Meniere’s
disease and right sided BPPV are the clearest diagnosis according to what have
been mentioned of symptoms in the case study; right sided tinnitus, aural
fullness, rotatory vertigo lasting for hours, hearing loss. In addition, she
has noticed movement evoked imbalance even in the dark (no fixation what make
us sure that it’s peripheral problem), and when she move her head quickly. Veer
to the right when walking, rotatory vertigo on turning to her right side in
bed.

Meniere’s
disease in an inner ear disorder associated with endolymphatic hydrops. In most
cases, the cause is idiopathic but some researchers found that environmental
and genetic factor are related.

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BPPV (benign proximal positional vertigo) is a balance disorder in the
inner ear. It occurs when the calcium carbonate crystals in utricle migrate
into one or more of the 3 fluid-filled semicircular canals especially the
posterior semicircular canal, where they are not supposed to be.

The tests we can do for this client, first ENG/VNG (elctro/video nystagmography) it is a test
that asses eyes movement to evaluate the balance function. In the inner ear,
the balance-related sensors linked to muscles that control eye movement. By
this connection, you can move your head while keeping the eyes focused on a
specific point , from the case history and diagnosis we can expected that the
test will be abnormal and we will see nystagmus while the fixation is stop like
what happen to her in the dark.

Caloric test which is a test of the vestibulo-occular
reflex, that involves irrigating
air also water work and it should be cold or warm into the external
auditory canal. In our case we can know that the patient suffer from
the right ear and most of the problem occur their so caloric test will show
unilateral weakness , and slow phase and nystagmus will be affected , if it was
only Meniere’s disease results could show normal results but when doing hearing
test it would be opposite .

And in BPPV
the tests we perform is depend on which canal is affected ; for anterior and
posterior it’s better to perform dix hall-pike and side lying ,rose test only
for anterior and for horizontal canal we perform roll horizontal. 

Side lying is when the patient is seated on the bed and the head is turned only
for 45 degrees , then the patient is in supine position on his side. The
clinician to reach the needed maneuver does all this movements. In this test we
will see nystagmus in the same side of the effected ear which is right in our
case. If posterior canal affected the nystagmus direction will be Torsional to
side involved with up beat , and if it is in anterior canal we will see
nystagmus direction Torsional to side involved + down beat, and if it is
horizontal it will depend if it’s canalithasis or cupulithasis .

 

Imaging can
help too, Magnetic Resonance Imaging (MRI) it can show tumors and
abnormal lesions from normal tissues and this test done by a modern technology.
In addition, because it can clearly show various types of nerves tissues, it is
mostly for brain disorders. It has a lot of advantages; It is noninvasive which
mean it doesn’t hurt, nothing rupture into your body and you are not exposed to
radiation and it’s also provide clear pictures. It can evaluate blood flow and
the flow of cerebrospinal fluids. Another type of imaging also can help which
is computer tomography.   

We generally ask to
do MRI test in this case specially when having Meniere’s disease to cancel the
possibility to any abnormal physical conditions in your head. This is a
physical image, a picture of the actual tissue.