BPPV. These initials stand for benign paroxysmal positional vertigo. BPPV occurs when tiny calcium particles (canaliths) are dislodged from their normal location and collect in the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. It helps you keep your balance.
Meniere's disease. This is an inner ear disorder thought to be caused by a buildup of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (tinnitus) and hearing loss.
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Treatment for vertigo depends on what's causing it. In many cases, vertigo goes away without any treatment. This is because your brain is able to adapt, at least in part, to the inner ear changes, relying on other mechanisms to maintain balance.
Canalith repositioning maneuvers. Guidelines from the American Academy of Neurology recommend a series of specific head and body movements for BPPV. The movements are done to move the calcium deposits out of the canal into an inner ear chamber so they can be absorbed by the body. You will likely have vertigo symptoms during the procedure as the canaliths move.
Attacks of vertigo can develop suddenly and last for a few seconds, or they may last much longer. If you have severe vertigo, your symptoms may be constant and last for several days, making normal life very difficult.
BPPV involves short, intense, recurrent attacks of vertigo (usually lasting a few seconds to a few minutes). It is often accompanied by nausea, although vomiting is rare. You may also experience your eyes briefly moving uncontrollably (nystagmus).
When your head is still, the fragments sit at the bottom of the canal. However, certain head movements cause them to be swept along the fluid-filled canal, which sends confusing messages to your brain, causing vertigo.
When the labyrinth becomes inflamed, the information it sends to your brain is different from the information sent from your unaffected ear and your eyes. These conflicting signals cause vertigo and dizziness.
Your GP may also carry out a physical examination to check for signs of conditions that may be causing your vertigo. This could include looking inside your ears and checking your eyes for signs of uncontrollable movement (nystagmus).
The Epley manoeuvre involves performing four separate head movements to move the fragments that cause vertigo to a place where they no longer cause symptoms. Each head position is held for at least 30 seconds. You may experience some vertigo during the movements.
In rare cases, where the symptoms of vertigo last for months or years, surgery may be recommended. This may involve blocking one of the fluid-filled canals in your ear. Your ENT specialist can give more advice on this.
If your GP suspects you have central vertigo, they may organise a scan or refer you to a hospital specialist, such as a neurologist or an ENT (ear, nose and throat specialist) or audiovestibular physician.
During VRT, you keep moving despite feelings of dizziness and vertigo. Your brain should eventually learn to rely on the signals coming from the rest of your body, such as your eyes and legs, rather than the confusing signals coming from your inner ear. By relying on other signals, your brain minimises any dizziness and helps you to maintain your balance.
In some cases, it may be possible to use VRT without specialist help. Research has shown that people with some types of vertigo can improve their symptoms using a self-help VRT booklet. However, you should discuss this with your doctor first.
Benign paroxysmal positional vertigo occurs most often in people age 50 and older, but can occur at any age. BPPV is also more common in women than in men. A head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.
Treatment options for vertigo can depend on the underlying cause. To improve symptoms, vestibular rehabilitation therapy as well as medications, such as meclizine (Antivert), have been found to be effective.
Certain clinical tests and observations can be helpful when assessing for vertigo. These include head impulse testing or the Dix-Hallpike maneuver (patients are quickly lowered from a seated position to lying down).
Treating the underlying cause of your vertigo is the most effective way to decrease discomfort and provide long-term relief. There are also many home remedies, exercises, and medications that may be beneficial.
Vertigo is a common presenting complaint in primary care and emergency departments. It is a symptom of vestibular dysfunction and has been described as a sensation of motion, most commonly rotational motion. It is important to differentiate vertiginous symptoms from other forms of dizziness, such as lightheadedness, which is most often associated with presyncope. This activity describes the evaluation and management of vertigo and highlights the role of the interprofessional team in improving care for affected patients.
Objectives:Describe the pathophysiology of vertigo.Outline the typical presentation of a patient with vertigo.Explain the common physical exam findings differentiating central vertigo from peripheral vertigo.Describe the importance of collaboration and coordination among the interprofessional team to improve outcomes for patients affected by vertigo.Access free multiple choice questions on this topic.
