Vertigo

1 by Wardah RI 21032014

Disorder of

vestibular system

dr Wardah Rahmatul Islamiyah SpS


DESKRIPSI

1 Merupakan suatu sensasi perub orientasi thd ruang

2 Dpt disebabkan oleh bbrp mekanisme patofisiologi yg berbeda2


ANAMNESIS

1 Deskripsi sensasi

2 Bagaimana mulainya

3 Berapa lama

4 Berapa sering terjadi

5 Faktor yang mencetuskan

6 Gejala2 yg menyertai

7 Terapi


EPIDEMIOLOGI DIZZINESS

bull Lazim pd semua kelompok

bull gt wanita

bull Prevalensi meningkat seiring bertambahnya usia

bull Presyncope dan vertigo merupakan subtipe yg paling lazim (13 px dg keluhan dizziness)

Evaluation of the lsquoDizzyrsquo patient

Nasher

Posture is controlled by two basic mechanisms

1 Local regulation from spinal reflexes commanded by information from muscle and tendon stretch receptors

2 Regulation from extra spinal feedback such as input from the vestibular system

3 Visual input


II Which Converging System Is Involved

A Oculomotor (Visual)

B Proprioceptive

C Vestibular

9

10




B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular


KLASIFIKASI (SUBTIPE TERSERING)

1 Fisiologis = mabuk gerakan

2 PRESYNCOPE (near-faint) 4-14

Kepala teras ringan sensasi sebelum hilangnya kesadaran atau jatuh

3 PSIKOFISIOLOGIS 2 ndash 16

Disosiasi ldquomengambangrdquo ldquoberenangrdquo

4 DISEQUILIBRIUM 2

ldquoDizzyrdquo tdk seimbang yg timbul hanya ketika berdiri atau berjalan tdk berhub dg sensasi kepala yg abnormal

5 VERTIGO 50

Ilusi gerakan rotasi kdg px merasa perpindahan linier atau diangkat


PRESYNCOPE


PATOFISIOLOGI - PRESYNCOPE

bull Berlt CBF

bull Light headedness

bull Jika CBF ltltlt rarr syncope

bull ARITMIA bull episode syncope berulang

bull terjadi pd berbagai posisi

bull Disertai keluhan cardiac lainnya (nyeri dada atau palpitasi)

bull HIPOTENSI ORTOSTATIK bull Blood loss akut

bull Volume lt

bull Tx diuretik atau anti hipertensi

bull Ketika px berdiri drh terkumpul di tungkai dan vaskuler splanchnic (gravitasi)



bull VASOVAGAL

bull Presyncope yg diperantarai neural

bull Terjadi ketika pasien berdiri

bull TD tdk menurun sesaat ketika px berdiri

bull Mx

bull Signal aferen dr mekanoreseptor arterial viseral

bull HIPERVENTILASI

bull Menurunnya kadar CO2 dlm drh

bull Konstriksi pemb darah cerebral


DIAGNOSIS - PRESYNCOPE

a Hipotensi ortostatik pedarr TD gt 10 ndash 15 mmHg ketika pasien berubah posisi dari berbaring ke berdiri

b Aritmia cardiac

Pasien presyncope episodic

ECG sinus pauses sinus bradikardi atrial fibrilasi dan supraventricular takikardi

c Vasodepressor presyncope anamnesis khas pd px tanpa ggn neurologis atau cardiovaskuler

d Hiperventilasi gx khas yg menyertai rarr

anxiety dyspnea


TERAPI - PRESYNCOPE

1 HIPOTENSI ORTOSTATIK

bull Hentikan obat2an atau koreksi faktor2 yg menyebabkan penurunan volume darah

bull Px dg insufisiensi otonom berikan intake tinggi garam utk meningkatkan volume darah dan menggunakan elastic stocking utk mencegah pengumpulan darah pada ekstremitas inferior

bull Pd kasus berat

bull Steroid fluocortisone (yg dpt menahan garam) menambah volume darah

bull 1 adrenergik agonis (midodrine) meningkatkan tonus vaskuler


TERAPI - PRESYNCOPE

2 VASOVAGAL PRESYNCOPE

bull KIE mengenai perjlnan dan mekanisme penyakit

bull Pemberian intake tinggi garam dan cairan

bull Hindari kondisi yg dpt menjadi predisposisi terjadinya hipotensi atau dehidrasi

bull Penggunaan obat beta blocker midodrine serotonin reuptake inhibitor ACE inhibitor fluorocortisone (tp hsl RCT efek = plasebo)


