CVT CVT Pharmacology & Medication Effects on Vestibular Function 2 — Questions and Answers
Question 1: Which agent is administered intratympanically to chemically ablate vestibular function in refractory Meniere's disease?
- Corticosteroids
- Gentamicin (Correct answer)
- Lidocaine
- Meclizine
Correct answer: Gentamicin
Low-dose intratympanic gentamicin selectively destroys vestibular hair cells while attempting to spare cochlear function, reducing the frequency of drop attacks.
Question 2: Betahistine is thought to benefit Meniere's disease by:
- Suppressing the vestibulo-ocular reflex centrally
- Blocking H1 receptors in the cortex
- Improving microvascular blood flow in the inner ear stria vascularis (Correct answer)
- Reducing otoconia formation in the utricle
Correct answer: Improving microvascular blood flow in the inner ear stria vascularis
Betahistine is believed to act as an H3 antagonist and H1 agonist, improving cochlear and vestibular microcirculation to reduce endolymphatic hydrops.
Question 3: A vestibular therapist should educate patients taking benzodiazepines for vertigo that long-term use:
- Permanently resolves BPPV
- Is safe with no significant side effects
- May slow or impair central vestibular compensation (Correct answer)
- Increases vestibulo-ocular reflex gain
Correct answer: May slow or impair central vestibular compensation
Benzodiazepines suppress CNS activity, reducing the error signals that drive neuroplastic vestibular compensation and delaying recovery.
Question 4: Scopolamine transdermal patches are most commonly used in vestibular care to treat:
- Acute BPPV
- Vestibular neuritis
- Motion sickness (Correct answer)
- Labyrinthitis-associated hearing loss
Correct answer: Motion sickness
Scopolamine, an anticholinergic, blocks muscarinic receptors in the vestibular nucleus and vomiting center, making it effective for motion sickness prevention.
Question 5: Which medication class used for vestibular migraine prophylaxis includes topiramate and valproate?
- Antihistamines
- Anticonvulsants and mood stabilizers (Correct answer)
- Aminoglycosides
- Corticosteroids
Correct answer: Anticonvulsants and mood stabilizers
Anticonvulsants such as topiramate and valproate reduce cortical spreading depression and neuronal hyperexcitability implicated in vestibular migraine.
Question 6: Furosemide (loop diuretic) ototoxicity most commonly manifests as:
- Benign paroxysmal positional vertigo
- Central vestibular lesion
- Sensorineural hearing loss and potential vestibular damage (Correct answer)
- Increased canal paresis on caloric testing
Correct answer: Sensorineural hearing loss and potential vestibular damage
Loop diuretics reduce endocochlear potential by inhibiting ion transport in the stria vascularis, causing sensorineural hearing loss and possible vestibular hypofunction.
CVT CVT Pharmacology & Medication Effects on Vestibular Function 2
Which agent is administered intratympanically to chemically ablate vestibular function in refractory Meniere's disease?