What are the most effective treatments for vertigo. How can you manage vertigo symptoms at home. What lifestyle changes can help reduce vertigo episodes. When should you seek medical attention for vertigo. What are the underlying causes of chronic vertigo. How is vertigo diagnosed by medical professionals. Can vertigo be completely cured.

Understanding Vertigo: Symptoms, Causes, and Diagnosis

Vertigo is a disorienting condition characterized by a false sense of motion or spinning. It can significantly impact daily life, making simple tasks challenging and potentially dangerous. But what exactly causes this unsettling sensation?

What is vertigo and how does it feel?

Vertigo is more than just feeling dizzy. It’s a specific type of dizziness where you feel as if you or your surroundings are moving or spinning, even when everything is stationary. This sensation can be mild and brief, or severe and long-lasting, sometimes persisting for hours or even days.

Common causes of vertigo

Vertigo often stems from issues within the inner ear, which plays a crucial role in maintaining balance. Some of the most common causes include:

• Benign Paroxysmal Positional Vertigo (BPPV): Caused by calcium crystals in the inner ear becoming dislodged
• Ménière’s disease: A disorder of the inner ear that can lead to vertigo, hearing loss, and tinnitus
• Vestibular neuritis or labyrinthitis: Inflammation of the inner ear nerves, often due to viral infections
• Acoustic neuroma: A non-cancerous tumor on the vestibular nerve
• Migraine-associated vertigo: Dizziness and vertigo as symptoms of migraine headaches

How is vertigo diagnosed?

Diagnosing vertigo involves a comprehensive approach. Your healthcare provider will likely:

1. Take a detailed medical history, asking about the frequency, duration, and triggers of your symptoms
2. Perform a physical examination, including tests to assess your balance and eye movements
3. Conduct specialized tests such as the Dix-Hallpike maneuver to check for BPPV
4. Order imaging studies like MRI or CT scans if a central nervous system cause is suspected
5. Refer you to an ENT specialist or neurologist for further evaluation if needed

Effective Medical Treatments for Vertigo

While vertigo can be distressing, numerous medical treatments can provide relief. The most appropriate treatment depends on the underlying cause of your vertigo.

Medications for vertigo relief

Several medications can help alleviate vertigo symptoms:

• Antihistamines: Such as meclizine (Antivert) can reduce the severity of vertigo episodes
• Anticholinergics: Like scopolamine can help with nausea and dizziness
• Benzodiazepines: In some cases, drugs like diazepam may be prescribed for severe vertigo
• Antibiotics: If vertigo is caused by a bacterial infection of the inner ear

Vestibular rehabilitation therapy

This specialized form of physical therapy aims to retrain your brain to process balance information more effectively. It involves exercises designed to:

• Improve gaze stability during head movements
• Enhance balance and reduce the risk of falls
• Decrease sensitivity to certain movements that trigger vertigo

Canalith repositioning procedures

For BPPV, a series of head movements known as the Epley maneuver can be highly effective. This procedure aims to move the displaced calcium crystals back to their proper position in the inner ear.

Home Remedies and Lifestyle Changes to Manage Vertigo

While medical treatments are often necessary, there are several steps you can take at home to manage vertigo symptoms and reduce their frequency.

Dietary modifications for vertigo relief

Certain dietary changes may help alleviate vertigo symptoms:

• Reduce salt intake: This can help manage fluid buildup in the inner ear
• Limit caffeine and alcohol: These substances can affect your body’s fluid balance
• Stay hydrated: Proper hydration is crucial for maintaining inner ear function
• Consider supplements: Some people find relief with ginger or vitamin D supplements, but consult your doctor first

Stress management techniques

Stress can exacerbate vertigo symptoms. Incorporating stress-reduction techniques into your daily routine can be beneficial:

• Practice mindfulness meditation
• Try deep breathing exercises
• Engage in regular moderate exercise, such as yoga or tai chi
• Ensure you get adequate sleep each night

Environmental modifications

Making some changes to your living space can help reduce the risk of falls and manage vertigo symptoms:

• Install handrails in the bathroom and along staircases
• Use night lights to improve visibility during nighttime trips to the bathroom
• Remove throw rugs and secure loose carpeting to prevent tripping
• Organize your living space to minimize the need for sudden head movements

When to Seek Immediate Medical Attention for Vertigo

While vertigo is often manageable, certain symptoms warrant immediate medical attention. It’s crucial to recognize these red flags to ensure prompt treatment of potentially serious underlying conditions.