TERAPI - PRESYNCOPE

3 PENYAKIT JTG bull Ggn cardiac output merupakan warning sign dan

resiko kematian mendadak

bull Penatalaksanaan aritmia tgt perjalanan penyakit yg mendasari atau pemasangan pacemaker

4 HIPERVENTILASI bull KIE

bull Fisioterapi dan psikoterapi

bull Tx farmakologis

bull Tricyclic amine

bull Selective serotonine reuptake inhibitor rarr panic disorder

bull Tranquilizer jangka panjang dihindari karena efek ketergantungan


PROGNOSIS

bull Benign

bull Masalah jtg mengancam jiwa

bull Hipotensi ortostatik berkaitan dg penyakit2 neurologis degeneratif (Shy-Drager dan Parkinson) rarr

disabilitas berat


PSIKOFISIOLOGIS


PATOFISIOLOGI - PSIKOFISIOLOGIS bull Mx

bull Akibat gangguan integrasi central dari signal sensoris

bull Sering disertai anxietas akut atau kronis

DIAGNOSIS - PSIKOFISIOLOGIS

a Disertai gejala anxietas akut dan kronis

b Pasien terfokus pada gx somatik dizziness dan gx otonom

Intensitas lebih berat dp intensitas anxietas


TERAPI - PSIKOFISIOLOGI

bull KIE bahwa gx yg ditimbulkan benar2 akibat perub fisiologis

bull Tiga kelompok obat yg lazim digunakan pd kasus panic disorder (penggunaan alprazolam bisa menyebabkan ketergantungan shg hati2)

1 Tricyclic amine (imipramine amp desipramine)

2 Benzodiazemine potensi tinggi (alprazolam)

3 SSRI (paroxetine dan fluoxetine)

bull Tx suportif psikoterapi (behavioral tx)


PROGNOSIS

bull Bertahan selama bbrp thn

bull Kambuh setelah periode remisi yg panjang

bull Keluhan sepanjang hari

bull Intensitas bervariasi sesuai tingkat stress

bull Berhub dg keluhan panik dan fobia (agorafobia)


DISEQUILIBRIUM


PATOFISIOLOGI - DISEQUILIBRIUM

bull Akibat hilangnya input sensoris perifer (seringkali dari vestibular proprioseptif atau visual)

bull Atau karena lesi central pada pusat motorik ( basal ganglia cerebellum dan cortex)

DIAGNOSIS - DISEQUILIBRIUM

a Gait dari ggn cerebellar ggn vestibular ggn sensoris

b Ggn vestibular bilateral disertaitanpa penurunan pendengaran

bull Respon menurun atau (-) pada pemeriksaan stimulasi kalorik dan rotasional


TERAPI DISEQUILIBRIUM

bull Tx fisik bertuj utk gait amp balance training (melatih otak agar menggunakan signal sensori yg masih bertahan shg dpt mengkompensasi area yg telah rusak)

bull Gait amp balancing training lt bermanfaat pd px dg lesi cerebellum krn cerebellum merupakan kunci refleks2 postural adapting

bull Disequilibrium yg disebabkan ok kel supratentorial (parkinson hidrsefalus) atasi underlying process


PROGNOSIS

bull Hilangnya sensori perifer (vestibular proprioseptif atau visual) rarr Menyebabkan ggn pola jln rarr Pasien tetap dpt bergerak