Peripheral etiologies include the more common causes of vertigo, such as benign paroxysmal positional vertigo (BPPV) and Mnire disease.[3] BPPV results from calcium deposits or debris in the posterior semicircular canal and causes frequent transient episodes of vertigo lasting a few minutes or less.[1] Unlike BPPV, the patients with Mnire disease often experience tinnitus, hearing loss, and aural fullness in addition to vertigo. Endolymphatic hydrops is a distinct pathologic feature of Mnire disease.[4] Symptoms of Mnire disease result from an increased volume of endolymph in the semicircular canals. Two additional distinct causes of peripheral vertigo include acute labyrinthitis and vestibular neuritis. Both arise from inflammation, often caused by a viral infection.[1] Another viral-induced cause of vertigo includes Herpes zoster oticus, also known as Ramsay Hunt syndrome.[5] In Ramsay Hunt syndrome, vertigo results from reactivation of latent Varicella-zoster virus (VZV) in the geniculate ganglion leading to inflammation of the vestibulocochlear nerve. The facial nerve is often involved as well, resulting in facial paralysis.[1] Less common peripheral causes include cholesteatoma, otosclerosis, and a perilymphatic fistula. Cholesteatomas are cyst-like lesions filled with keratin debris.[6] Cholesteatomas most often involve the middle ear and mastoid. Otosclerosis is characterized by abnormal growth of bone in the middle ear, which leads to conductive hearing loss and may affect the cochlea, also causing tinnitus and vertigo.[7] A perilymphatic fistula is another less common cause of peripheral vertigo and results from trauma.[1]
Central etiologies of vertigo should always be considered in the differential. Ischemic or hemorrhagic strokes, particularly involving the cerebellum or vertebrobasilar system, are life-threatening and must be ruled out by history, physical and other diagnostic tests if warranted.[8][1] Other more serious central causes include tumors, particularly those arising from the cerebellopontine angle.[9] Examples of such tumors include a brainstem glioma, medulloblastoma, and a vestibular schwannoma, which can lead to sensorineural hearing loss as well as vertiginous symptoms.[1] Vestibular migraines are a common central cause of vertigo. They are characterized by unilateral headaches associated with other symptoms, including nausea, vomiting, photophobia, and phonophobia. Finally, multiple sclerosis has been associated with both central and peripheral causes of vertigo. Centrally, multiple sclerosis can cause vertigo with the development of demyelinating plaques in the vestibular pathways.[10] BPPV is a common peripheral cause of vertigo in patients with multiple sclerosis.[1]
Other causes can lead to vertigo. These include medication-induced vertigo and psychologic disorders, including mood, anxiety, and somatization. Medications that have been associated with vertigo include anticonvulsants such as phenytoin and salicylates.[1]
Vertigo affects both men and women but is about two to three times more common in women than men.[1] It has been associated with various comorbid conditions, including depression and cardiovascular disease. Prevalence increases with age and varies depending on the underlying diagnosis. Based on a survey of the general population, the 1-year prevalence of vertigo is about 5% and an annual incidence of 1.4%. Dizziness including vertigo affects about 15% to over 20% of adults yearly.[11] For benign paroxysmal positional vertigo, the one-year prevalence is about 1.6%, and it is less than 1% for vestibular migraine. The impact of vertigo should not be underestimated as nearly 80% of survey respondents reported an interruption in daily activities, including employment and the need for additional medical attention. The prevalence of Menire's disease has been recently reported to be 0.51% which is much higher than previous reports.[12][11]
Asymmetry in the vestibular system accounts for the symptom of vertigo. Asymmetry may result from damage or dysfunction in the peripheral system, such as the vestibular labyrinth or vestibular nerve or a central disturbance in the brainstem or cerebellum.[1] Though there may be a permanent vestibular disturbance, the symptom of vertigo is never permanent as the central nervous system adapts over days to weeks.[13] Tumors can cause vertigo. Schwannoma is the most common lesion in the cerebellopontine angle.[14] Meningioma is the most common extra-axial tumor in adults. It is the second most common lesion in the cerebellopontine angle. Glomus jugulare and glomus jugulotympanicum are tumors of the chemoreceptor system and are the main primary tumors of the jugular foramen. Metastases should be a consideration in patients with known primary neoplasia or multiple brain lesions. Infectious causes should be considered. Viral labyrinthitis is the most common example. Otomastoiditis is an infection of the tympanic and mastoid cavities. It is typically caused by bacterial agents with the most common being Streptococcus pneumoniae and Haemophilus influenzae. Acute cerebellitis is encephalitis that is restricted to the cerebellum. It is most common in children. Varicella-zoster virus is the leading cause. Cholesteatoma can be acquired or congenital, occurring in the pars flaccida or pars tensa. It is the proliferation of keratinized stratified squamous epithelium.[15] 17dc91bb1f
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