Introductory materials.- Part 1: Introductory materials:The field and the diagnostic process.- 1.The field and its practitioners, logistics and infrastructure.- 2. Symptom terminology. Does the description of “dizziness” matter? Triggers, timing, etc.- 3. Diagnostic thinking.- 4. Questionnaires.- 5. Preliminary diagnostic algorithm.- Part 2: Introductory materials — Physiology, phenomena and concepts.- 6. Overview of the auditory system.- 7. Overview of the vestibular system.- 8. Nystagmus, definition and characterization.- 9. Vestibulo-ocular reflex.- 10. Vestibular tuning spectrum.- Part 3: Introductory materials:Specific eye movements and their normative ranges.- 11. Spontaneous nystagmus, normative ranges.- 12. Saccades, normative ranges.- 13. Gaze evoked nystagmus, normative ranges.- 14. Smooth pursuit, normative ranges.- 15. Optokinetic nystagmus, normative ranges Diagnoses.- Part 4: Diagnoses:Diseases of the labyrinth.- 16. Benign paroxysmal positional vertigo (BPPV) in general.- 17. Posterior canal BPPV.- 18. Lateral canal BPPV.- 19. Anterior canal BPPV.- 20. Meniere’s disease.- 21. Otolithic catastrophe of Tumarkin.- 22. Post-traumatic endolymphatic hydrops.- 23. Autoimmune inner ear disease (AIED).- 24. Sympathetic ear disease.- 25. Noise induced hearing loss.- 26. Noise induced vestibular damage.- 27. Otic barotrauma.- 28. Presbycusis (age-related hearing loss).- 29. Ototoxicity.- 30. Inner ear ischemia.- 31. Labyrinthine ossification.- 32. Audio-vestibular symptoms following cochlear implantation.- Part 5: Diagnoses:Diseases of the vestibulo-cochlear nerve.- 33. Vestibular, cochlear, and vestibulocochlear paroxysmia.- 34. Vestibular schwannoma.- 35. Auditory neuropathy.- 36. Ramsay Hunt syndrome (herpes zoster oticus).- 37. Multiple myeloma.- Part 6: Diagnoses: Diseases involving the middle ear.- 38. Middle ear myoclonus (tensor tympani myoclonus, stapedial myoclonus).- 39. Eustachian tube dysfunction (ETD).- 40. Otitis media and middle ear effusion.- 41. Cholesteatoma.- 42. Glomus tympanicum.- Part 7: Diagnoses:Diseases potentially involving multiple otologic structures.- 43. Vestibular weakness in general.- 44. Bilateral vestibular weakness (BVW).- 45. Vestibular neuritis.- 46. Labyrinthitis.- 47. Sudden sensorineural hearing loss (SSNHL).- 48. A continuum of vestibular neuritis, labyrinthitis and sudden sensorineural hearing loss?.-49. Third window phenomena.- 50. Semicircular canal dehiscence (SCD).-51. Perilymphatic fistula (PLF).- 52. Idiopathic tinnitus.- 53. Exploding head syndrome.- 54. Pulsatile tinnitus.-55. Tinnitus related to temporomandibular joint dysfunction.-56. Tinnitus related to the neck (cervicogenic tinnitus).- 57. Otosclerosis.- 58. Paget’s disease of bone (osteitis deformans).- 59. Fibrous dysplasia.- 60. Labyrinthine concussion.- 61. Temporal bone fracture.- 62. Hyperacusis.- 63. Otalgia and referred otalgia.- Part 8: Diagnoses:Congenital otologic malformations.- 64. Large vestibular aqueduct.- 65. Large cochlear aqueduct.- 66. Mondini dysplasia.- 67. Pendred syndrome.- 68. Usher syndrome.- Part 9: Diagnoses:Diseases involving the brain, spinal cord and peripheral nerves.- 69. Migraine associated vertigo (MAV).- 70. Cyclic vomiting syndrome.-71. Motion sickness (constitutional motion sensitivity).- 72. Cybersickness.- 73. Motorist disorientation syndrome.- 74. Mal de debarquement syndrome (MdDs).-75. Persistent postural perceptual dizziness (PPPD).- 76. Concussion and post-concussive disequilibrium.- 77. Stroke and disequilibrium.