Questions

What is vertigo?

Vertigo (from the Latin verto” a whirling or spinning movement”) is a sub type of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of vestibular system (vestibular system is the sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance)

Symptoms of Vertigo

·         Nausea or vomiting.

·         Unsteadiness (postural instability).

·         Blurred vision.

·         Difficulty in speaking

·         A lowered level of consciousness.

·         Hearing loss.

·         Motion sickness – one of the most prominent symptoms of vertigo and develops most often in the persons with inner ear problems.

Causes of Vertigo?

Vertigo is classified into either peripheral or central depending on the location of the dysfunction of the vestibular pathway.

Peripheral: Vertigo caused by problems with the inner ear or vestibular system, which is composed of semicircular canals, the vestibule, and the vestibular nerve.

 The most common cause is benign paroxysmal positional vertigo (BPPV), which accounts for 32% of all peripheral vertigo.

 Other causes include Meniere’s disease (12%), superior canal dehiscence syndrome, labyrinthitis, and visual vertigo.

Any cause of inflammation such as common cold, influenza, and bacterial infections may cause transient vertigo if it involves the inner ear, as may chemical insults (e.g., aminoglycosides) or physical trauma (e.g., skull fractures).

Central: Vertigo that arises from injury to the balance centers of the central nervous system (CNS), often from a lesion (wound or injury) in the brainstem or cerebellum. It is generally associated with less prominent movement illusion and nausea than vertigo of peripheral origin. A number of conditions that involve the central nervous system may lead to vertigo including:

·         Lesions caused by infarctions or hemorrhage.

·         Tumor present in the cerebellopontine angle such as cerebral tumors.

·         Cervical spine disorders such as cervical spondylosis.

·         Migraine headaches.

Diagnosis of Vertigo

Tests for vertigo often attempt to elicit nystagmus and to differentiate vertigo from other causes of dizziness such as presyncope, hyperventilation syndrome, disequilibrium, or psychiatric causes of lightheadedness.

Tests of vestibular system (balance) function include:

·         Elecrtonystagmography  (ENG)

·         Dix-Hallpike maneuver

·         Rotation tests, head thrust test.

·         Caloric reflex test

·         Computerized dynamic posturography (CDP)

Tests of auditory system (hearing) function include:

·         Pure tone audiometry

·         Speech audiometry

·         Acoustic reflex

·         Electrocochleography (ECoG)

·         Otoacoustic emissions (OAE)

·         Auditory brainstem response test.

Treatment of Vertigo

Definitive treatment depends on the underlying cause of vertigo. Some of the treatment options for vertigo may include the following:

PHARMACOLOGICAL MANAGEMENT:

·         Anticholinergics such as scopolamine.

·         Anticonvulsants such as valproic acid for vestibular migraines.

·         Antihistamines such as meclizine, which have antiemetic properties.

·         Beta blockers such as metoprolol for vestibular migraine.

·         Corticosteroids such as methylprednisolone for inflammatory conditions such as vestibular neuritis.

PHYSIOTHERAPY MANAGEMENT:

Canalith repositioning procedure (Epley maneuver) – employs gravity to move calcium build-up that causes benign positional paroxysmal vertigo. It can also be performed by trained otolaryngologists, neurologists, chiropractors or audiologists. It is performed as:

1)      Patient starts in long sitting, head rotated 45 degrees to affected side.

2)      Patient rapidly reclined to supine position with neck slightly extended. Hold position for 30 seconds, or until nystagmus and dizziness subside.

3)      Rotate head 90 degree to opposite side. Hold position for 20 seconds, or until nystagmus and dizziness subside.

4)      Patient rotated 90 degrees from supine to side-lying. Hold position for 20 seconds, or until nystagmus and dizziness subside.

5)      Bring patient up into short-sitting. May need to complete this maneuveer 1to 3 visits for resolution of symptoms.

 

o    Liberatory oe Semont maneuver:

a)      Patient sits in short sitting, head rotated 45 degrees towards unaffected ear.

b)      Examiner places one hand under the bottommost shoulder while the other hand supports the neck

c)      Patient rapidly moves into side-lying to the affected side (face should be oriented towards ceiling). Hold this position for 30 seconds.

d)      Without any head movement, patient is to move to side- lying on opposite side of the body (face oriented towards bed). Hold this position for 30 seconds.

 

o   Gufoni Maneuver: Treatment for horizontal/lateral canal BPPV.

a)      Patient taken from sitting to side-lying on affected or unaffected side

b)      Geotropic nystagmus: unaffected

c)      Apogeotropic: affected

d)      Turn patient head quickly towards ground (45-60 degrees), hold in this position for 2 minutes.

Patient returns to sitting with head maintained in that position

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