Emergency symptoms accompanying vertigo

Seek immediate medical care if your vertigo is accompanied by:

• Sudden, severe headache
• Chest pain or difficulty breathing
• Weakness or numbness, especially on one side of the body
• Slurred speech or difficulty speaking
• Vision changes or double vision
• Loss of consciousness

These symptoms could indicate a more serious condition, such as a stroke or heart attack, requiring urgent medical intervention.

Persistent or worsening vertigo

If your vertigo symptoms persist for more than a few days or worsen over time, it’s important to consult your healthcare provider. They may need to reassess your condition and adjust your treatment plan.

Advanced Treatment Options for Chronic Vertigo

For individuals with severe or persistent vertigo that doesn’t respond to conservative treatments, more advanced options may be considered.

Surgical interventions for vertigo

In some cases, surgery may be recommended to address the underlying cause of vertigo:

• Labyrinthectomy: Removal of the inner ear sense organ for severe Ménière’s disease
• Vestibular nerve section: Cutting the vestibular nerve to stop vertigo while preserving hearing
• Endolymphatic sac decompression: A procedure to relieve pressure in the inner ear

These surgeries are typically considered last-resort options when other treatments have failed to provide relief.

Intratympanic injections

For some forms of vertigo, especially those related to Ménière’s disease, injections of medications directly into the middle ear can be effective:

• Gentamicin injections: Can reduce vertigo attacks but may affect hearing
• Steroid injections: May help reduce inflammation and vertigo symptoms

Vestibular implants

An emerging technology, vestibular implants are devices designed to restore balance function in individuals with bilateral vestibular loss. While still in the research phase, these implants show promise for severe cases of chronic vertigo.

Complementary and Alternative Therapies for Vertigo

While scientific evidence is limited for some of these approaches, many people with vertigo report benefits from complementary and alternative therapies.

Acupuncture for vertigo relief

Some studies suggest that acupuncture may help alleviate vertigo symptoms:

• Targets specific points believed to influence balance and dizziness
• May help reduce the frequency and intensity of vertigo episodes
• Could be particularly beneficial when combined with conventional treatments

Herbal remedies and supplements

Certain herbs and supplements have been traditionally used to manage vertigo symptoms:

• Ginkgo biloba: May improve blood flow to the brain and inner ear
• Ginger: Known for its anti-nausea properties, which can help with vertigo-related nausea
• Vitamin D: Deficiency has been linked to BPPV, so supplementation may help in some cases

Always consult with your healthcare provider before starting any new supplements, as they may interact with medications or have side effects.

Biofeedback and relaxation techniques

These approaches focus on helping you gain conscious control over certain bodily processes:

• Biofeedback: Uses sensors to provide information about physiological processes, allowing you to learn to control them
• Progressive muscle relaxation: Can help reduce tension and anxiety associated with vertigo
• Guided imagery: May help manage stress and improve overall well-being

Living with Vertigo: Coping Strategies and Support

While managing vertigo can be challenging, there are numerous strategies to help you cope with the condition and maintain a good quality of life.

Developing a vertigo action plan

Working with your healthcare provider to create a personalized action plan can help you feel more in control:

• Identify your specific triggers and learn how to avoid or manage them
• Know which medications to take and when
• Have a list of emergency contacts readily available
• Practice vertigo-stopping techniques that work for you

Adaptive devices and technologies

Several tools and technologies can help you navigate daily life with vertigo:

• Walking aids: Canes or walkers can provide extra stability
• Vestibular rehabilitation apps: Guide you through exercises at home
• Balance training systems: Use visual feedback to improve balance
• Personal emergency response systems: Ensure help is available if you fall

Support groups and counseling

Connecting with others who understand your experience can be invaluable:

• Join online or in-person support groups for people with vertigo or balance disorders
• Consider cognitive-behavioral therapy to help manage anxiety related to vertigo
• Engage family and friends in your care plan to create a strong support network

Remember, while vertigo can be a challenging condition, with proper management and support, many people are able to significantly improve their symptoms and quality of life. Always work closely with your healthcare provider to find the best treatment approach for your individual needs.