- 78. White matter disease and disequilibrium.- 79. Encephalitis.- 80. Epileptic vertigo.- 81. Superficial siderosis.- 82. Cervicogenic vertigo (CV).- 83. Spinal cord disorders.- 84. Peripheral neuropathy in general.- 85. Charcot-Marie-Tooth disease.- 86. CANVAS (cerebellar ataxia, neuropathy, vestibular areflexia syndrome).- 87. Susac syndrome.- Part 10: Diagnoses:Ataxias.- 88. Spinocerebellar ataxias and other genetic ataxias.- 89. Episodic ataxias and acetazolamide responsive ataxias.- 90. Gluten ataxia.- 91. Friedreich ataxia.- Part 11: Diagnoses:Movement disorders.- 92. Parkinsonism.- 93. Idiopathic Parkinson’s disease.- 94. Progressive supranuclear palsy (PSP).- 95. Multiple system atrophy (MSA).- 96. Huntington’s disease.- 97. Stiff person syndrome (SPS).- 98. Fahr disease (FD).- Part 12: Diagnoses:Posterior fossa lesions.- 99. Chiari malformations.- 100. Basilar invagination.- 101. Paraneoplastic syndrome.- Part 13: Diagnoses:Intracranial pressure disorders.- 102. Hydrocephalus with increased intracranial pressure.- 103. Normal pressure hydrocephalus (NPH).- 104. Intracranial pressure fluctuations and hearing loss.- Part 14: Diagnoses:Neurologically-mediated visual disorders.- 105. Visual snow syndrome (VSS).- 106. Misokinesia.- Part 15: Diagnoses:Neurologically-mediated auditory disorders.- 107. Cortical deafness.- 108. Misophonia.- 109. Musical hallucinations.- Part 16: Diagnoses:Specific ocular motor syndromes.- 110. Centripetal nystagmus.- 111. Congenital nystagmus.- 112. Convergence-retraction nystagmus
113. Internuclear ophthalmoplegia (INO).- 114. Latent nystagmus.- 115. Opsoclonus and the opsoclonus myoclonus syndrome.- 116. Oculopalatal tremor.- 117. Periodic alternating nystagmus (PAN).- 118. Rebound nystagmus.- 119. See-saw nystagmus.- 120. Spontaneous down beat nystagmus.- 121. Spontaneous up beat nystagmus.- 122. Square wave jerks.- 123. Staircase saccades.- 124. Windmill nystagmus.- Part 17: Diagnoses:Eye movements elicited by specific provocative maneuvers.- 125. Head-shaking nystagmus.- 126. Hyperventilation-induced nystagmus.- 127. Valsalva-induced nystagmus.- 128. Vibration-induced nystagmus.- Part 18: Diagnoses:Other central nervous system pathologies.- 129. Neurologic disease processes that can involve any part of the central nervous system (infarction, demyelination, space-occupying lesions).- 130. Selected vascular phenomena in otoneurology.- Part 19: Diagnoses:Intersections between otovestibular disease, psychology and psychiatry.-
131. Psychological disequilibrium.- 132. Dissociative experiences in vestibular disorders.- 133. Psychiatric disease and vestibular dysfunction.- 134. Cognitive impairment and disequilibrium.- 135. Cognitive impairment and hearing loss.- 136. Cognitive impairment and tinnitus.- Part 20: Diagnoses — Ophthalmologic and visual factors in disequilibrium.- 137. Visual vertigo (VV).- 138. Ophthalmological visual deficits and disequilibrium.- 139. Superior oblique myokymia.- 140. Illusions of inversion and tilt.- Part 21: Diagnoses:Cardiovascular causes of disequilibrium.- 141. Orthostatic hypotension and postural orthostatic tachycardia.- 142. Orthostatic hypertension.- 143. Cardiac arrhythmia.- 144. Vestibular syncope.- Part 22: Diagnoses:Medical causes of disequilibrium.- 145. Pharmacologic causes of disequilibrium.- 146. Postprandial disequilibrium.- Part 23: Diagnoses:Infectious causes of disequilibrium.- 147. COVID-19.- 148. Epstein-Barr virus.- 149. Human immunodeficiency virus (HIV) and otovestibular symptoms.