head movements. *Infective labyrinthitis* - **Infective labyrinthitis** is an inflammation of the inner ear, typically caused by a viral or bacterial infection, leading to vertigo, hearing loss, and tinnitus. - Its treatment involves antibiotics or antivirals and symptomatic relief, not physical maneuvers. *Cervical spondylosis* - **Cervical spondylosis** is a degenerative condition affecting the neck vertebrae and discs, causing neck pain, stiffness, and sometimes neurological symptoms. - Treatment focuses on physical therapy, pain management, and sometimes surgery, not the Epley's maneuver. *Tinnitus* - **Tinnitus** is the perception of noise or ringing in the ears without an external source, often a symptom of an underlying condition. - Management involves addressing the underlying cause, sound therapy, and cognitive behavioral therapy, with no role for the Epley's maneuver.

Question 73: First-line treatment for BPPV is:

A. Intralabyrinthine streptomycin
B. Epley's manoeuvre (Correct Answer)
C. Valsalva manoeuvre
D. Intralabyrinthine steroids

Explanation: ***Epley's manoeuvre*** - The **Epley's manoeuvre** (also known as the canalith repositioning procedure) is the most effective and widely accepted **first-line treatment** for **benign paroxysmal positional vertigo (BPPV)**. - It involves a series of specific head and body movements designed to move dislodged otoconia (calcium carbonate crystals) from the semicircular canals back into the utricle, where they belong. *Intralabyrinthine streptomycin* - **Intralabyrinthine streptomycin** is an **ablative therapy** used in severe, intractable cases of **Ménière's disease** for chemical labyrinthectomy. - It is not indicated for BPPV, which is a mechanical problem with a non-ablative solution. *Valsalva manoeuvre* - The **Valsalva manoeuvre** is a technique of forced exhalation against a closed glottis, often used to equalize pressure in the middle ear or to stop certain types of **tachycardia**. - It has no role in the treatment of BPPV, as it does not address the underlying **otoconia displacement**. *Intralabyrinthine steroids* - **Intralabyrinthine steroids** are sometimes used in conditions involving **inflammation of the inner ear**, such as **Ménière's disease** or sudden sensorineural hearing loss. - They are not effective for BPPV, which is a mechanical rather than an inflammatory condition.

Question 74: All are true about vestibular neuritis EXCEPT:

A. Horizontal nystagmus
B. Positive head thrust
C. Vertical nystagmus (Correct Answer)
D. Normal hearing

Explanation: ***Vertical nystagmus*** - **Vestibular neuritis** primarily affects the **horizontal semicircular canal** and superior vestibular nerve, leading to **horizontal or rotational nystagmus**, not vertical. - **Vertical nystagmus** is often indicative of a **central lesion** rather than a peripheral vestibular disorder like neuritis. *Horizontal nystagmus* - This is a characteristic finding in **vestibular neuritis**, where the **nystagmus is usually horizontal or rotatory** and beats away from the affected side. - The nystagmus typically **increases in intensity** when looking in the direction of the fast phase. *Positive head thrust* - A **positive head thrust test** (or **head impulse test**) is a hallmark of **peripheral vestibular dysfunction**, including vestibular neuritis. - It demonstrates a **saccadic corrective eye movement** when the head is quickly turned towards the affected side, indicating impaired vestibulo-ocular reflex. *Normal hearing* - **Vestibular neuritis** specifically involves inflammation of the **vestibular nerve**, sparing the cochlear nerve. - Therefore, patients with vestibular neuritis typically **maintain normal hearing**, differentiating it from labyrinthitis.

Question 75: Which of the following is not true about Meniere’s disease?

A. Fluctuating hearing loss
B. Bilateral involvement (Correct Answer)
C. Tinnitus
D. Vertigo

Explanation: ***Bilateral involvement*** - Meniere's disease **characteristically presents as a unilateral disorder** affecting one ear. - Only **15-30% of patients** eventually develop bilateral involvement, typically occurring **years to decades** after initial presentation. - Since bilateral involvement is **not a typical feature**, this statement is **not true** about Meniere's disease, making it the correct answer. *Fluctuating hearing loss* - **Intermittent and progressive hearing loss** is a hallmark symptom of Meniere's disease, often worsening during acute attacks. - This symptom is due to **endolymphatic hydrops** affecting the cochlea and is part of the classic presentation. *Tinnitus* - **Tinnitus** (ringing, roaring, or buzzing sound) is one of the cardinal symptoms of Meniere's disease. - It typically **worsens during vertiginous episodes** and can fluctuate in intensity between attacks. *Vertigo* - **Recurrent, spontaneous episodes of rotational vertigo** are the defining characteristic of Meniere's disease. - Episodes last from **20 minutes to several hours**, often accompanied by nausea, vomiting, and prostration.