How Vertigo Can Be Cured?

Living with vertigo can be incredibly difficult. As well as making you feel dizzy and uncomfortable, it can also get in the way of everyday activities and prevent you from driving. It can also be very hard to convince other people to take your symptoms seriously, as vertigo and dizziness can seem like minor problems to someone who’s never been affected. So what can you do to free yourself from your symptoms?

What is Vertigo?

Vertigo is a feeling of dizziness and motion that can make you lose your sense of balance. It feels as if the world is moving, tilting or spinning around you, even when everything is still. Some people get a sense of vertigo when they’re in a moving vehicle or on a funfair ride because the world is moving around them while their bodies are sitting still. However, vertigo can also happen if there is a problem with the balance organs in your inner ear. You can experience vertigo in any time and place if your sense of balance gets confused.

• Symptoms can last for just a few seconds or for hours at a time (in severe cases, vertigo can affect people for even longer)
• The problem often goes away by itself, but you should see a doctor if it doesn’t or if it keeps coming back
• Ask for an urgent appointment if you also have a bad headache, you’re feeling sick or you have a fever too
• If you have double vision, hearing loss, trouble speaking, or you feel weakness, numbness or tingling in your arm or leg then you should go to A&E right away

Possible Causes of Vertigo

Vertigo can happen for many different reasons. If it is associated with other symptoms, it could be a sign of infection or even a stroke. However, in most cases it will be linked to the balance organs in your inner ear.

When you see a doctor about vertigo, they will ask about how and when the symptoms appear. The doctor will want to know if they tend to happen when you’re doing particular activities or if you have any other symptoms or health problems.

You might also need some tests to check on your balance or examine your ears. The test could be as simple as getting you to sit down and then stand up quickly to see how it affects your balance. However, in some cases more specialised tests may be needed to understand what’s wrong.

If the problem is linked to your inner ears then it could be caused by:

• Benign Paroxysmal Positional Vertigo: when tiny particles in the ear affect your balance organs as they move around, often when you change position suddenly
• Ménière’s Disease: an inner ear disorder associated with a build up of fluid, it often causes tinnitus too
• Labyrinthitis: when an infection causes inflammation in the inner ear that affects the nerves carrying messages from the balance organs

Treatments for Vertigo

Vertigo will often go away by itself, but if it is severe or happens regularly then it’s important to see a doctor. An ENT consultant will be able to find out why it is happening and recommend treatments to relieve or manage your symptoms. The best approach will depend on the cause of your vertigo.

Possible treatments for vertigo include:

• Antibiotics to clear bacterial infections
• Repositioning manoeuvres to shift any debris affecting the balance organs
• Medication to relieve associated symptoms like nausea
• Surgery can sometime help, for example if there is an injury or tumour affecting the inner ear

Some kinds of vertigo can be completely cured. For example, if you’re experiencing vertigo because you have an ear infection, it may be possible to prescribe antibiotics to eliminate the cause. However, some conditions that cause vertigo can’t be cured so easily. You may need to find ways to manage your symptoms if they can’t be stopped completely.

You can also do some simple things at home to reduce the effects of your vertigo. When your symptoms appear then you can try:

• Sit down as soon as you start feeling dizzy or off balance. However, try to do it calmly and smoothly so that you don’t make your symptoms worse.
• Lie down in a darkened room if sitting doesn’t help. It should help to relieve the spinning or tilting sensations. Take as long as you need to recover and don’t rush back to work or other activities.

Taking these steps should help to relieve your symptoms so that you feel less dizzy. Taking precautions such as sitting or lying down will also prevent you from hurting yourself by falling over while your balance is bad. You might also want to use a walking stick if you’re worried about falling.