(mobile)

bull Penyebab central

bull Infark atau degenerasi cerebelllum

bull Ggn pola jln yg lebih berat


VERTIGO

Definisi

Vertigo is defined as a An illusion or hallucination of movement which is usually rotation either of oneself or the environment

This may be a sensation of turning spinning falling rocking etc

Central (15)

bull Brainstem infarctischemia

bull Tumor

bull Cerebellopontine angle

bull Brainstem

Vertigo acute vestibular asymmetry

Peripheral (85)

bull Benign positional

bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central

Gradual onset (except stroke)

Persistent

Neuro findings common

Nystagmus any direction - changes with gaze

Nystagmus not suppressable

Unable to stand

Vertigo history and exam

Peripheral

Sudden severe

Episodic

Ear symptoms common

Nystagmus horizontaltorsional no change with gaze

Nystagmus suppressed with fixation

Able to stand lean to lesion


PATOFISIOLOGI - VERTIGO

bull Ketidak seimbangan tonus vestibular

bull Akibat

bull tdk adanya input perifer karena kerusakan labirin atau nervus vestibular atau

bull disebabkan gangguan aktivitas nuclear vestibular atau vestibulocerebellar unilateral


bull TX TERBAIK = TX DEFINITIF

bull 2 kategori tx simptomatis

bull Vestibular suppressant

bull Anti emetik

bull Tx vestibular suppressant bekerja pd tk neurotransmitter mempengaruhi impuls2 dari neuron vestibular primer ke sekunder serta mempertahankan tonus nuclei vestibular

bull Bekerja setelah 30 mnt

bull Pemberian im atau iv lebih disukai

bull Es mulut kering dan sedasi

TERAPI SIMPTOMATIS


CTH VESTIBULAR SUPPRESSANT

1 MECLIZINE 125 ndash 59 mgpo tiap 8 jam

2 DIMENHYDRINATE 25- 100 mg im iv po supp tiap 8 jam

3 SCOPOLAMINE 15 mg transdermal patch tiap 3 hr

4 PROMETHAZINE 125 ndash 50 mg im iv po supp tiap 8 jam

5 LORAZEPAM 05 ndash 2 mg im iv po tiap 8 jam


OBAT ANTI EMETIK

bull Antagonis dopamin dan kolinergik shg mencegah mual dan muntah pd pusat muntah

bull Efek samping parkinsonism akathisia distonia dan diskinesis

bull Cth

1 PROCHLORPERAZINE 25 ndash 10 mg im iv po supp tap 8 jam

2 METCLOPRAMIDE 5 ndash 10 mg im iv po tiap 8 jam

3 TRIMETHOBENZAMIDE 100 ndash 200 mg im iv po supp tiap 8 jam

4 DROPERIDOLE 25 ndash 10 mg im iv tiap 8 jam


REHABILITASI VERTIGO

bull Stlh terjadi lesi vestibular perifer akut kompensasi central scr bertahap bekerja dlm beberapa hari

bull Penggunaan vestibular suppresant dan anti emetik dpt mengganggu proses kompensasi shg penggunaannya hendaknya hanya bbrp hari pertama Segera setelah muntah berhenti tx dihentikan scr bertahap utk menstimulasi kompensasi yg normal akan terjadi

bull Program exercise dpt mempercepat prses kompensasi setelah terjadinya lesi vestibular perifer akut


SAMPEL EXERCISE

bull Fase akut fokus mata amp menghindari gerakan mata yg memprovokasi dizziness

bull Minimalisasi nistagmus dg fixasi 1 target target bergerak

bull Latihan berdiri dan berjalan dkt dinding atau dg asisten

bull Disertai gerakan kepala

bull Proses kompensasi selama 2 ndash 6 bln stlh kerusakan vestibular akut

bull Dizziness yg menetap menunjukkan proses yg sedang berlanjut atau kmpensasi central yg lemah