Question 76: Which of the following is NOT seen in Meniere's disease?

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

Explanation: ***Otalgia*** - **Otalgia** (ear pain) is **not a typical symptom** of Meniere's disease. Meniere's disease is characterized by an imbalance of fluid in the inner ear, leading to a specific triad of symptoms. - While other ear conditions can cause pain, it is not part of the diagnostic criteria or common presentation of Meniere's. *Tinnitus* - **Tinnitus**, often described as a ringing, buzzing, or roaring sound in the ear, is a **hallmark symptom** of Meniere's disease. - It often accompanies or precedes the vertigo attacks and can fluctuate in intensity. *Hearing loss* - **Fluctuating sensorineural hearing loss**, usually affecting the lower frequencies initially, is a key diagnostic criterion for Meniere's disease. - The hearing loss can worsen during attacks and may become more permanent over time. *Vertigo* - **Episodic rotational vertigo**, often severe and lasting from 20 minutes to several hours, is the most debilitating symptom of Meniere's disease. - It is typically associated with nausea and vomiting and is a core part of the diagnostic criteria.

Question 77: A 45-year-old female presents with hearing loss, vertigo, and tinnitus in her right ear. Which condition is most likely?

A. Acoustic neuroma
B. Meniere's disease (Correct Answer)
C. Chronic otitis media
D. Otosclerosis

Explanation: ***Meniere's disease*** - This condition classically presents with the triad of **vertigo**, **tinnitus**, and **fluctuating sensorineural hearing loss**, often in one ear. - The symptoms are thought to be caused by an excess of fluid, known as **endolymphatic hydrops**, in the inner ear. *Acoustic neuroma* - While it can cause **unilateral hearing loss** and **tinnitus**, it typically causes more persistent, progressive symptoms and **vertigo is less common or severe** than in Meniere's. - An acoustic neuroma is a **benign tumor** on the vestibulocochlear nerve (cranial nerve VIII) that can also cause **facial numbness** or weakness in later stages. *Chronic otitis media* - This condition primarily causes **conductive hearing loss** due to damage to the middle ear structures and often involves **tympanic membrane perforation** and **otorrhea**. - It does not typically present with vertigo unless there is an erosion into the inner ear (labyrinthitis), and **tinnitus is less prominent** than in Meniere's disease. *Otosclerosis* - This condition primarily causes **progressive conductive hearing loss** in younger to middle-aged adults, often bilaterally, due to abnormal bone growth in the middle ear. - While **tinnitus can occur**, **vertigo is rare** and not a primary symptom, distinguishing it from Meniere's disease.

Question 78: How does Meniere's disease affect hearing?

A. Fluctuating sensorineural hearing loss. (Correct Answer)
B. Conductive hearing loss due to ossicle fusion.
C. Conductive hearing loss due to eardrum perforation.
D. Immediate permanent sensorineural hearing loss.

Explanation: ***Fluctuating sensorineural hearing loss.*** - Meniere's disease causes **endolymphatic hydrops**, where excess fluid in the inner ear damages hair cells, leading to **sensorineural hearing loss**. - The hearing loss is particularly characteristic for being **fluctuating**, meaning it can vary in severity and duration, often worsening during attacks and partially improving afterwards. - This fluctuating pattern is the **hallmark presenting feature** that distinguishes Meniere's from other causes of hearing loss. *Conductive hearing loss due to ossicle fusion.* - **Ossicle fusion**, as seen in conditions like **otosclerosis**, results in **conductive hearing loss** by impairing the transmission of sound vibrations through the middle ear. - Meniere's disease is an inner ear disorder and does not directly involve the ossicles or cause their fusion. *Conductive hearing loss due to eardrum perforation.* - An **eardrum perforation** causes **conductive hearing loss** by creating a direct pathway for sound to bypass the ossicular chain, reducing sound transduction. - Meniere's disease is an **inner ear disorder** and does not involve damage to the tympanic membrane or middle ear structures. *Immediate permanent sensorineural hearing loss.* - Meniere's disease does **not** present with immediate permanent hearing loss; rather, it begins with **fluctuating, reversible episodes**. - While recurrent attacks over years can lead to progressive permanent hearing loss, the characteristic **initial presentation** is fluctuating hearing loss that improves between attacks. - Immediate permanent hearing loss would suggest acute causes like **sudden sensorineural hearing loss (SSNHL)**, **acoustic trauma**, or **labyrinthitis**, not Meniere's disease.