If you’ve been diagnosed with a balance disorder or you’re often affected by vertigo, there are also some simple things you can do to reduce the chances of your symptoms coming back:

• Don’t bend down if you need to pick something up. Use your knees to reach the ground while keeping your head upright instead.
• Try not to stretch your neck, for example when exercising or reaching up to take things from high shelves or cupboards. Choose different activities or ask for help instead.
• Keep your head as stable as possible. Don’t make any fast or sharp movements.
• Always turn the lights on before getting out of bed in the dark. Being able to see will help you to stay balanced when you can’t trust your inner ears.
• Don’t change position suddenly, especially when standing up after sitting or lying down. Use a couple of pillows to keep your head raised during the night and take a moment to pause and sit on the edge of the bed when you get up in the morning.
• Anxiety can make your symptoms worse, so try not to worry too much. Relaxation techniques such as mindfulness or breathing exercises might help. You can also see your GP or a therapist for help.

Do you have any other tips for managing vertigo?

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Epley, Semont, Foster, and Brandt-Daroff

Written by WebMD Editorial Contributors

• Epley Maneuver
• Semont Maneuver
• Half-Somersault or Foster Maneuver
• Brandt-Daroff Exercise
• Follow Up

The spinning sensation and dizziness you get from vertigo can limit your activities and make you feel sick. Depending on the cause, though, some simple maneuvers you can do at home might bring relief.

The most common type of this condition is BPPV (benign paroxysmal positional vertigo). It happens when small crystals of calcium get loose in your inner ear. You may feel it when you’re getting in or out of bed, or tilting your head up. People over age 60 are more likely to get BPPV. It’s also the easiest type of vertigo to treat.

Before you try to treat it yourself, see your doctor. If you have vertigo, you’ll need to know what type it is and which ear has the problem. To determine affected side:

1. Sit on a bed so that if you lie down, your head hangs slightly over the end of the bed.
2. Turn your head to the right and lie back quickly.
3. Wait 1 minute.
4. If you feel dizzy, then the right ear is your affected ear.
5. If no dizziness occurs, sit up.
6. Wait 1 minute.
7. Turn your head to the left and lie back quickly. 
8. Wait 1 minute. 
9. If you feel dizzy, then the left ear is your affected ear.

If you have BPPV, certain actions can move the calcium crystals that cause the problem out of your ear canal. That should bring relief.

Your doctor or a therapist can show you how to do these moves.

If your vertigo comes from your left ear and side:

1. Sit on the edge of your bed. Turn your head 45 degrees to the left (not as far as your left shoulder). Place a pillow under you so when you lie down, it rests between your shoulders rather than under your head.
2. Quickly lie down on your back, with your head on the bed (still at the 45-degree angle). The pillow should be under your shoulders. Wait 30 seconds (for any vertigo to stop).
3. Turn your head halfway (90 degrees) to the right without raising it. Wait 30 seconds.
4. Turn your head and body on its side to the right, so you’re looking at the floor. Wait 30 seconds.
5. Slowly sit up, but remain on the bed a few minutes.
6. If the vertigo comes from your right ear, reverse these instructions. Sit on your bed, turn your head 45 degrees to the right, and so on.

Do these movements three times before going to bed each night, until you’ve gone 24 hours without dizziness.

This exercise is for dizziness from the left ear and side:

1. Sit on the edge of your bed. Turn your head 45 degrees to the right.
2. Quickly lie down on your left side. Stay there for 30 seconds.
3. Quickly move to lie down on the opposite end of your bed. Don’t change the direction of your head. Keep it at a 45-degree angle and lie for 30 seconds. Look at the floor.
4. Return slowly to sitting and wait a few minutes.
5. Reverse these moves for the right ear.

Again, do these moves three times a day until you go 24 hours without vertigo.

Some people find this maneuver easier to do:

1. Kneel down and look up at the ceiling for a few seconds.
2. Touch the floor with your head, tucking your chin so your head goes toward your knees. Wait for any vertigo to stop (about 30 seconds).
3. Turn your head in the direction of your affected ear (i.e. if you feel dizzy on your left side, turn to face your left elbow). Wait 30 seconds.
4. Quickly raise your head so it’s level with your back while you’re on all fours. Keep your head at that 45-degree angle. Wait 30 seconds.
5. Quickly raise your head so it’s fully upright, but keep your head turned to the shoulder of the side you’re working on. Then slowly stand up.

You may have to repeat this a few times for relief. After the first round, rest 15 minutes before trying a second time.