BPPV

Teori BPPV

bull Cupulolithiasis

bull calcific deposits on cupula rendering SCC gravity dependent

bull Canalolithiasis

bull calcific debris in SCC

bull pulling of cupula by plunger-like effect


bull Kristal calsium carbonat bebas (normalnya dlm macula utricula yg masuk dalam canalis semisircularis posterior)

bull Dg adanya perub posisi kristal berpindah ke dalam endolimfe dan menggeser cupula

46

47



50

Causes

bull Idiopathic

bull Infection (viral neuronitis)

bull Head trauma

bull Degeneration of the peripheral end organ

bull Surgical damage to the labyrinth


DIAGNOSIS

bull Benign kondisi yg tdk terlalu serius atau progresif

bull Paroxysmal onsetnya mendadak dan tdk dpt diprediksi

bull Positional timbul ketika ada perubahan posisi kepala

bull Vertigo menyebabkan keluhan dizziness

52

Diagnosis

bull Lab Studies

bull No pathognomonic laboratory test for BPV exists Laboratory tests may be ordered to rule out other pathology

bull Imaging Studies

bull No

bull Procedures

bull The Dix-Hallpike test along with the patients history aids in the diagnosis of BPV

53

Treatment

bull Medications

bull The Canalith Repositioning Procedure (CRP)

bull Surgery

54

Medications - symptomatic

bull Antiemetic

bull Antihistaminic

bull Anticholinergic


bull TEGAKKAN DX DG DIX HALLPIKE

bull Manuver repositioning

bull Tk perbaikan meningkat dg pengulangan manuver amp vibrasi pd regio mastoid

bull Nistagmus yg persisten krn

bull Debris menempel pd ddg kanalis semisirkularis

bull Debris terperangkap dlm cupula amp tdk dpt bergerak bebas

bull Saat posisi kepala tergantung ketika manuver kepala jgn elevasi krn partikel dpt menjau dr utricle

bull Vertigo yg timbul ketika kembali ke posisi duduk krn bolus debris otolit jatuh keluar dr kanal menuju utricle



MANUVER REPOSITIONING

bull Tingkat keberhasilan 80 setelah 1 sesi terapi dan 100 setelah gt1 sesi Tingkat kekambuhan 30 setelah periode 30 bln

bull Epley manuver

bull Brandt ndash daroff exercise

bull Semont manuver






BPV VARIAN HORISONTAL

bull Px digulingkan pd bid canal semisircularis horisontal saat baring supinasi 90deg sisi normal pronasi posisi awal

bull Px berbaring pd sisi telinga yg sehat di bawah utk beberapa jam atau sepanjang malam


INSTRUKSI DI RUMAH

bull BPV yg sering kambuh manuver di rumah

bull Vibrator massage leher

bull Pd bbrp px debris tdk dpt dihiangkan sempurna terangkan kemungkinan kekambuan dan pasien menghindari posisi ke belakang scr ekstrim (salon dan drgigi) yg akan menyebabkan debris masuk kembali ke canalis semicirkularis posterior


PEMBEDAHAN (TAMB)

bull Singular neurectomy

bull Vestibular Nerve Section

bull Posterior Canal Plugging Procedure


PROGNOSIS

bullRemisi spontan stlh beberapa mgg ndash bln

bullKekambuhan

bullInsiden meningkat ~ bertambahnya usia


Vestibulopathy perifer acute = neuritis vestibular


PATOFISIOLOGI

bull Epidemik

bull Riw familial

bull Musim semi dan awal musim panas

bull Infeksi virus

bull Atropi pd 1gt serabut saraf vestibular

bull Proses infeksi atau postinfeksi


DIAGNOSIS

bull Karakteristik klinis vertigo spontan berkepanjangan membaik bertahap dlm bbrp hari

bull Nistagmus unilateral dg fase cepat menjauhi telinga yg sakit amplitudo nistagmus lt ketika melihat ke arah telinga yang sakit

bull Tdk adanya tanda dan gx neurologis lain yang menyertai


TX SIMPTOMATIS

bull Vestibular suppressant dan anti emetik

bull 2 RCT membandingkan

bull Dimenhydrinate iv (50 mg)

bull Lorazepam 2 mg

bull Dimenhydrinate im (50 mg)

bull Droperidol 25 mg

Utk tx vertigo perifer akut di IRD bull Dimenhydrinate gt efektif dp lorazepam

bull Efektivitas Dimenhydrinate = droperidole

bull Es sedasi (es lt meclizine amp scopolamine transdermal)


