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Why the

‘eyes are the liars’

Relevance of the AVNS in

Patient Care and Management

in whiplash & mTBI Patients

Brenda E. Berge, Au.D. , F-ADA

Doctor of Audiology, Fellow ADA

Important Note*

Images in this presentation are used with

permission from the sources or as set out

in the rules of use

They are not to be reproduced without

permission or used for distribution

Referencing and acknowledgment of

these copyrights are provided

Vestibulocochlear Nerve: Schema

Anterior (superior) semicircular canal and duct

Posterior semicircularcanal and duct

Common crus and duct

Lateral semicircularcanal and duct

Stapes in oval(vestibular) window

Incus

Malleus

Tympanic cavity

External acoustic meatus

Tympanic membrane

Round (cochlear) window (closed by secondary tympanic membrane)

Auditory (Eustachian) tube

Vestibule

Cochlear aqueduct

Scala tympani

Cochlear duct

Scala vestibuli

Ductus reuniens

Helicotrema of cochlea

Saccule

Utricle

Endolymphatic sac

Endolymphatic duct in vestibular aqueduct

Dura materAmpullae

Membranous Labyrinths

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Superior division of vestibular nerve (from utricle and anterior and lateral ampullae)

Cochlear duct (basal turn)

Cochlear nerve

Vestibulocochlear nerve (VIII)

Vestibular nerve

Vestibular ganglion

Inferior division of vestibular nerve (from saccule and posterior ampulla

Saccule

Endolymphatic duct

Posterior membraneous ampulla

Posterior semicircular duct

Lateral semicircular duct

Common membranous duct

Lateral membranous ampulla

Anterior membranous ampulla

Anterior (superior) semicircular duct

Utricle

Inner Ear

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Axial T2 MRI

http://www.emedicine.com/ent/images/Large/597REVD622Ccloseupnorm_2.jpg

Cochlea

http://www.emedicine.com/ent/images/Large/664698FIG11.JPG

Superior Canal

Dehiscence

http://www.emedicine.com/ent/images/Large/21472147SCDS.jpg

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Auriculotemporal Nerve

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Muscles of Neck: Anterior View

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VSRVESTIBULO-

SPINAL REFLEX

SENDS DESCENDING

MOTOR CONTROL

SIGNALS TO THE

MUSCULOSKETAL

SYSTEM FOR

POSTURAL CONTROL

VCRVESTIBULOCOLLIC

REFLEX

ACTS ON THE MUSCLES

IN THE NECK TO

STABLIZE THE HEAD.

THE HEAD RESPONDS

TO MOVEMENT

SENSED BY THE

OTOLITHIC OR SCC

ORGANS.

From Halmagyi & Curthoys, In Herdman

Cervical Reflexes

COR - Cervico-Ocular: Eye movements driven

by the neck muscle proprioceptors. COR

supplements the VOR.

CSR - Cervicospinal: Changes in limb position

driven by neck muscle afferent activity. CSR

supplements the VSR.

CCR - Cervicocollic: Cervical reflex that

stabilizes the head on the body.

VOR

VESTIBULOCULAR

REFLEX

ALLOWS VISUAL

STABILIZATION

DURING ACTIVE

HEAD MOVEMENT

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Peripheral

pathways for

vertigo and

nystagmus

Medial longitudinal

fasciculus

Labyrinth

Vestibular nuclei

Vestibular

nerves

Internal

auditory canal

Scarpa’s

ganglion

III nerve

VI nerveIV nerve

Modified Fully-Supported Hallpike - BPPV

Vertebral Artery Test VOG Screening- Congenital Nystagmus