Here’s what you need to do for this exercise:

1. Start in an upright, seated position on your bed.
2. Tilt your head around a 45-degree angle away from the side causing your vertigo. Move into the lying position on one side with your nose pointed up.
3. Stay in this position for about 30 seconds or until the vertigo eases off, whichever is longer. Then move back to the seated position.
4. Repeat on the other side.

You should do these movements from three to five times in a session. You should have three sessions a day for up to 2 weeks, or until the vertigo is gone for 2 days.

For the rest of the day after doing any of these exercises, try not to tilt your head too far up or down. If you don’t feel better after a week of trying these moves, talk to your doctor again, and ask them what they want you to do next.

You might not be doing the exercises right, or something else might be the cause of your dizziness.

Top Picks

psychogenic, non-systemic and systemic, symptoms, causes, treatment

This text was written by a reader in the Community. Carefully edited and formatted according to editorial standards.

Shumik Ksenia

experienced psychogenic dizziness

Author profile

Until November 2019, I had never suffered from dizziness in principle. The first episode came about unexpectedly.

I was calmly choosing products in the supermarket, and the ground abruptly disappeared from under my feet. For a moment, I even thought that an earthquake had begun, but it was unlikely. I went home and lay in silence on the sofa for about half an hour until I got back to normal. Then she chalked it up to fatigue.

In December, everything happened again. I fell ill with SARS, which developed into acute bronchitis. I was struck with dizziness on the way to the doctor in the district clinic. Since that day, my whole life has changed dramatically: dizziness and feeling of lightheadedness did not go away around the clock.

See a doctor

We do not make recommendations in this article. Please consult with your doctor before deciding on treatment. The responsibility for your health rests solely with you.

How I searched for the cause of dizziness

During the New Year holidays, I mostly stayed at home. The seizures almost did not bother me when lying down or sitting, but if I went outside, my head was spinning again, there was a feeling of instability and unsteadiness. It seemed to me that I was standing still and the space was spinning around me, and not vice versa, as often happens with dizziness.

Numbness of the hands and palpitations were added to the symptoms, and I also had vision problems: it felt like I could not focus my eyes.

Immediately after the holidays, I firmly decided to visit a neurologist at the nearest paid clinic from a large network. I planned to sign up for the week, but I felt so bad that I decided to go without an appointment, at random.

I had difficulty getting to the doctor, making stops every ten meters so as not to fall.

Fortunately, there was a free window in the clinic. The neurologist was a pleasant person, communicated with understanding, ordered an x-ray of the cervical spine with functional tests. The results showed instability of the vertebrae, and the doctor suggested that dizziness may be due to problems with the neck. He said that the instability of the vertebrae can affect blood circulation and because of this I felt bad. He prescribed nootropics and a course of massage.

I started treatment: I took pills and went for a massage that I got as a gift. But nothing helped, and I decided to consult other doctors. I visited a cardiologist and did an ECG, visited an endocrinologist and took tests for hormones, vitamins and trace elements. According to the tests, I was healthy, except for the lack of vitamin D, which is often the case with residents of Russia. I also visited an ophthalmologist who examined the fundus of the eye and found nothing critical, only pointed out a small minus.

/guide/nootropics/

Nootropics: do they really improve brain function? Insomnia joined the symptoms, the muscles in the legs became stone and hurt. In such a shattered state, I came to the second neurologist, already on VMI. She asked me in detail about my illness, ordered blood tests, performed a neurological examination, and unexpectedly handed me a questionnaire for signs of depression and anxiety.

The test revealed a high level of anxiety. After evaluating my condition, the doctor diagnosed me with somatoform dysfunction of the autonomic nervous system with a pronounced anxiety syndrome.

What is a somatoform disorder of the autonomic nervous system

Medical edition

on guard of health

The autonomic or autonomic nervous system is the part of the body that is responsible for its involuntary functions and reactions, such as sweating, heartbeat or digestion.

At the same time, the autonomic nervous system is closely related to the emotional state of a person. For example, if something frightening happens, the body will react to it, including involuntarily: the pulse may increase or the pressure may increase. This is important so that in case of danger a person can quickly react and survive.

These conditions, occurring without external causes, may be symptoms of diseases, such as cardiovascular or endocrine. To identify them, doctors prescribe additional tests and studies.