VESTIBULAR EXERCISE

bull Perbaikan memerlukan bbrp minggu

bull Tuj utk akselerasi proses kompensasi vestibular dan memperbaiki tk kesembuhan akhir

bull Kompensasi dpt diakselerasi dg amfetamin dan dihambat dg obat sedasi (diazepam)

bull Latihan gt sering menyebabkan perbaikan yg gt cpt


STEROID amp OBAT ANTIVIRAL

bull Acyclovir 1 grhr selama 10 hr utk herpes zoster oticus

bull 1 studi placebo ndash controlled berskala kecil pemberian steroid do tinggi akan memberikan efek anti inflamasi dan scr signifikan memperpendek perjalanan penyakit dan derjat berat gx vestibulopathy perifer unilateral akut

bull Acyclovir + steroid do tinggi tdk gt baik dp penggunaan steroid do tinggi saja


PROGNOSIS

bullMonophasic

bullOnset selama bbrp jam menghilang secara berthp dlm bbrp hari

bull Kembali normal setelah bbrp minggu


MENIERE SYNDROME

1861


PATOFISIOLOGI

bull Peningkatan volume endolimfe disertai distensi sistem endolimfatik ( hidrops endolimfatik)

bull Ruptur membran labirin yg dpt menjelaskan adanya keluhan mendadak (merupakan karakteristik sindrom ini)




KEMUNGKINAN ETIOLOGI (TAMB)

bull Anatomical-abnormalities

bull Genetic-autosomal dominant

bull Immunological-immune complex deposition

bull Viral-serum IgE to herpes simples virus types I and II Epstein-Barr virus and CMV

bull Vascular-associated with migraines

bull Metabolic-potassium intoxication


DIAGNOSIS

bull Ggn pendengaran yg berfluktuatif (terutama utk suara frekuensi yang rendah)

bull menyertai keluhan vertigo yg episodik

bull Ada periode intra-aural fullness

bull Pemeriksaan weber menunjukkan lateralisasi menjauh dari telinga yg sakit

bull Tes rinne menunjukkan konduksi udara lebih baik daripada konduksi tulang

bull Audiometri ECOG ENG


bull Pembatasan diet garam 1 ndash 2 grr selama 3 bln baik intake garam ditingkatkan bertahap dan monitor ketat gx

bull Hindari mkn yg byk mgd gula dan garam hindari alkohol kopi coklat

bull HCT 50 mg 1 ndash 2 xhr efek tambahan tp tdk dpt menggantikan tx restriksi garam

bull Acetazolamide 250 mg 1 ndash 2 xhr menurunkan tek osmtik dlm telinga (RCT - )

bull Tx profilaksis dg vestibular suppressant utk serangan moderate ndash berat yg lebih sering

bull Vestibular exercise perannya minimal

TERAPI


PEMBEDAHAN

1 SHUNT ENDOLIMFATIC DUCT amp SAC bull Tdk efektif krn teknik sulit utk mempertahankan

shunt tetap terbuka dlm sistem endolimfe

2 ABLASI bull gt efektif pd px dg ggn unilateral dg kerusakan

pendengaran fungsional bull Vestibular neurectomy utk memelihara fungsi

pendengaran pd px dg fungsi residu cochlear

3 INJ GENTAMYCIN dlm telinga tengah bull Mudah bull Dpt dilakukan dg rawat jalan bull Tdk mempengaruhi prosedur tx definitif

pembedaan lanjutan bull SelektIf utk ototoksisitas vestibular


PEMBEDAHAN (TAMBAHAN)

bull Vestibular neurectomy

bull Stellate ganglionetomy

bull Labyrinthectomy


PROGNOSIS

bull Episode berulang

bull Fluktuatif penurunan pendengaran tinitus dan vertigo selama bbrp jam

bull Perjalanan penyakit hilangnya pendengaran unilateral scr progresif dlm bbrp thn hingga mencapai stadium ldquoburnt outrdquo (episode vertigo menghilang)

