The Dizzy Patient 2016 - swedish.org/media/Images/Swedish/CME1/SyllabusPDFs...6 History Onset...

Sixth Annual Intensive Update in Neurology 0915-162016

1

The Dizzy Patient 2016

Judith White MD PhD

Medical Director Balance Center

Swedish Neuroscience Institute


2

VESTIBULAR LABYRINTH


3

Objectives

bull Differentiate nystagmus of benign paroxysmal

positional vertigo canal variants

bull Discuss benefits of steroids in acute vestibular

neuritis

bull Review efficacy of intratympanic therapies in

Menierersquos syndrome

bull Describe symptoms of superior semicircular

canal dehiscence

bull Summarize evidence for acute vestibular

syndrome evaluation


4

Dizziness

bull Most common complaint over age 75

bull 8 million annual US visits

bull Chronic dizziness (gt 2 weeks) affects 16 of self-

reported US population

bull 354 of US adults aged 40 and older have vestibular

dysfunction (National Health and Nutrition Examination

Survey 2001-2004Arch Inter Med 169 (10) 938-44

2009)


5

History

bull 70 of dizzy patients can be diagnosed with a careful

history (Gufoni 2005)

bull Equilibrium is an unconscious sensation Few

descriptions exist to describe its absence


6

History

Onset ndash detailed description of first episode and most

recent episode

ndash Character

ndash Frequency

ndash Duration (vertigo andor milder symptoms)

ndash Associated hearing loss or tinnitus

ndash Provoking factors (noise pressure changes position change)


7

Neuro-otology Physical Exam

bull Otologic ndash check hearing and rule out active infection or

cholesteatoma

bull Oculomotor- saccade pursuit in vertical and horizontal

planes

bull Nystagmus ndash spontaneous gaze evoked and

positionalpositioning testing (best observed using

Frenzel lenses)

bull Special testing ndash head thrust head shake


8

Peripheral Nystagmus

bull Jerk nystagmus (slow

and fast phase)

bull Direction fixed

bull Generally beats away

from affected ear

bull Worse in the

direction of gaze that

is towards the fast

phase


9

Benign Paroxysmal Positional Vertigo (BPPV)

bull Vertigo of sudden onset and brief duration provoked by changes in head positionndash Lying down

ndash Rolling over in bed

ndash Bending over

ndash Looking up

ndash Washing hair in shower

ndash Dentist or beauty parlor


10

Right Posterior BPPV


11

IncidencePrevalence of BPPV

bull Most common referred diagnosis in tertiary centers

bull 9 of randomly selected community dwelling elderly

(Oghalai JS et al 2000)

bull Incidence increases 38 with each decade of life

(Froehling 1991)


12

Benign Positional Vertigo (BPPV)

bull Diagnosed with lateral supine head turns and Dix-

Hallpike positioning

ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14

DHT - HHR Orientation


15

Dix-Hallpike to the Right


16

Right posterior BPPV


17

Canalith Repositioning Procedure


18



19



20



21

Canalith Repositioning

bull R posterior

BPPV

CPT 95992


22

Posterior semicircular canalith repositioning


23

Supine Positional Tests


24

Lateral SCC-BPPV

bull Short latency horizontal nystagmus provoked by supine bilateral head turns with prolonged duration and poor fatigability

bull Uncommon (2-15 of total BPPV)

bull Two formsndash Geotropic ndash beating towards undermost ear

ndash Apogeotropic ndash beating away from undermost ear


25

Geotropic Lateral Canal BPPV

bull Patient is positioned

first to the right lateral

position ndash nystagmus

beats right

bull Patient is then

positioned to the left

lateral position and

nystagmus reverses

and beats left


26

Left Geotropic Lateral Semicircular Canal BPPV


27

Repositioning Maneuvers for Geotropic Lateral Semicircular Canal (LSC) BPPV

bull Roll maneuver (Lempert Baloh)

