Otolaryngologic Manifestations of Arnold-Chiari Malformation
This presentation is the property of its rightful owner.
Sponsored Links
1 / 27

Otolaryngologic Manifestations of Arnold-Chiari Malformation PowerPoint PPT Presentation


  • 162 Views
  • Uploaded on
  • Presentation posted in: General

Otolaryngologic Manifestations of Arnold-Chiari Malformation. Syboney Zapata, M.D., F.A.A.P. Pediatric Otolaryngology Austin Ear, Nose, & Throat Clinic. Objectives. Recognize symptoms of ACM pertinent to ENT Discuss differential diagnosis Review diagnostic studies.

Download Presentation

Otolaryngologic Manifestations of Arnold-Chiari Malformation

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Otolaryngologic manifestations of arnold chiari malformation

Otolaryngologic Manifestations of Arnold-Chiari Malformation

Syboney Zapata, M.D., F.A.A.P.

Pediatric Otolaryngology

Austin Ear, Nose, & Throat Clinic


Objectives

Objectives

  • Recognize symptoms of ACM pertinent to ENT

  • Discuss differential diagnosis

  • Review diagnostic studies


Arnold chiari malformation

Arnold-Chiari Malformation

  • Herniation of cerebellar tonsils through foramen magnum

  • Neuronal impairment of brainstem, upper spinal cord, & cranial nerves


Symptoms of acm pertinent to the otolaryngologist

Symptoms of ACM Pertinent to the Otolaryngologist

Auditory/vestibular dysfunction

Vocal cord paralysis

Sleep apnea


Vestibular symptoms in cerebellar disorders

Vestibular Symptoms in Cerebellar Disorders

  • Cerebellum largely involved in COORDINATION

  • Cerebellar dysfunction presents as unsteadiness, clumsiness, and difficulty with stabilizing eye movements


Vestibular findings in cerebellar disorders

Vestibular Findings in Cerebellar Disorders


Mechanism of auditory vestibular symptoms

Mechanism of Auditory/Vestibular Symptoms

  • Direct pressure on vestibular areas

  • Increased fluid pressure throughout the brain

  • Increased pressure of inner ear via cochlear aqueduct


Mechanism of auditory vestibular symptoms1

Mechanism of Auditory/Vestibular Symptoms

  • Further stretching of elongated nerves

  • Bending of 8th nerve over bony edge of porus acousticus

  • Compression of brainstem nuclei


Auditory vestibular symptoms in acm

Auditory/Vestibular Symptoms in ACM

  • Sensorineural hearing loss

  • Vertigo & Dizziness

  • Nystagmus (Downbeating) and Poor Pursuits


Diagnostic evaluation of auditory vestibular symptoms in acm

Diagnostic Evaluation of Auditory/Vestibular Symptoms in ACM

  • Electronystagmography (ENG)

  • Rotational chair testing

  • Vestibular Evoked Myogenic Potential Testing (VEMP)

  • Electrocochleography testing (ECOG)

  • Fistula testing

  • Moving platform posturography


Diagnostic evaluation of auditory vestibular symptoms in acm1

Diagnostic Evaluation of Auditory/Vestibular Symptoms in ACM

  • Electronystagmography (ENG)

  • Rotational chair testing

  • Vestibular Evoked Myogenic Potential Testing (VEMP)

  • Electrocochleography testing (ECOG)

  • Fistula testing

  • Moving platform posturography


Electronystagmography

Electronystagmography


Electronystagmography1

Electronystagmography

  • Determines whether or not dizziness is due to inner ear disease

  • Excellent for diagnosis of unilateral ear disorders

  • 4 main parts:

    - Calibration test

    - Tracking test

    - Positional test

    - Caloric test

Intended to diagnose CNS disorders


Rotational chair testing

Rotational Chair Testing


Rotational chair testing1

Rotational Chair Testing

  • Determines whether or not dizziness is due to inner ear or brain disorder

  • Obtained in addition to ENG

  • 3 main parts:

    - Chair test

    - Optokinetic test

    - Fixation test


Vocal cord paralysis

Vocal Cord Paralysis

Flexible laryngoscopy demonstrates bilateral vocal cords in the paramedian position and no mobility with vocalization


Vocal cord paralysis1

Vocal Cord Paralysis

  • Congenital TVC paralysis

  • ACM accounts for most central neurologic causes of bilateral TVC paralysis

  • Tracheostomy often necessary


Sleep apnea

Sleep Apnea

  • Central Apnea: Cessation of both airflow and respiratory effort

  • Obstructive Apnea: Cessation of airflow in the presence of continued respiratory effort

  • Mixed Apnea


When to order a sleep study in the pediatric population

When to Order a Sleep Studyin the Pediatric Population

  • Symptoms in morbidly obese patient

  • Apnea in absence of snoring

  • Apnea without adenotonsillar hypertrophy

  • Underlying neurologic disorders

  • Craniofacial abnormalities


Central sleep apnea

Central Sleep Apnea


Central sleep apnea1

Central Sleep Apnea

  • Dysfunction of medullary centers of respiratory control

  • Cranial nerve dysfunction involving laryngeal nerves or bulbar muscles, which mediate airway patency


Central sleep apnea2

Central Sleep Apnea


Central sleep apnea3

Central Sleep Apnea


Central sleep apnea4

Central Sleep Apnea

  • Anticipate immediate improvement after decompression surgery

  • Reports of recovery taking up to 6-12 months


Conclusions

Conclusions

  • Physical exam in combination with diagnostic studies may indicate central cause of imbalance and hearing loss

  • ACM should be considered in bilateral TVC paralysis

  • High index of suspicion of ACM in central/mixed sleep apnea


Otolaryngologic manifestations of arnold chiari malformation

Thank You


Otolaryngologic manifestations of arnold chiari malformation

  • Ada M, et al. Congenital vocal cord paralysis. J Craniofac Surg. 2010 Jan;21(1):273-4

  • Dauvilliers Y, et al. Chiari malformation and sleep related breathing disorders. J Neurol Neurosurg Psychiatry 2007;78:1344-1348

  • Hain TC. www.dizziness-and-balance.com

  • Hershberger ML and Chidekel A. Arnold-Chiari Malformation Type I and Sleep-Disordered Breathing: Review of Literature. J Pediatr Health Care. 2003;17(4)

  • Kuma A, et al. The Chiari I malformation and the neurologist. Otol Neurotol. 2002 Sep;23(5):727-35

  • Murray C, et al. Arnold Chiari type I malformation presenting with sleep disordered breathing in well children. Arch Dis Child. 2006 April;91(4):342-343

  • Rowley JA. Obstructive Sleep Apnea-Hypopnea Syndrome: Multimedia. www.emedicine.com. Updated May 14, 2010


  • Login