If the cause cannot be determined, a psychiatric consultation may be necessary: ​​psychiatric disorders such as anxiety or depression often cause autonomic nervous system reactions. In this case, it is they who need to be treated, and not the nervous system.

When the condition cannot be linked to any psychiatric disease, the doctor may make an independent psychiatric diagnosis – somatoform disorder. To treat dizziness and other symptoms, your doctor may prescribe psychotherapy, as well as certain drugs, such as anti-anxiety or antidepressants.

It is extremely rare for symptoms to indicate a disease of the autonomic nervous system itself. To exclude them, doctors may prescribe additional tests and studies to the patient.

My treatment

Taking a tranquilizer

The neurologist recommended that I see a psychotherapist and prescribed Grandaxin, an anti-anxiety daily drug. I didn’t know if it would help my dizziness, but I didn’t really mind lowering my anxiety level.

It took two months to take the medicine, but after three weeks of proper use, the impossible happened: my dizziness disappeared in a second. It was March or early April. I remember how I was walking along the corridor with dizziness, which stopped in one moment – like all other symptoms. I was happy.

The happiness continued until September 2020, when the dizziness attacked me again. I went to the same neurologist, the treatment was standard – anti-anxiety drugs. The pills helped again, the effect appeared in a week, but then there was a rollback.

/list/nevrolog-vopros/

9 important questions for neurologist Pavel Brand

I changed my doctor again because my work schedule with my neurologist’s schedule no longer coincided. The new and already third neurologist decided to send me for an MRI and ultrasound of the vessels of the neck and brain, explaining that with my symptoms it is necessary to exclude serious diseases. I don’t know why among the many tests that I was prescribed earlier, there were no these examinations. The cost of all this was again covered by VHI.

I went to the MRI like I was going to be shot. I was not afraid of the closed space and the hum of the apparatus, like some of my friends. I was terribly afraid of the results of the MRI and ultrasound. Luckily, they turned out great.

In March 2021, a neurologist concluded that my non-systemic vertigo was purely psychogenic. Associated dizziness with triggers: shopping malls, streets, other places with which the sensation of dizziness is strongly associated. And he prescribed the same treatment – Grandaxin.

I bought a package of 60 tablets – this one costs 800 R

I spent 14,600 R on examinations and treatment with Grandaxin

Expenses

Expenses

Analyzes and examinations

7000 R

Medical appointments

9000 2 5000 R

Medicines

2600 R

Massage

Free

My treatment

Psychotherapy and lifestyle changes

I didn’t want to depend on drugs, so I eventually stopped taking Grandaxin and began to work with a psychotherapist. Now I visit him once a week or two, I pay 4000 R for an appointment. The psychotherapist recently again prescribed me another anti-anxiety drug – the neuroleptic Teraligen in a small dosage.

I also search for information about therapy methods, about proper relaxation, and so on. Now I have rules that help to cope with dizziness.

/trevoga/

How I treated Generalized Anxiety Disorder according to CHI

Get enough sleep. For me, that’s eight, but no more than nine hours of sleep. Go to bed earlier and wake up earlier.

Do not neglect physical activity. It can be anything: yoga, stretching or a pool, the main thing is to do it regularly. I bought an annual membership to a fitness club for 35,000 R. I still get dizzy on the streets or food courts, but during physical activity they pass.

Remember about leisure. Outdoor trips, meetings with friends, intellectual and entertaining games in bars – all this has a beneficial effect on mood.

In case of exacerbation, do not change the built lifestyle. For example, do not lock yourself at home. Non-systemic dizziness should not define my life. As soon as you feel signs of dizziness, switch your thoughts to work, family issues.

Do not discuss exacerbations with loved ones. Do this only when there is a real need. Otherwise, the conversation once again focuses attention on the problem. When I feel a breakdown, emotional emptiness, uncertainty, it is better to use the support of a psychotherapist.

It also helps to remember that, despite the illusion, I will never fall in the street. This is just a subjective feeling, nothing more.

Expenses

Now the treatment costs me about 12,200 R per month. Of these, only 1200 R is spent on an antipsychotic, the rest goes to classes in a fitness club and consultations with a psychotherapist.

