Vertigo is defined as a condition of dizziness of feeling of spinning, or swaying when one is stationary. Dizziness is a general, non-specific term to indicate a sense of disorientation. Some researchers suggested that vertigo
is a subtype of dizziness and refers to an erroneous perception of
self- or object-motion or an unpleasant distortion of static
gravitational orientation that is a result of a mismatch between
vestibular, visual, and somatosensory systems, affecting
approximately 20-30% of the general population(1) and about two to three times higher in women than in men.
Treatments
A. In conventional medicine perspective
1. Manoeuvres
The most common Epley maneuver is performed by a
doctor, audiologist, physical therapist, or with a BPPV maneuver at
home. Dr, and the research team at in the study of Diagnosis and
treatment of 318 benign paroxysmal positional vertigo cases, suggested that 318 patients, 221 (69.5%) with posterior semicircular canal involvement, Epley repositioning maneuver was performed; 62 (19.5%) with horizontal semicircular canal involvement, Barbecue maneuver combined forced prolonged position maneuver were applied; 23 (7.2%) with anterior canal involvement were treated with Epley maneuver;
12 (3.8%) had the mixed type and were treated with corresponding
repositioning maneuvers. After one week the total improvement rate was
82.1% (261/318) and 91.8% three months later (292/318)(58).
Some researchers suggested that Prevention begins by maintaining good
hydration and avoiding rapid movements
of the head can be helpful. Researchers at the Università degli Studi di
Palermo, indicated that Gufoni's manoeuvre is effective in treating
patients suffering from BPPV
of LSC; it is simple to perform; there are not many movements to
execute, it needs low time of positioning, and positions are comfortable
to the patient(59). Others suggested that Vannucchi maneuver and Log
Roll. For more information of the above. (60)
2. Postural restriction therapy
The treatment of benign paroxysmal positional vertigo (BPPV)
consists of a repositioning maneuver in order to remove otoliths
from
the posterior semicircular canal and subsequent postural restrictions to
prevent debris from reentering the canal.but researchers at Chonnam
National University Medical School and other showed that Postural
restriction therapy, practiced after the modified Epley repositioning maneuver, did not have a significant effect on the final outcomes of BPPV. Based on our results, we do not recommend this therapy since there was no significant benefit for the patients who utilized postural restrictions(61).
3. Vestibular training (VT)
In the study on treatment effects of vestibular training (VT) for benign paroxysmal positional vertigo was performed. The VT was compared with courses of patients in three different groups: patients treated by medication, by VT, and by VT with medication during 8 weeks. Dr. Fujino A and the team of reserachers at Kitasato University found that In the groups treated by VT, the effects were not influenced by time
since onset of disease or by patient age. It is therefore assumed that
VT can be used as a first-choice treatment in patients with benign paroxysmal positional vertigo, even in long-term cases or older patients(65).
3. Medication
Certain medication are used in treating vertigo depending to the
underlying cause. Dr Hain TC, and Dr. Uddin M. at the , Northwestern
University indicated that therapy of vertigo
is optimised when the prescriber has detailed knowledge of the
pharmacology of medications being administered as well as the precise
actions being sought. There are four broad causes of vertigo, for which specific regimens of drug therapy can be tailored. Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo
(BPPV) and bilateral vestibular paresis. In both Ménière's disease and
vestibular neuritis, vestibular suppressants such as anticholinergics
and benzodiazepines are used. In Ménière's disease, salt restriction and
diuretics are used in an attempt to prevent flare-ups. In vestibular
neuritis, only brief use of vestibular suppressants is now recommended.
Drug treatments are not presently recommended for BPPV and bilateral
vestibular paresis, but physical therapy treatment can be very useful in
both. Central vertigo includes entities such as vertigo associated with migraine and certain strokes. Prophylactic agents (L-channel calcium channel antagonists, tricyclic antidepressants, beta-blockers) are the mainstay of treatment for migraine-associated vertigo.
In individuals with stroke or other structural lesions of the brainstem
or cerebellum, an eclectic approach incorporating trials of vestibular
suppressants and physical therapy is recommended. Psychogenic vertigo
occurs in association with disorders such as panic disorder, anxiety
disorder and agoraphobia. Benzodiazepines are the most useful agents
here(62).
Other researchers suggested that treatment by medication
together with two maneuvers-the particle repositioning maneuver (PRM)
reported by Parnes and Price-Jones and the liberatory maneuver (LM)
reported by Semont et al.-were compared with treatment by medication alone. The most important benefit of these maneuvers seemed to be the speedier recovery than with medication alone, as there was no significant difference in the late success rate after 3 months between the maneuvers and medication alone(63).
4. Surgery (Tenotomy)
In the study to compare the unique
long-term results of tenotomy of the stapedius and
tensor tympani muscles in definite Meniere's disease refractory to
medical treatment and presents a hypothesis on why tenotomy seems
effective, Dr. Loader B, and the research team at Medical University of
Vienna showed that a statistically significant improvement of inner ear
hearing levels postoperatively (p = 0.041) and a major reduction in vertigo
attacks in all groups (p < 0.001) with complete absence of attacks
in 26/30 patients was noted. Results remained constant up to 9 years
postoperatively. Although tinnitus persisted, the intensity was lower
overall (p = 0.013)(64)
5. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22377855
(58) http://www.ncbi.nlm.nih.gov/pubmed/22509688
(59) http://www.ncbi.nlm.nih.gov/pubmed/19239952
(60) http://www.dizziness-and-balance.com/disorders/bppv/lcanalbppv.htm
(61) http://www.ncbi.nlm.nih.gov/pubmed/15378315
(62) http://www.ncbi.nlm.nih.gov/pubmed/12521357
(63) http://www.ncbi.nlm.nih.gov/pubmed/9186970
(64) http://www.ncbi.nlm.nih.gov/pubmed/22201453
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