Question 79: A 25-year-old woman presents with episodes of dizziness, tinnitus, and hearing loss in the right ear. What is the most likely diagnosis?

A. Labyrinthitis
B. Ménière's disease (Correct Answer)
C. Acoustic neuroma
D. Benign paroxysmal positional vertigo

Explanation: ***Ménière's disease*** - This condition is characterized by a classic triad of **episodic vertigo (dizziness)**, fluctuating **sensorineural hearing loss**, and **tinnitus**, often accompanied by aural fullness, typically affecting one ear. - The symptoms arise from an accumulation of **endolymph** in the inner ear, leading to increased pressure and dysfunction. *Labyrinthitis* - **Labyrinthitis** is an inflammation of the inner ear, usually viral, causing sudden, severe **vertigo** potentially with hearing loss and tinnitus. - Unlike Meniere's disease, **hearing loss** and **tinnitus** in labyrinthitis are usually constant rather than episodic or fluctuating. *Acoustic neuroma* - An **acoustic neuroma** (vestibular schwannoma) is a benign tumor on the eighth cranial nerve, often causing **gradual, progressive unilateral hearing loss**, tinnitus, and **balance issues**, but typically not episodic severe dizziness. - While it can cause hearing loss and tinnitus, the **episodic nature of vertigo** is less common than in Ménière's disease. *Benign paroxysmal positional vertigo* - **BPPV** is characterized by sudden, **brief episodes of vertigo** triggered by specific head movements, caused by dislodged **otoconia** in the semicircular canals. - Critically, BPPV does **not** typically cause associated **hearing loss or tinnitus**, which are prominent symptoms in the presented case.

Question 80: Which structure is commonly affected in Meniere's disease?

A. Cochlea (Correct Answer)
B. Semicircular canals
C. Eustachian tube
D. Vestibule

Explanation: ***Cochlea*** - Meniere's disease is characterized by **endolymphatic hydrops** (increased endolymphatic fluid pressure) affecting the entire membranous labyrinth of the inner ear. - The **cochlea** is prominently affected, leading to the characteristic auditory symptoms: **fluctuating sensorineural hearing loss** (typically low-frequency initially), **tinnitus**, and **aural fullness**. - The cochlear involvement with endolymphatic hydrops is responsible for the **hearing-related symptoms**, which along with vertigo form the classic tetrad of Meniere's disease. - While multiple structures are affected, the cochlea is commonly referenced as the primary affected structure due to the **hallmark hearing loss** that distinguishes Meniere's disease. *Semicircular canals* - The semicircular canals are also affected by endolymphatic hydrops in Meniere's disease, contributing to **episodic vertigo** (spinning sensation). - However, they are **relatively less affected** compared to the cochlea and vestibule, and the vertigo in Meniere's is primarily attributed to **vestibular dysfunction** rather than semicircular canal pathology alone. *Eustachian tube* - The Eustachian tube connects the **middle ear** to the nasopharynx and functions to **equalize pressure** across the tympanic membrane. - It is **not involved** in Meniere's disease pathophysiology, which is a disorder of the **inner ear** (membranous labyrinth), not the middle ear. - Eustachian tube dysfunction causes different conditions such as **otitis media with effusion** or **barotrauma**. *Vestibule* - The vestibule (containing the **utricle and saccule**) is significantly affected by endolymphatic hydrops in Meniere's disease, particularly the **saccule**. - The vestibular involvement contributes to **vertigo and balance disturbances**. - However, the question asks for the "commonly affected" structure, and the **cochlea** is traditionally emphasized because the **hearing loss** is the most specific and measurable symptom that distinguishes Meniere's disease from other vestibular disorders.

Practice by Chapter

Anatomy and Physiology of Balance

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Vestibular Testing Methods

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Videonystagmography

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Rotational Chair Testing

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Vestibular Evoked Myogenic Potentials

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Video Head Impulse Test

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Benign Paroxysmal Positional Vertigo

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Vestibular Neuritis

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Ménière's Disease

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Vestibular Migraine

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Central Vertigo

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Vestibular Rehabilitation

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