ndash Patient rolls in 90 degree increments towards the good side

completely rolling over R LSC-BPPV repositioning shown


28

Repositioning Maneuvers for Geotropic LSC BPPV

bull Gufoni maneuver

ndash Patient lies quickly onto good side and turns face-down to

floor for two minutes


29

Left Apogeotropic LSC BPPV


30

Nystagmus observed During Repositioning

bull Nystagmus should remain in the same torsional

direction as seen on DHT throughout the treatment of

posterior BPPV

bull Reversal of nystagmus direction suggests the particle

has fallen back into the canal and predicts failure

bull In Lateral BPPV nystagmus should beat towards the

good ear


31

Posterior to Lateral canal conversion


32

R Posterior to Lateral Canal conversion - geotropic


33

BPPV Recurrence

bull Recurrence is common (15yr)

bull Otoconial adherence or mineralization demineralization

abnormalities may contribute to recurrence

bull Home canalith repositioning is effective (Radke 2004)


34

Question 1

bull The most likely semicircular canal to be affected in

BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined

Answer 3 See references at end of lecture


36

Acute Vestibular Syndrome

bull Rapid unilateral injury to either peripheral or central

vestibular structures produces prolonged vertigo

(days to weeks)

bull Severe vertigo nausea and vomiting spontaneous

nystagmus and postural instability


37


bull 25 of patients with risk factors who present with isolated severe vertigo nystagmus and postural instability in the ER have an acute infarction of the inferior cerebellum (AICA PICA) Central imaging is suggested (Baloh 1998 NEJM)

ndash HTN diabetes smoking age gt65 Afib valvular heart disease occlusive vascular disease


38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew

ndash More sensitive than MRI in the diagnosis of acute stroke in

patients with acute vestibular syndrome with at least one risk

factor (Kattah J et al Stroke 2009)


39

Head Impulse Test

bull No special equipment needed

bull Examiner stands in front of seated patient and

randomly moves head left and right Patient is asked to

focus on examinerrsquos nose

bull Rapid low amplitude thrust from lateral to straight

ahead causes a compensatory saccade when

performed towards the weak side

bull This finding is a permanent feature of unilateral

vestibular loss


40

Head Impulse Test


41

Head CT ndash Academy of Emergency Medicine 2013

bull The clinical value of head CT in isolated

dizzinessvertigo without any associated neurological

symptoms is very low

bull Less than 1 of head CTs ordered for dizziness and

vertigo have significant abnormalities and those

patients had severe headache and neurological deficits

in addition to dizziness

bull Forgoing unnecessary emergency head CTs could

save 360 million dollars annually


42

Question 2

Head CT is not indicated for the evaluation of dizziness

and vertigo without additional neurological complaints because

1 It is too expensive

2 Less than 1 of CTs done for dizziness and vertigo are

abnormal and those patients had associated severe

neurological complaints

3 CT is the best imaging choice for the posterior fossa

4 Acoustic neuromas are well seen on CT


43

Question 2











44


bull Usually peripheral and can be associated with

hearing loss (labyrinthitis)

bull Timely diagnosis improves recovery (ASAP

prednisone 1mgkgday for ten days and taper 10

mgday ndash Strupp M 2004 NEJM)

bull Avoid vestibular suppressants after 3 days and begin

vestibular rehabilitation to hasten compensation


45

Question 3

bull Treatment for Acute Vestibular Syndrome

1) oral prednisone 1 mgkgday

2) Treat dehydration if necessary

3) Minimize vestibular suppressants after 3 days

4) Consider vestibular physical therapy

5) All of the above


46

Question 3






5) All of the above



47


bull Fluctuating low frequency hearing loss

bull Tinnitus andor aural fullness

bull Vertigo lasting hours


48

Normal


49

Hydrops


50


ndash Diagnosis- Exclusion (RO acoustic)

