What Are The Treatments For Vertigo And How Is It Diagnosed?

How is vertigo diagnosed?

Symptoms related to dizziness are commonly found in many conditions and illnesses. It is important for the doctor to eliminate them in order to be able to diagnose accurately. A diagnosis of vertigo will require careful interpretation of the answers to the following questions:

• A detailed description of symptoms
• How regularly symptoms occur
• The duration of symptoms each time they occur

Dix-Hallpike's maneuver

This maneuver triggers vertigo and nystagmus (rapid rhythmic repetitious involuntary eye movements) symptoms and is effective for diagnosing BPPV (benign paroxysmal position vertigo). The patient is asked to:

• Sit upright.
• Quickly move to a supine position (lie down facing upwards), the head must be below the horizontal line of the body - so it is usually hanging over the examining table.
• Head is turned to right or left. When the head is turned towards the affected ear vertigo is elicited.

Patients with BPPV will experience vertigo symptoms for several seconds.

Standing still with eyes closed

If the patient's balance is affected there is a strong likelihood that there is a middle ear problem.

If the patient also has tinnitus the GP (general practitioner, primary care physician) may refer him/her to an ENT (ear, nose and throat) specialist, also known as an otolaryngologist. The ENT specialist may order an ear X-ray, hearing tests, and further balance tests. Imaging scans, such as MRI or CT scans may also be ordered if the doctor needs to check for any kind of tumor.

Electronystagmography (ENG) or videonystagmography (VNG)

The aim here is to detect any abnormal eye movement. An ENG is done with electrodes, while a VNG uses small cameras. Both tests can check for eye movements, which determine whether the dizziness is due to inner ear disease. The patient's head is placed in different positions while the balance organs are stimulated with water or air.

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What are the treatment options for vertigo?

Treatment options depend on several factors, including the cause of the vertigo, severity, and the patient's age and general state of health.

Treatment for Labyrinthitis

In most cases, labyrinthitis resolves itself without any treatment. If it is caused by a bacterial infection the doctor may prescribe antibiotics.

If symptoms are severe and the patient has suffered hearing loss from one ear the doctor may perform a labyrinthectomy - surgical removal of the vestibular labyrinth. After the operation the other ear will take over the patient's hearing and balance. A labyrinthectomy results in total hearing loss of the affected ear; therefore it is only performed if that ear has already suffered serious hearing loss.

Treatment for Benign paroxysmal positional vertigo (BPPV)

Canalith repositioning procedure - the doctor, audiologist or physical therapist may treat the patient with a series of movements. These consist of several simple and slow maneuvers for positioning the patient's head. The aim is to move particles from the fluid in the semicircular canals of the inner ear into a vestibule (small bag like open area) where the otolith organs are - if the particles can be moved there they won't cause any problems and are more easily absorbed.

Each head position is held for about 30 seconds after vertigo symptoms or abnormal eye movements stop. The patient must avoid lying flat or placing the affected ear below shoulder level for a specified period after treatment - usually about a week, but this may vary. This will mean propping the head up with some pillows while sleeping so that it is higher than the rest of the body.

Some patients will be taught how to do the procedure themselves so that they can do them at home.

If the canalith repositioning procedure does not work there is the option of surgery. A bone plug is used to block the portion of the inner ear that causes the dizziness.

Treatment for Meniere's disease

There is no cure for Meniere's Disease; however there is treatment for the symptoms.

Motion sickness medications, such as meclizine (Antivert) or diazepam (Valium) may reduce the spinning sensation of vertigo and help control nausea and vomiting.

Anti-nausea medications, such as Prochlorperazine. External link" target="_blank">prochlorperazine, may ease nausea and vomiting during an episode of vertigo.

Diuretic medication, such as the drug combination triamterene and hydrochlorothiazide (Dyazide, Maxzide) may reduce fluid retention which lowers pressure in the inner ear, resulting in fewer episodes and less severe symptoms of Meniere's disease. Patients on long-term diuretics should supplement their diets with extra potassium-rich foods, such as oranges, bananas, spinach, cantaloupes, and sweet potatoes.

Dietary changes can help reduce fluid retention. Eating regularly throughout the day helps regulate body fluids; several small meals are better than a few large ones. Limiting salt consumption helps reduce fluid retention, as well as avoiding foods with MSG (monosodium glutamate).

As a last resort, surgery can help reduce the severity of vertigo attacks caused by Meniere's disease. Some of the bones surrounding the inner ear are removed, which reduces swelling in the labyrinth - this procedure is called endolymphatic sac decompression.

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How to prevent attacks of vertigo

Betahistine

Betahistine hydrochloride is the generic name for the anti vertigo drug SERC. It helps raise blood flow around the inner ear. It is said to reduce the number and severity of vertigo attacks if the patient takes it long-term.

Physical therapy (physiotherapy)

With a well trained physical therapist (physiotherapist) a patient can learn useful techniques, such as using alternative signals from the eyes, ankles, legs and neck to maintain balance. There are also various exercise techniques which help improve balance.

The following measures may help prevent bouts of vertigo, as well as reducing their severity:

• Sleep with your head slightly higher than the rest of your body. Slightly prop up your head and shoulders with a couple of extra pillows.


• If you have to pick something up from the floor or a surface far below your head, try to avoid bending down - the aim being to prevent your head from being lower or much lower than your shoulders. If you have good legs, try bending your legs to lower yourself rather than bending over.


• When reaching up for something, try not to extend your neck.


• If your neck is extended, or when you are lying down flat, more your head slowly.


• If you feel an episode of vertigo coming on sit down immediately. Avoid triggers that can make symptoms worse, such as bright lights, reading, sudden movements or watching TV.


• After an attack is over do not rush to return to normal activities; take your time.


• Stop smoking - people who suffer from episodes of vertigo usually experience fewer episodes and less severe symptoms if they give up smoking.


• If your vertigo is due to motion sickness, such as a rocking boat, and you feel symptoms coming on, fix your eyes on an unmoving object in the distance.


• A walking stick will not prevent symptoms, but can help with balance and prevent falls and injuries.