108

Rangkuman = Vertigo perifer

Durasi Gejala penyerta

BPPV Detik Perubahan posisi kepala

Menierersquos disease

Menit Tinitus penurunan

pendengaran

Neuritis vestibularis

Jam Flue like syndrome



AAO-HNS Committee on Hearing and Equilibrium revised definition in 1995 bull Possible Menieres disease

bull Episodic vertigo of the Menieres type without documented hearing loss or bull Sensorineural hearing loss fluctuating or fixed with dysequilibrium but without

definitive episodes bull Other causes excluded

bull Probable Menieres disease bull One definitive episode of vertigo bull Audiometrically documented hearing loss on at least one occasion bull Tinnitus or aural fullness in the treated ear bull Other causes excluded

bull Definite Menieres disease bull Two or more definitive spontaneous episodes of vertigo 20 minutes or longer bull Audiometrically documented hearing loss on at least one occasion bull Tinnitus or aural fullness in the treated ear bull Other cases excluded

bull Certain Menieres disease bull Definite Menieres disease plus histopathologic confirmation


Definition of Menierersquos

bull Staging of Hearing Loss in DefiniteCertain Menierersquos

Stage Four Tone Average dB

1 lt=25

2 26-40

3 41-70

4 gt70

Committee on Hearing and Equilibrium Guidelines for Diagnoses and Evaluation

of Therapy in Menierersquos Disease AAOHNS Board of Directors March 1994


Physiology

bull Production and flow of Endolymph - Theories

bull Longitudinal ndash produced in membranous labyrinth flows to endolymphatic sac then to dural venous sinuses

bull Diffuse ndash produced and absorbed along the membranous labyrinth

bull Periodic Flow ndash endolymph flows only with changes in volume or pressure

Andrews JC Intralabyrinthine fluid dynamics Meniere disease 12(5)

Oct 2004 pp408-412


Medical Management

bull Acute Therapy

bull Relatively non-controversial

Brookes GB The pharmacological treatment of Menierersquos disease Clinical Otolaryngology

21(1) Feb1996 pp3-11


Endolymphatic Sac Surgery

Coker Newton J et al Atlas of Otologic Surgery WB Saunders

2001


Vestibular Nerve Section

Coker Newton J et al Atlas of Otologic Surgery WB Saunders 2001



Cerebellar stroke (cont)

1 SCA lateral midbrainpons and

superior cerebellum bull vertigo less common

bull ipsi dysmetria

bull ipsi Hornerrsquos

bull contra hearing loss (lateral lemniscus)

2 AICA lateral pons and anterior cerebellum also internal auditory artery

bull vertigo

bull ipsi dysmetria

bull ipsi tinnitushearing loss (often from IAA injury)

bull ipsi V VII Hornerrsquos

3 PICA dorsolateral medulla and posterior medial cerebellum

bull origin Wallenberg syndrome (8)

bull medial branch vertigo ataxia nystagmus

bull lateral branch vertigo ataxia limb dysmetria nystagmus

Timothy Hain MD

From wwwtchaincom



CRP Summary--What to use When

1048715 Posterior BPPV - Cupulothiasis

ndash Liberatory Maneuver (Semont)

