Acute peripheral vestibular dysfunction: diagnostics and treatment

Abstract

The aim of this article is to demonstrate ENT specialists, neurologists and general practitioners how to examine and treat patients with acute vertiginous complaints. Traditional otoneurologic testing that carried out for accurate topic diagnostics of acute vestibular dysfunction is described as available «Vestibular passport». Clinical diagnosis can be achieved after thorough assessment of patient’s complaints as well as history of the present illness. Gaze tests and posture control trials are demonstrated in details. Diagnostic value of each probe is shown from the viewpoint of differential diagnostics of peripheral and central vestibular dysfunction. High diagnostic value of registration and analysis of oculogyric reactions is presented by history cases of acute labyrinthopathy and acute vestibular neuronitis. In these cases absence of saccadic and pursuit gaze disturbances rule out central vestibular system dysfunction. The salient feature of these two variants of peripheral vestibular dysfunction is spontaneous nystagmus that revealed by Frenzel glasses. This significant oculomotor symptom as well as disturbances of static and dynamic postural control confirm patient’s vestibular complaints in objective way. Revelation of decompensation signs of vestibular dysfunction needs urgent medicine vertigo therapy and spare vestibular rehabilitation. Actually, medications of choice are sedative drugs with antiemetic effect, non-loop diuretics and glucocorticoids.