Now I spend 12,200 R per month on treatment

Expenses

Expenses

Psychotherapist appointments

8000 R

Sports 9000 3

3000 R

Teraligen medicine

1200 R

Case history. Here readers talk about their illnesses that have affected the way of life or attitude to it

Tell your story

Intractable dizziness. Difficulties in diagnosis and treatment

Transcript of the report of Professor NS Alekseeva, devoted to the treatment of vertigo.

Professor Drapkina O.M.: – We are moving into an exciting area for therapists – neurology. And today, in fact, I would say, professor Alekseeva Natalia Stepanovna will support this entire section. “Unruly dizziness.”

Professor Alekseeva N.S.: – “Recalcitrant dizziness: diagnosis and treatment” – the topic of our lecture. Why did we call her that? Because so many doctors of different specialties – therapists, cardiologists, otolaryngologists – meet patients almost daily with complaints of dizziness. However, realizing that dizziness is most often caused by the pathology of the vestibular apparatus, they offer to carry out their own treatment regimens and do not get a good enough effect as a result of this treatment. That is why we gave this report such a title that there is dizziness, but it does not obey the doctor so well in terms of treatment.

Accordingly, there are two problems here. First: in order to properly treat dizziness, it is necessary to correctly diagnose the level of damage to the vestibular apparatus. And secondly: you still need to understand how much which disease is more likely to cause this dizziness. These are vascular processes, this is an inflammatory process in the ear. For this, of course, a detailed history is needed, without which we cannot go anywhere.

But since, nevertheless, my experience shows that the largest number of patients suffering from dizziness are vascular patients, and in the first place, perhaps, I would still put patients with arterial hypertension, then the following material shows quite clearly, that in patients with arterial hypertension, mainly those patients who complain of dizziness, tinnitus, their dizziness proceeds in different ways. These may be attacks of short-term rotational vertigo, often associated with a change in position. Unsteadiness when walking, drunken gait or non-systemic dizziness, sometimes even with a fall. Often, the appearance or intensification of dizziness indicates an increase in blood pressure.

Dizziness may be of vestibular origin – this is a peripheral lesion. A classic example is Meniere’s disease or syndrome, or associated with other causes of orthostatic hypotension, syncope and other conditions. Much more often, dizziness is a symptom of damage to the vestibular analyzer, both at the peripheral and central levels. It must be said that the vestibular analyzer is widely represented in the central nervous system, and it extends from the labyrinth of the inner ear outside the brain structure to the temporal cortex of the brain. At the same time, its influence on the central nervous system can be compared with the influence of the vagus on the periphery, because, indeed, in order to stabilize the vertical position and comfort when changing the position of the head and body, the influence of such a powerful analyzer with powerful connections in the central nervous system is necessary.

Target organs in arterial hypertension can be different parts of the brain, as well as the labyrinth. In the brain, these are the trunk, cerebellum, and cerebral hemispheres. The age category of patients with arterial hypertension is middle-aged and elderly patients. It is important to note that the difference in blood pressure in middle-aged people with the development of hypertension in middle-aged people at an early stage of the disease can lead to cerebral complications, transient ischemic attacks and cause cerebral infarction and dyscirculatory encephalopathy.

Thus, classifying cochleovestibular disorders, we distinguish the peripheral level, in which we distinguish two levels: labyrinthine and radicular, that is, the inner ear and the vestibular nerve to the nuclei. Central lesion: subtentorial stem lesion and supratentorial lesion. And, of course, there are patients with a combined syndrome.

To get a good idea of ​​how wide the range of diseases that can lead to dizziness, I compared the levels of damage – from the peripheral to the cerebral cortex – with those diseases that are most often encountered. And you see that Meniere’s disease, and vascular disorders in the labyrinth artery, which proceed as a thrombosis of this artery, and fissures of the pyramid of the temporal bones, damaging the inner ear and the vestibular portion of the VIII nerve, are presented in the right half of the table. This is also intoxication with toxic antibiotics, these are otogenic inflammatory processes – arachnoiditis – of the cerebellopontine angle, these are neuritis of the vestibular portion, causing dizziness. It is also very important that such a pathology as a neurovascular conflict has become very common, when the vessel is close to the auditory nerve and the vestibular portion, and against the background of an increase in blood pressure in the vessel in the intracranial region, pressure of the vestibular nerve and an attack of dizziness are caused with a complete shutdown of the labyrinth on one side, resulting in a fall, but without loss of consciousness. In addition, small intracanal neuromas are also accompanied by dizziness in the early stages of development.

