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The case revealed a person who suffers from a balance
disorders. In this assignment we will discuss and provide enough information about
the diagnosis, test that emphasize the diagnosis and appropriate treatments for
this case.

According to the case history, this patient suffering from Meniere’s
disease that is later on convert to posterior SCC Bppv. This diagnosis based on
the symptoms that are mentioned in the case history. The
episodes of drop in hearing in the right side, tinnitus, aural fullness and
vertigo in the same side, these symptoms indicate and usually associated with Meniere’s
disease. Veering to the right when walking, not feel stable in the dark, quick
head movements causing imbalanced and short lived rotatory vertigo on turning
to the right side in bed and looking up give indication for Bppv.

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It is important to do tests that
emphasize this diagnosis. Following are the tests:

For Meniere’s disease:

Hearing tests:


The audiometric presentation of a
patient with MD expected to be fluctuating and low freq sensorineural HL.

Brainstem-evoked auditory responses:

There are 3 patterns that may suggest the presence of hydrops
in affected ear. The first one is that the affected ear show shorter latency
compared to the other ear. The second one is delayed latency in the affected
ear. Shifting of the first, third and fifth waves latency is the third pattern.

Electrocochleography (ECOG):

The mechanism of this test gives information if there are linear or
nonlinear responses in Reissner’s membrane. In Meniere’s disease,the nonlinear
response which is caused by elevated endolymphatic pressure (hydrops)
will increase the size of the SP(summating potential)/AP( 

Balance Test:

 Electronystagmography (ENG):

This technique is used to test eye movement and to find any abnormal eye
movement (nystagmus). In this case the nystagmus is more often directed toward
left side.

Caloric test:

The presence of a classic canal paresis at the end of organ
in right ear with caloric stimulations will be expected in this test.

Rotary-chair testing:

This test is used to determine if the dizziness
caused by inner ear problems and to determine whether or not both inner
ears are impaired

There are 3 types of this test:

Caloric test:





For Bppv:

The dix hallpike can’t be performed
because of neck pain, and so the side lying test should be the second option. Torsional
to side and up beating which indicate posterior SCC Bppv  

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