ndash Possibly CRP with vibration

ndash Brandt - Daroff

1048715 Anterior BPPV - Cupulothiasis

ndash Liberatory Maneuver (Semont) with initial head position rotated 90 deg


1048715 Horizontal BPPV - Cupulothiasis

ndash Modified Brandt-Daroff


DESKRIPSI

1 Merupakan suatu sensasi perub orientasi thd ruang

2 Dpt disebabkan oleh bbrp mekanisme patofisiologi yg berbeda2


ANAMNESIS

1 Deskripsi sensasi


3 Berapa lama




7 Terapi




bull gt wanita




Nasher




3 Visual input




B Proprioceptive

C Vestibular

9

10




B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














ANAMNESIS

1 Deskripsi sensasi


3 Berapa lama




7 Terapi




bull gt wanita




Nasher




3 Visual input




B Proprioceptive

C Vestibular

9

10




B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















bull gt wanita




Nasher




3 Visual input




B Proprioceptive

C Vestibular

9

10




B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














Nasher




3 Visual input




B Proprioceptive

C Vestibular

9

10




B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















B Proprioceptive

C Vestibular

9

10




B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













9

10




B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













10




B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















B Proprioceptive

C Vestibular




B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















B Proprioceptive

C Vestibular








4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom




















4 DISEQUILIBRIUM 2


5 VERTIGO 50



PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PRESYNCOPE



bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom















bull Berlt CBF







bull Volume lt





bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom















bull VASOVAGAL




bull Mx


bull HIPERVENTILASI






b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















b Aritmia cardiac





anxiety dyspnea


TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














TERAPI - PRESYNCOPE




bull Pd kasus berat




TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














TERAPI - PRESYNCOPE







TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














TERAPI - PRESYNCOPE











PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PROGNOSIS

bull Benign



disabilitas berat


PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PSIKOFISIOLOGIS


















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom






























PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom






















PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PROGNOSIS







DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














DISEQUILIBRIUM















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom



























PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom



















PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PROGNOSIS


(mobile)





VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














VERTIGO

Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













Definisi



Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













Central (15)


bull Tumor


bull Brainstem


Peripheral (85)


bull Labyrinthitis

bull Menierersquos

bull Otitis media

Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













Central


Persistent




Unable to stand


Peripheral

Sudden severe

Episodic

Ear symptoms common







bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















bull Akibat







bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom

















bull Anti emetik





TERAPI SIMPTOMATIS









OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom





















OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














OBAT ANTI EMETIK



bull Cth











SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom



















SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














SAMPEL EXERCISE








BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














BPPV

Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













Teori BPPV









46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













46

47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













47



50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom















50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













50

Causes

bull Idiopathic


bull Head trauma




DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














DIAGNOSIS





52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













52

Diagnosis

bull Lab Studies



bull No

bull Procedures


53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













53

Treatment

bull Medications


bull Surgery

54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













54


bull Antiemetic

bull Antihistaminic















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom


























bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom

















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















bull Epley manuver


bull Semont manuver










INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom






















INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom





















INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom




















INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom



















INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom


















INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














INSTRUKSI DI RUMAH





PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PEMBEDAHAN (TAMB)





PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PROGNOSIS


bullKekambuhan





PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PATOFISIOLOGI

bull Epidemik

bull Riw familial


bull Infeksi virus




DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














DIAGNOSIS





TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














TX SIMPTOMATIS




bull Lorazepam 2 mg







VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














VESTIBULAR EXERCISE











PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom



















PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PROGNOSIS

bullMonophasic




MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














MENIERE SYNDROME

1861


PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PATOFISIOLOGI














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
























DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom























DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom






















DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














DIAGNOSIS














TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom




















TERAPI


PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PEMBEDAHAN














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom



















PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














PROGNOSIS




108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom













108






pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom


















pendengaran















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom

























1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
























1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom

















1 lt=25

2 26-40

3 41-70

4 gt70




Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














Physiology






Oct 2004 pp408-412


Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom














Medical Management

bull Acute Therapy



21(1) Feb1996 pp3-11




2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom
















2001









bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom





















bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom


















bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom

















bull ipsi dysmetria




bull vertigo

bull ipsi dysmetria







Timothy Hain MD

From wwwtchaincom




































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