ndash 23 of Menierersquos patients will improve spontaneously

ndash Treatment-1500 mgday low sodium triamterene375-

hydrochlorothiazide 25 vestibular suppressants (lorazepam

1 mg tablet sublingual Q 8 prn attacks) off label use


51

Menierersquos syndrome ndash intratympanic steroids

ndash A newer treatment option for those failing medical management

ndash 90 response rate (Boleus-Aguirre MS Otology Neurotology

2008)

ndash Outcomes data confirm excellent clinical response in 3941

Menierersquos patients treated with intratympanic steroids in 2008


52

Question 4

bull Menierersquos syndrome diagnosis is based on

1) Recurrent vertigo lasting at least 20 minutes

2) Aural fullness

3) Documented hearing loss

4) Other causes excluded

5) All of the above


53

Question 4



2) Aural fullness



5) All of the above

Answer 5 See references at end


54

Superior Semicircular Canal Dehiscence (SSCD)

bull Sound andor pressure induced oscillopsia

bull CT reformatted in the plane of the superior canals

shows dehiscence of overlying bone

bull Low frequency ldquoconductive hyperacusisrdquo with elevated

bone thresholds normal reflexes and a conductive loss


55

SSCD

bull Positive middle ear pressure or loud sound stimulates ampullofugal endolymph flow -canal activation

bull Eye movements are tonic upwards with ipsilateral intorsion


56

SSCD

bull Valsalva against a closed glottis or jugular compression causes increased intracranial pressure and ampullopetal endolymph flow -canal inhibition

bull Eye movements are tonic downwards with ipsilateral extorsion


57

Reconstructed left superior semicircular canal


58


59

SCHEMATIC DRAWING OF AN OTOLITHIC MACULA


60

MACULAE OF THE UTRICLESACCULE


61

HAIR CELLS


62

SCANNING ELECTRON MICROGRAPH OF OTOCONIA


63

Ocular VEMP

bull Response to loud clicks (80-110 dB) or forehead tap (Halmagyi and Curthoys 2003)

bull Contralateral oculomotor nucleus (CN III)

bull Inferior oblique muscle contraction (8 msec) detected by 5sec event triggered averaging

bull Noninverting electrode inferior to eye

bull Inverting below non-inverting electrode

bull Ground to forehead

bull Normal subjects have very low response


64

Clinical applications

bull The o-VEMP is a sensitive test of otolithutricular

function

bull Complements vestibular test procedures that assess

semicircular canals

bull Abnormally robust responses are associated with third

window abnormalities such as semicircular canal

dehiscence

bull Serves as an excellent screening test for semicircular

canal dehiscence


65

Question 5

bull Superior semicircular canal dehiscence

1) Causes increased ability to hear vibratory sounds

2) Improves hearing

3) Causes meningitis

4) Always needs surgical repair


66

Question 5



2) Improves hearing



Answer 1 References at end of lecture


67

Enlarged vestibular aqueduct

bull Axial temporal bone CT showing right temporal bone with enlarged vestibular aqueduct (arrow)

bull Vestibular symptoms accompany progressive sensorineural hearing loss in 4-50 of patients in selected series


68

Migraine

bull Family or personal history of migraine

bull 25 of migraine patients experience spontaneous vertigo (Baloh 1997)

bull Neuhauser criteria(2001) have been used to construct structured diagnostic interviews (Furman 2003)

bull Not always associated with headache

bull Motion sensitivity

bull Medication responsive


69

ICHD-III beta Criteria for Vestibular Migraine

bull A At least five attacks fulfilling criteria C and D

bull B A current or past history of 11 migraine without aura or 12 migraine with aura

bull C Vestibular symptoms of moderate or severe intensity lasting between 5 minutes and 72 hours

