Peripheral vestibular disorders: an update

Abstract

Purpose of review First, to update the diagnosis, pathophysiology, and treatment of the most frequent peripheral vestibular disorders. Second, to identify those disorders for which the diagnostic criteria are still deficient and treatment trials are still lacking. Recent findings Bilateral vestibulopathy can be reliably diagnosed by the head-impulse test, caloric irrigation, and vestibular-evoked myogenic potentials. A new frequent subtype has been described: cerebellar ataxia, neuropathy, and vestibular areflexia syndrome. Benign paroxysmal positioning vertigo can be easily diagnosed and effectively treated. Vestibular neuritis is most likely caused by the reactivation of a herpes simplex type 1 infection; the inferior vestibular nerve subtype is now well established. More evidence is needed that the recovery can be improved by corticosteroids. Endolymphatic hydrops in Menière's disease can be depicted by high-resolution MRI after transtympanic gadolinium injection; a high-dosage and longterm prophylactic treatment with betahistine is evidently effective. Its mechanism of action is most likely an increase in the inner-ear blood flow. Vestibular paroxysmia is now a well established entity; carbamazepine is the treatment of first choice. Superior canal dehiscence syndrome can be reliably diagnosed; the best current treatment option is canal plugging. Summary Although progress has been made in the diagnosis and treatment of most peripheral vestibular disorders, more state-of-the-art trials are needed on the treatment of bilateral vestibulopathy to prove the efficacy of balance training, of vestibular neuritis (in terms of recovery of peripheral vestibular function and central compensation), of vestibular paroxysmia to prove the effects of carbamazepine, and of Menière's disease to find the optimal dosage of betahistine. Keywords benign paroxysmal positioning vertigo, bilateral vestibulopathy, Menière's disease, vestibular neuritis, vestibular paroxysmia ]. Currently, the Classification Committee of the Bárány Society is defining and redefining the diagnostic criteria for these disorders [2]. This is important not only for daily clinical practice, but also for

Prophylactic treatment of vestibular migraine

“…1,2 Vestibular disorders are the main diseases that manifest with dizziness complaints and, among them, the most common are Benign Paroxysmal Positional Vertigo (BPPV), Vestibular Migraine (VM), Meniere's disease and vestibular neuritis, in decreasing order of frequency. 2 Migraine is a multifactorial chronic disease. Its main symptom is headache, typically unilateral, pulsatile, associated with photophobia and phonophobia, nausea and vomiting.…”

Hyperventilation-Triggered Vertigo and Nystagmus in Vestibular Paroxysmia

“…Vestibular paroxysmia (VP) is a rare vestibular disease characterized by brief attacks of spinning or nonspinning vertigo that last from around 1 second to a few minutes. 1 2 3 4 5 Most attacks occur spontaneously, but they can be induced by turning the head to the right or left in the upright position. Arteries (or veins in rare cases) in the cerebellopontine angle are the pathophysiological cause of a segmental, pressure-induced dysfunction of the eighth nerve (primary VP).…”

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

“…Patients were clinically diagnosed according to the international guidelines, most of the classification committee of the international Bárány Society (www.jvr-web.org/ICVD.html or www.baran ysoci ety.nl) for the diagnosis of vestibular migraine [23], Menière's disease [24], vestibular paroxysmia [25], bilateral vestibulopathy [26], acute unilateral vestibulopathy/vestibular neuritis [27] and benign paroxysmal positional vertigo [28]. The diagnoses of the patients within D1 and D3 can be viewed in Table 1.…”

“…A 3D-FLAIR sequence was used to differentiate endolymph from perilymph and bone, and a CISS sequence to delineate the total inner ear fluid space from the surrounding bone. A T2-weighted, threedimensional, fluid-attenuated inversion recovery sequence [23], MD [24], VP [25], BPPV [26], BVP [1] and acute unilateral vestibulopathy/vestibular neuritis [2]. Grading of the ELH in the vestibulum and cochlea was based on criteria described previously [3], which constitutes a fusion of two classification systems [4,5] 2 , 56 slices, base resolution 384, averages 4, acceleration factor of 2 using GRAPPA algorithm, slice thickness of 0.5 mm and acquisition time 8:36 min.…”