- 150. Lyme disease.- 151. Syphilis (otosyphilis).- Part 24: Diagnoses — Endocrinological, nutritional and metabolic causes of disequilibrium.- 152. Thyroid disease and disequilibrium.- 153. Vitamin B1 (thiamine) deficiency.- 154. Vitamin B12 (cyanocobalamin) deficiency.- 155. Vitamin D deficiency.- 156. Wilson’s disease.- 157. Zinc deficiency.- 158. Altitude sickness.- Part 25: Diagnoses:Toxic causes of disequilibrium.- 159. Alcohol.- 160. Heavy metals.- 161. Caffeine.- 162. Carbon monoxide.- 163. Cocaine.- 164. Marijuana (cannabis).- 165. MDMA (“ecstasy”).- 166. Nicotine and tobacco.- 167. Phencyclidine (PCP).- Part 26: Diagnoses:The role of electromagnetic fields and radiation in disequilibrium.- 168. Radiation and its otovestibular effects.- 169. Electromagnetic fields (EMFs).- Part 27: Diagnoses:Presentations with multiple potential causes.- 170. Multifactorial disequilibrium.- 171. Presbyvestibulopathy.- 172. Drop attacks.- 173. Coital vertigo.- Part 28: Diagnoses:Otovestibular symptoms occurring in the context of other conditions.- 174. Chronic fatigue syndrome (CFS) and otovestibular symptoms.- 175. Fibromyalgia and otovestibular symptoms.- 176. Ehlers-Danlos syndrome (EDS) and otovestibular symptoms.- 177. Pregnancy.- Part 29: Diagnoses:Immunologically-mediated otovestibular symptoms.- 178. Allergy and otovestibular symptoms.- 179. Lupus (systemic lupus erythematous) and otovestibular symptoms.- 180. Rheumatoid arthritis (RA) and otovestibular symptoms.- 181. Sarcoidosis and otovestibular symptoms.- 182. Scleroderma and otovestibular symptoms Evaluation.- Part 30: Evaluation:Bedside physical examination.- 183. Dynamic visual acuity testing.- 184. Ophthalmoscope test.- 185. Bedside head impulse testing.- 186. Otoscopy (handheld, monocular).- 187. Bedside hearing tests (finger rub, whisper, Weber, Rinne).- 188. Romberg test.- 189. Fukuda-Unterberger stepping test.- 190. Vertebral artery testing.- Part 31: Evaluation:Instrumented testing.- 191. Why do we do testing at all? Confidence and uncertainty.- 192. Binocular otomicroscopy.- Part 32: Evaluation:Audiometric testing.- 193. Audiometry.- 194. Stenger effect and Stenger test.- 195. Tympanometry.- 196. Otoacoustic emissions (OAEs).- 197. Auditory evoked brainstem responses (ABRs).- 198. Electrocochleography (ECoG).- Part 33: Evaluation:Ocular motor vestibular tests.- 199. Why do we look at eye movements?.- 200. Magnetic scleral search coils.- 201. Electronystagmography (ENG).- 202. Videonystagmography (VNG).- 203. Caloric testing.- 204. Video head impulse testing (vHIT) and its variants.- 205. Rotatory chair testing (RCT).- 206. Retinal imaging.- Part 34: Evaluation:Vestibular evoked myogenic potentials.- 207. General comments on vestibular evoked myogenic potentials.- 208. Cervical vestibular evoked myogenic potentials (cVEMPs).- 209. Ocular vestibular evoked myogenic potentials (oVEMPs).- Part 35: Evaluation:Other vestibular tests.- 210. Computerized dynamic posturography (CDP).- 211. Tests limited to research settings.- Part 36: Evaluation: Cardiovascular testing in otoneurology
212. Tilt table testing (TTT).- 213. Cardiac monitoring.- Part 37: Evaluation — Imaging in otoneurology.- 214. General comments about imaging in otoneurology.- 215. MRI of the brain and internal auditory canals.- 216. Temporal bone CT.- Part 38: Evaluation:Miscellaneous modalities.- 217. Telemedicine in otoneurology
