The case revealed a person who suffers from a balance disorders. In
this assignment we will discuss and provide enough information about the diagnosis,
tests that emphasize the diagnosis and appropriate treatments for this case.
According to the case history, this patient suffering from
Meniere’s disease that is later on convert to posterior SCC Bppv. This
diagnosis based on the symptoms that are mentioned in the case history.
episodes of drop in hearing in the right side, tinnitus, aural fullness and
vertigo in the same side, these symptoms indicate and usually associated with
Meniere’s disease. The symptoms of veering to the right when walking, not feeling
stable in the dark, imbalanced during quick head movement and short lived
rotatory vertigo when turning to the right side in bed and looking up give
indication for Bppv.
It is important to do tests that emphasize this diagnosis.
Following are the tests:
For Meniere’s disease:
v Hearing tests:
The audiometric presentation of a patient with MD expected to be
fluctuating and low freq sensorineural HL accompanied by recruitment.
Brainstem-evoked auditory responses:
There are 3 patterns that may suggest the presence of hydrops in
affected ear. The first one is that the affected ear show shorter latency
compared to the other ear. The second one is delayed latency of fifth wave in
the affected ear. Shifting of the first, third and fifth waves latency is the
of this test gives information if there are linear or nonlinear responses in Reissner’s membrane. In Meniere’s disease, the
nonlinear response which is caused by elevated endolymphatic pressure (hydrops)
will increase the size of the SP(summating potential)/AP(action
This test is
recommended when there is more than 40 dB hl in low frequencies. The oral
administration of glycerol helps the flued to extract from endolymphatic space
and produce improving about 10 Db when repeating the pure tone audiometry.
v Balance Test:
is used to test eye movement and to find any abnormal eye movements
(nystagmus). In this case the nystagmus is more often directed toward left side.
The presence of a classic canal paresis at the end of organ in
right ear with caloric stimulations will be expected in this test.
test is used to determine if the dizziness caused by inner ear problems and to
or not both inner ears are impaired. There are 3 types of this
Chair test, optokinetic test and fixation test. The results
of these tests may give a unilateral vestibular system dysfunction (right ear).
This test is
performed when the patient maintains sight fixed
during high-acceleration, high-velocity and head rotation. Because of the right
vestibular system is not completed in Meniere’s patient, the result will give abnormal
video head impulse test.
disease has a fluctuating deficit, and so this test will provide different
results from one trial to another and from one patient to another.
involves testing of the three systems that are responsible for balance in six
conditions. For this patient; the result may reveal normal response because the
dysfunction of the affected vestibular system in right ear will be compensated
by the other systems (proprioception and vision systems).
The dix hallpike can’t be performed because of neck pain, and so
the side lying test should be the second option. Torsional to side and up beating
which indicate posterior SCC Bppv