bull D At least 50 associated with one of the following migrainous features

ndash 1 Headaches

ndash 2 Photophobia and phonophobia

ndash 3 Visual Aura

bull E Not better accounted for by another vestibular disorder


70

Incidence of vertigo in MS

bull True vertigo (the perception of environmental

movement typically rotational) occurs in about

20 of MS patients and is the presenting

manifestation in 5

bull Up to 78 of MS patients report abnormalities

in balance at some point in their illness

Frohman et al Multiple Sclerosis 2003 9250


71

Vertigo in MS due to demyelination

bull The most common neuroanatomic locations are the

root entry zone of CN VIII (giving absent calorics but

normal hearing and fixation suppression) and the

medial vestibular nucleus

bull Usually treated with steroids and vestibular

suppressants

Brandt 1993 Gass 1998 Thomke 1999


72

Vertigo in MS

Frohmanrsquos large series (1153) reported that 52 of MS patients with acute vertigo had benign paroxysmal positional vertigo while 32 had new brainstem lesions

To avoid misdiagnoses and inappropriate treatment interventions alternative etiologies should be considered in all acute vertigo episodes in MS

E M Frohman Neurology 2000 and Multiple Sclerosis 2003


73

Vestibular compensation

bull Acute unilateral or bilateral vestibular loss will prompt compensation thru central cervico-ocular visual and proprioceptive pathways

bull Unilateral loss may require several weeks for compensation to occur and activity especially head movements hastens compensation

bull Vestibular suppressant medication prolongs compensation


74

Vestibular Rehabilitation

bull Performed by certified physical therapists many sites (Epic order vestibular PT) or check Vestibular Disorders of America website for providers

bull Assessment and treatment of benign positional vertigo

bull Directed rehab programs for central andor peripheral vestibular compensationndash Unilateral vestibulopathies

ndash Bilateral vestibular hypofunction

ndash Mutifactorial balance deficits and fall risk assessment


75

Summary of whatrsquos new in peripheral vestibular disorders

bull Lateral semicircular canal benign paroxysmal positional vertigo presents with horizontal positioning nystagmus

bull Oral steroids appear to improve outcome in acute vestibular neuritis

bull Intratympanic steroids offer promise in Menierersquos syndrome

bull Superior semicircular canal dehiscence causes pressure and noise induced dizziness VEMP offers diagnostic information


76

References

BPPVndash White J Benign paroxysmal positional vertigo Cleveland Clinic Journal of

Medicine 71(9)722-728 2004

ndash White J Coale K Catalano P Oas J Diagnosis and management of lateral semicircular canal benign positional vertigo Otolaryngology-Head and Neck Surgery 133 278-284 2005

ndash White J Savvides P Cherian N Oas J Canalith repositioning for benign paroxysmal positional vertigo Otology and Neurotology 26 704-710 2005

ndash White J Oas J Diagnosis and management of lateral semicircular canal conversions during particle repositioning therapy Laryngoscope 115(10) 1895-1897 2005

ndash Acute Vestibular Syndrome Hotson JR Baloh RW N Engl J Med 1998 Sep 3339(10)680-5

ndash Methylprednisolone valacyclovir or the combination for vestibular neuritis Strupp M Zingler VC Arbusow V Niklas D Maag KP Dieterich M Bense S Theil D Jahn K Brandt T N Engl J Med 2004 Jul 22351(4)354-61

ndash Intratympanic steroids for Meacuteniegraveres disease or syndrome Phillips JS Westerberg BCochrane Database Syst Rev 2011 Jul 6(7)CD008514 Review

ndash Sound- andor pressure-induced vertigo due to bone dehiscence of the superior semicircular canal Minor LB Solomon D Zinreich JS Zee DSArch Otolaryngol Head Neck Surg 1998 Mar124(3)249-58


2

VESTIBULAR LABYRINTH


3

Objectives




neuritis




canal dehiscence


syndrome evaluation


4

Dizziness








2009)


5

History






6

History


recent episode

ndash Character

ndash Frequency





7



cholesteatoma


planes



Frenzel lenses)



8



and fast phase)



from affected ear

bull Worse in the


is towards the fast

phase


9




ndash Bending over

ndash Looking up




10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









3

Objectives




neuritis




canal dehiscence


syndrome evaluation


4

Dizziness








2009)