Management.- Part 39: Management:General comments on pharmacological intervention.- 218. Comments on medication side effects.- Part 40: Management:Classes of pharmaceutical agents.- 219. Aminopyridines (4-AP, 3,4-DAP).- 220. Anti-nauseant and anti-emetic medications.- 221. Anti-oxidants.- 222. Benzodiazepines.- 223. Beta blockers.- 224. Botulinum toxins.- 225. cGRP inhibitors.- 226. Corticosteroids.- 227. Diuretics.- 228. Serotonin-norepinephrine reuptake inhibitors (SNRIs).- 229. Serotonin-specific reuptake inhibitors (SSRIs).- 230. Tricyclics.- Part 41: Management:Individual medications.- 231. Acetazolamide.- 232. Baclofen.- 233. Betahistine.- 234. Botulinum toxin.- 235. Dimenhydrinate.- 236. Fludrocortisone.- 237. Fluticasone and azelastine.- 238. Gabapentin.- 239. Meclizine.- 240. Melatonin.- 241. Memantine.- 242. Midodrine.- 243. Oxcarbazepine.- 244. Scopolamine.- 245. Topiramate.- 246. Trimetazidine.- 247. Venlafaxine.-.- 248. Verapamil.- Part 42: Management:Nutritional supplements.- 249. Coenzyme Q10. 250. Magnesium.- 251. Riboflavin.- 252. Vitamin D.- Part 43: Management:Herbal supplements.- 253. Butterbur.- 254. Feverfew.- Part 44: Management:Procedures, non-surgical.- 255. Acupuncture.- 256. Nerve blocks for headache.- 257. Transcutaneous electrical nerve stimulation (TENS).- 258. Transcranial magnetic stimulation (TMS).- 259. Vagal nerve stimulation (VNS).- 260. Hyperbaric oxygen therapy (HBOT).- Part 45: Management:Procedures, surgical.- 261. Tympanostomy tube placement.- 262. Transtympanic injections.- 263. Tympanoplasty.- 264. Silverstein MicroWick.- 265. Positive pressure therapies for Meniere’s disease.- 266. Labyrinthectomy and vestibular neurectomy.- 267. Surgery for superior semicircular canal dehiscence.- 268. Surgery for benign paroxysmal positional vertigo.- Part 46: Management:Vestibular rehabilitation therapy.- 269. General comments about physical therapy for benign paroxysmal positional vertigo (BPPV).- 270. Physical therapy for BPPV of the posterior canal, unilateral.- 271. Physical therapy for BPPV of the posterior canal, bilateral or unknown.- 272. Physical therapy for BPPV of the lateral canal (geotropic or apogeotropic), unilateral.- 273. Physical therapy for BPPV of the lateral canal, geotropic, unilateral.- 274. Physical therapy for BPPV of the lateral canal, apogeotropic, unilateral.- 275. Physical therapy for BPPV of the lateral canal (geotropic or apogeotropic), bilateral.- 276. Physical therapy for BPPV of the anterior canal, unilateral.- 277. Physical therapy for BPPV of the anterior canal, bilateral.- 278. Physical therapy for BPPV, other maneuvers.- 279. Mechanical chair treatment for benign paroxysmal positional vertigo.- 280. Physical rehabilitation therapy for vestibular weakness.- Part 47: Management:Therapies for the neck.- 281. Physical therapy for the neck.- 282. Chiropractic manipulation.- Part 48: Management:Other vestibular therapies.- 283. Motion desensitization (Puma method). 284. Mingjia Dai’s treatment for MdDs.- Part 49: Management:Auditory interventions.- 285. Hearing amplification.- 286. Hearing amplification, balance and falls.- 287. Treatment of idiopathic tinnitus.- Part 50:. Management:Other interventions.- 288. Vestibular compensation.- Part 51: Management:Bureaucratic issues.- 289. Provision of hearing aids.- 290. Functional capacity evaluation (FCE).- 291. Disability.- 292. Driving.
Marcello Cherchi, MD, PhD
Clinical Associate and Director of Otoneurology and Vestibular Medicine University of Chicago Medicine Department of Neurology 5841 South Maryland Avenue Chicago, IL 60637.
