Benign Paroxysmal Positional Vertigo (BPPV)
What is Benign Paroxysmal Positional Vertigo?
What are the symptoms of Benigh Paroxysmal Positional Vertigo?
How is Benign Paroxysmal Positional Vertigo diagnosed?
What is Endolymphatic Hydrops (Meniere’s Disease)?
What are the symptoms of Meniere’s Disease?
How is Meniere’s Disease diagnosed?
How is Meniere’s Disease treated?
What are labyrinthitis and vestibular neuronitis?
Labrynthitis and vestibular neuronitis are conditions of true vertigo. The patient experiences a sensation that the surrounding environment is spinning. The onset is usually sudden. Half of the cases are preceded by an upper respiratory tract infection or cold. The sensation of vertigo usually lasts for several hours or several days. It is unusual for this phase to last more than 48 hours. This is caused by a viral infection of the inner ear (labrynthitis) or the nerve going to the inner ear (vestibular neuritis). Many people will seek immediate attention in the emergency room or with their primary care physician because the symptoms are so extreme.
After the powerful symptoms of vertigo have passed (usually within 48 hours), patients are usually left with a feeling of disequilibrium (unsteadiness) that can last for days to months. The viral infection weakens the inner ear on one side, which creates an asymmetry within the balance centers of the brainstem. This creates a constant sense of unsteadiness. The disequilibrium is tolerable at rest but sudden movements of the head or body will trigger vertigo or light-headedness. As the affected inner ear recovers, the sensation of balance gradually returns.
How are these conditions treated?
The treatment of this condition is usually supportive. Medications, such as Meclizine, Antivert or Valium, can be given to help with the acute vertigo. These medications will help the patient if they are having symptoms of vertigo or nausea. These medications essentially cut off communication between the inner ear and the brain, so that the patient can have temporary relief of the vertigo.
It is important to keep in mind that these medications are not therapeutic; meaning they do not cure the problem. They are prescribed to make the patient comfortable in the short-term until the inner ear recovers. In fact, if these medications are taking too regularly, they will delay recovery. The brain and the inner ear have to interface in order for the natural function of the inner ear to recover. If these medications are constantly cutting off this interface, recovery will occur much more slowly.
Unfortunately, patients have to go through a period of compensation, where they will experience some dizziness, before the inner ear will recover. This period of compensation can be seen as a time when the inner ear is returning to full strength and getting back “on-line” with the brain so that balance function can be re-established. This process usually takes several weeks, but it can take months.
Patients who do not recover with several weeks of observation will require more intervention and investigation. This can include vestibular physical therapy to help strengthen the inner ear. It may also include a CT or MRI scan of the brain and an ENG (Electronystagmogram). An ENG is a specialized test that evaluates the strength and function of the inner ear’s balance function. Sometimes, something that was believed to be labrynthitis when it initially presented, turns out to be a completely different medical problem. This is why it is important to follow up with the ENT doctor until the symptoms are resolved or controlled.
By Joseph Chang, MD
What is a vestibular migraine?
People who suffer from chronic dizziness may be suffering from Vestibular Migraine. This condition involves a sense of disequilibrium rather than vertigo. Disequilibrium is a feeling that either the patient or the environment is swaying. Most patients describe it as “unsteadiness.” It is a sense of slow, rotational movement of one’s surrounding which can be mild or debilitating. The sensation can last from seconds to weeks and has a wide variety of manifestations. The exact neurological pathways responsible for a vestibular migraine are not completely understood.
Who gets vestibular migraine?
Most people with this condition have a personal or family history of migraine headaches. The dizziness does not have to occur with the headaches. Most patients also have a strong history of motion sickness. The dizziness can be associated with nausea, vomiting, sensitivity to light, sensitivity to sound, visual changes, and inability to continue normal activities. Stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods, smoking, and other factors can trigger migraine.
How is vestibular migraine diagnosed?
The diagnosis of vestibular migraine is largely established by the patient’s history, but the workup may include an audiogram, a CT or MRI scan of the brain and an ENG (Electronystagmogram). An ENG is a specialized test that evaluates the strength and function of the inner ear’s balance function.
How is vestibular migraine treated?
Treatments include observation, vestibular physical therapy or medical therapy. The medical therapies designed to treat vestibular migraine are the same medications used as prophylactic therapy for migraine headaches.
By Joseph Chang, MD