5

History






6

History


recent episode

ndash Character

ndash Frequency





7



cholesteatoma


planes



Frenzel lenses)



8



and fast phase)



from affected ear

bull Worse in the


is towards the fast

phase


9




ndash Bending over

ndash Looking up




10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









4

Dizziness








2009)


5

History






6

History


recent episode

ndash Character

ndash Frequency





7



cholesteatoma


planes



Frenzel lenses)



8



and fast phase)



from affected ear

bull Worse in the


is towards the fast

phase


9




ndash Bending over

ndash Looking up




10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









5

History






6

History


recent episode

ndash Character

ndash Frequency





7



cholesteatoma


planes



Frenzel lenses)



8



and fast phase)



from affected ear

bull Worse in the


is towards the fast

phase


9




ndash Bending over

ndash Looking up




10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









6

History


recent episode

ndash Character

ndash Frequency





7



cholesteatoma


planes



Frenzel lenses)



8



and fast phase)



from affected ear

bull Worse in the


is towards the fast

phase


9




ndash Bending over

ndash Looking up




10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









7



cholesteatoma


planes



Frenzel lenses)



8



and fast phase)



from affected ear

bull Worse in the


is towards the fast

phase


9




ndash Bending over

ndash Looking up




10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









8



and fast phase)



from affected ear

bull Worse in the


is towards the fast

phase


9




ndash Bending over

ndash Looking up




10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









9




ndash Bending over

ndash Looking up




10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









10



11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









11






(Froehling 1991)


12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









12




ndash Latency

ndash Duration

ndash Fatigue

ndash Habituation


13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









13

DHT - Sitting


14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









14



15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









15



16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









16



17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









17



18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









18



19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









19



20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









20



21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









21


bull R posterior

BPPV

CPT 95992


22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









22



23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









23



24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









24

Lateral SCC-BPPV






25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









25





beats right




nystagmus reverses

and beats left


26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









26



27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









27






28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









28






29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









29



30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









30




posterior BPPV




good ear


31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









31



32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









32



33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









33

BPPV Recurrence






34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









34

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined


35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









35

Question 1


BPPV is

ndash 1) superior

ndash 2) lateral

ndash 3) posterior

ndash 4) combined



36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









36




(days to weeks)




37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









37





38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









38

HINTS test

bull Head Impulse

bull Nystagmus

bull Test of Skew





39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









39

Head Impulse Test









vestibular loss


40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









40

Head Impulse Test


41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









41












42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









42

Question 2










43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









43

Question 2











44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









44










45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









45

Question 3






5) All of the above


46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









46

Question 3






5) All of the above



47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









47






48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









48

Normal


49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









49

Hydrops


50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









50








51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









51




2008)




52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









52

Question 4



2) Aural fullness



5) All of the above


53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









53

Question 4



2) Aural fullness



5) All of the above



54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









54








55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









55

SSCD




56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









56

SSCD




57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









57



58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









58


59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









59



60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









60



61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









61

HAIR CELLS


62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









62



63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









63

Ocular VEMP









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









64



function


semicircular canals



dehiscence


canal dehiscence


65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









65

Question 5



2) Improves hearing




66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









66

Question 5



2) Improves hearing





67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









67





68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









68

Migraine








69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









69






ndash 1 Headaches


ndash 3 Visual Aura



70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









70





manifestation in 5





71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









71







suppressants



72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









72

Vertigo in MS





73






74








75







76

References


Medicine 71(9)722-728 2004









73






74








75







76

References


Medicine 71(9)722-728 2004









74








75







76

References


Medicine 71(9)722-728 2004









75







76

References


Medicine 71(9)722-728 2004









76

References


Medicine 71(9)722-728 2004








The Dizzy Patient 2016 - swedish.org/media/Images/Swedish/CME1/SyllabusPDFs...6 History Onset...

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Transcript of The Dizzy Patient 2016 - swedish.org/media/Images/Swedish/CME1/SyllabusPDFs...6 History Onset...