evaluation of vertigo

A novel diagnostic approach to determine the probable etiology of dizziness or vertigo. It uses the Timing of the symptom, the Triggers that provoke the symptom, And a Targeted Examination. The patient's response determines the classification of dizziness as episodic triggered, spontaneous episodic, or continuous vestibular.

Questions regarding the timing (onset, duration, and evolution of dizziness) and triggers (actions, movements, or situations) that provoke dizziness can categorize the dizziness as more likely to be peripheral or central in etiology. Findings from the physical examination can help confirm a probable diagnosis. A diagnostic algorithm can help determine whether the etiology is peripheral or central

Findings from the physical examination—including a cardiac and neurologic assessment, with attention to the head, eye, ear, nose, and throat examination—are usually normal in patients presenting with dizziness.

Benign Paroxysmal Positional Vertigo

BPPV occurs when loose otoconia, known as canaliths, become dislodged and enter the semicircular canals, usually the posterior canal. BPPV can occur at any age, but is most common between 50 and 70 years, but head trauma is a possibility in younger persons.

Your ENT specialist may perform the Dix-Hallpike maneuver to diagnose BPPV. The eye movements called nystagmus are observed for, transient upbeat-torsional nystagmus during the maneuver is diagnostic of BPPV if the timing and trigger are consistent with BPPV. Nystagmus may not develop immediately, and a sense of vertigo may occur and last for one minute. A negative result does not rule out BPPV if the timing and triggers are consistent with BPPV.
Treatment of BPPV consists of a canalith repositioning procedure such as the Epley maneuver, which repositions the canalith from the semicircular canal into the vestibule. The success rate is approximately 70% on the first attempt, and nearly 100% on successive maneuvers.Home treatment with Brandt-Daroff exercises can also be successful.

Vestibular Neuritis

Vestibular neuritis, the second most common cause of vertigo, is thought to be of viral origin. It most commonly affects persons 30 to 50 years of age. Men and women are affected equally.

Vestibular neuritis is diagnosed on the basis of the clinical history and physical examination. It can cause severe rotatory vertigo with nausea and apparent movement of objects in the visual field (oscillopsia), horizontally rotating spontaneous nystagmus to the non-affected side, or an abnormal gait with a tendency to fall to the affected side. Hearing is not impaired in this condition.

Reassurance, explanation, and advice are essential, in combination with symptomatic treatment for the first few days.The prognosis is excellent, but development of BPPV after an attack of vestibular neuritis may occur in 15% of patients.

Vestibular neuritis is treated with medications and vestibular rehabilitation.

Meniere Disease

Meniere disease causes vertigo and unilateral hearing loss. Although it can develop at any age, it is more common between 20 and 60 years. The vertigo associated with Meniere disease is often severe enough to necessitate bed rest and can cause nausea, vomiting, and loss of balance. Other symptoms include sudden slips or falls, and headache with hearing loss worsened during an attack.The underlying pathology is excess endolymphatic fluid pressure leading to inner ear dysfunction; however, the exact cause is unknown.Patients manifest a unidirectional, horizontal-torsional nystagmus during vertigo episodes.Your doctor will prescribe you with medical treatment that involves lifestyle changes, including limiting dietary salt intake, reducing caffeine intake and vestibular suppressants.