Vestibular Disorders
Vestibular disorders cause the symptoms of vertigo, an illusion of motion, and imbalance. Vestibular disorders may be due to an inner ear or connecting brain pathway problem. The management of vestibular disorders depend on identifying the symptoms, examination findings during an episode of vertigo, and appropriate vestibular function tests.
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Benign paroxysmal positional vertigo
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Benign paroxysmal positional vertigo (BPPV) is the leading cause of vertigo. BPPV is due to movement of inner ear crystals that move in response to head motion. It causes very brief, repeated episodes of vertigo provoked by certain movements, such as lying down or rolling over in bed. It can be successfully treated with exercises designed to reposition the crystals.
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Vestibular Migraine
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Vestibular migraine is common especially in younger adults. It causes recurrent episodes of vertigo that can last minutes to days. Headache may or may not be present during an episode of vestibular migraine. A tendency to avoid movement often follows recovery from an episode. Unlike Meniere's disease, hearing is typically not affected. Vestibular migraine can be treated with medications and physical exercises.
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Vestibular Neuritis
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Vestibular neuritis causes sudden loss of balance function in one ear, resulting in vertigo lasting days to weeks. Vestibular function tests can identify the extent of balance involvement. Recurrence is uncommon. When the hearing is affected the term "labyrinthitis" is often used instead. The recovery is usually good, aided by vestibular physiotherapy.
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Meniere’s Disease
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Meniere's disease is less common than vestibular migraine as a cause of recurrent vertigo. Hearing is affected and characteristically change over time. There is often a feeling of ear blockage and tinnitus. Vestibular function tests are helpful, as certain components are typically affected. Treatment consists of reducing salt intake and medications such as betahistine and diuretics.
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Vestibular schwannoma (acoustic neuroma)
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Vestibular schwannoma is a benign slow growth of the hearing nerve, and typically produces hearing loss slowly. Balance symptoms are usually mild. Hearing tests and MRI are essential in the diagnosis and monitoring of vestibular schwannoma. The decision to treat with procedure depends on size and rate of growth.
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Persistent postural perceptual dizziness
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Previously termed "psychogenic vertigo", "psychophysical vertigo" and "psycho-physiological dizziness syndrome", persistent postural perceptual dizziness (PPPD) ranks among top causes of chronic dizziness. It is often triggered by the the development of another vestibular disorder, stress or major medical illnesses. The symptoms are usually present every day, but may fluctuate in severity over time. There are other accompanying features, such as head fullness, tinnitus, headache, nausea, tiredness, visual blurring and tinglings. PPPD responds to medications, physical therapies and cognitive behavioural therapy.
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