Comprehensive High-Yield Review of Vertigo and Balance Disorders: Peripheral vs Central Causes, Semicircular Canals, Utricle, Saccule, BPPV, Meniere’s Disease, Vestibular Neuritis, Labyrinthitis, Acoustic Neuroma, and Disequilibrium Verified Questions Pr

Comprehensive High-Yield Review of Vertigo and Balance Disorders: Peripheral vs Central Causes, Semicircular Canals, Utricle, Saccule, BPPV, Meniere’s Disease, Vestibular Neuritis, Labyrinthitis, Acoustic Neuroma, and Disequilibrium Verified Questions Provided with A+ Graded Rationales LATEST UPDATED 2026 Semicircular canals Fluid filled canals in the inner ear responsible for our sense of balance. Which inner ear structure is responsible for horizontal movements? Utricle Senses motion in horizontal plane (forward vs. backward, right vs. left) Which inner ear structure is responsible for vertical movements? Saccule Senses movement in saggital plane (up vs down) Horizontal movements = Vertical movements = Horizontal movements = UTRICLE Vertical movements = SACCULE Questions to ask during History Degree of Impairment Associated Symptoms Aggravating Factors Recent Trauma or illness Warning symptoms/aura Prior medical history Previous ear surgery HINTS exam Head Impulse Nystagmus Test of Skew Head Impulse Test have PT fixate their eyes onto your nose and then move their head side to side, if the PTs eyes cannot stay fixated on you = PERIPHERAL lesion horizontal nystagmus = _________ lesion vertical nystagmus = _________ lesion Horizontal movements [ Pt. looking in direction of fast phase]= PERIPHERAL Vertical movements = CENTRAL Test of skew have PT focus on your nose and then close one eye, and then close the other eye - if at any point the PTs eyes have to move to regain focus = CENTRAL LESION Dix-Hallpike maneuver Rapidly moving the pt from a sitting position to the supine position with the head turned 45 degrees - after waiting apx. 20-30 sec, the pt is returned to the sitting position If a nystagmus is observed = BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) What test can be used to diagnose benign paroxysmal positional vertigo (BPPV)? dix-hallpike maneuver - looking for nystagmus Peripheral vs. Central Vertigo Peripheral: - Labyrinth and vestibular nerve up to the brainstem Central: - Vestibular nuclei, cerebellum, brainstem, spinal cord and vestibular cortex Peripheral Symptoms vs Central Symtpoms Spinning Tinnitus Hearing Loss Central Dysarthria Dysphagia Diplopia Limb Numbness or weakness Benign Paroxysmal Positional Vertigo (BPPV) False sense of motion/spinning sensation - Caused by displacement of otolith - TRIGGERED - PERIPHERAL ***(+) Dix-Hallpike with positional nystagmus Treatment: Epley Maneuver Is BPPV trigger or spontaneous? Triggered - head turning, rolling around in bed Is BPPV central or peripheral? Peripheral A 68 year old feel presents to your clinic complaining of the room feeling like its constantly spinning. She said it started since she had a tossing and turning sleepless night a few days ago. She reports having no hearing loss. Her Dix Hallpike maneuver exam shows a nystagmus on the right. Diagnosis? Peripheral or Central? Benign Paroxysmal Positional Vertigo - perip