But the largest number of patients, of course, are patients with vascular disorders in the vertebrobasilar system against the background of not only arterial hypertension, but atherosclerosis, vascular thrombosis, hemorrhagic disorders and acute ischemic cerebrovascular accident. But this is not only a vascular pathology. Encephalitis, tumors of the cerebellum, tumors of the fourth ventricle, because they are mobile and can directly affect the vestibular nuclei, which are located at the bottom of the fourth ventricle. And as for the cortical sections, this is the vestibular aura in the form of dizziness in temporal lobe epilepsy, tumor, inflammatory and vascular cytology.

The nature of the peripheral vestibular syndrome lies in the fact that when assessing spontaneous nystagmus, which is most often horizontal unilateral, rarely with a rotator component and a mandatory combination of vestibular disorders with unilateral noise and hearing loss. It is this combination of symptoms – auditory and vestibular – that suggests a peripheral level of damage. As a rule, during experimental tests, the excitability of the labyrinth on the side of the lesion decreases with a caloric rotational test, and the absence of neurological symptoms is a prerequisite.

Peripheral vestibular syndrome, of course, can be divided into different diseases according to the etiological moment. Labyrinth hydrops or Meniere’s disease, not associated with vascular pathology, possibly associated with the expansion of the subarachnoid spaces. Subarachnoid spaces and endolymphs are interconnected.

The second is an inflammatory disease, chronic otitis media and labyrinthitis. Patients are often admitted with a diagnosis of vestibulopathy, while no one looked at the patient’s eardrum. Otoscopy reveals perforations and exacerbations of chronic otitis media, which are also the cause of peripheral vestibular syndrome.

We should not forget that there may be psychogenic dizziness, which is in no way connected with the pathology of the vestibular analyzer, but patients, having experienced dizziness once, begin to worry about slight even some changes in their condition, believing that these conditions are related or due to dizziness.

This is a traumatic brain injury and benign oppositional paroxysmal vertigo, most often associated with operations on the middle ear cavity with avulsion of otoliths that fall into the semicircular canals. Infrequent pathology, it is necessary to differentiate with positional and ischemic dizziness.

In this diagram, you can clearly see that the inner ear is supplied with blood from the pool of vertebrobasilar vessels, most often from the anterior and inferior cerebellar arteries. It is important to note that the blood supply to the inner ear is provided by terminal branches in this system. Therefore, any fluctuations in blood pressure, both an increase and a decrease in blood pressure, slowing of the pulse, tortuosity of the vertebral artery, vertebrogenic effects due to the pathology of the cervical region, stenosis or occlusion of the subclavian artery, as well as pathology of the intracranial branches of the vertebrobasilar system. Everything will be reflected and cause inferiority of the blood supply of the inner ear. But since the semicircular canals and the cochlea are located nearby, peripheral vertigo will necessarily be accompanied by auditory symptoms.

Assessing the peripheral vestibular syndrome with the state of the vessels, we found that in this pathology an anomaly in the form of hypoplasia of one vertebral artery is most often detected; into the canal, that is, higher than usual, which is subjected to extravasal compression, as well as the absence of posterior communicating arteries.

This slide shows an angiogram, an outpatient magnetic resonance angiogram, of a patient with 9 episodes of dizziness.-10 hours with nausea and vomiting, which was based on circulatory failure in the vestibular-basilar system, due to hypoplasia, in this case, of the left vertebral artery.

This slide shows that the attack continued with vomiting for two hours, without neurological symptoms. During the examination of the patient, symptoms of peripheral vestibular syndrome were revealed, which manifested as unilateral spontaneous nystagmus and a decrease in the vestibular function of the labyrinth. Examination revealed hypoplasia.

Hypoplasia is very well detected by ultrasound, in this case, duplex scanning of the vertebral artery, showing a reduction in blood flow in it and a decrease in volumetric blood flow.

The next slide is an anomaly of the entry of the vertebral artery into the canal just at the level of C4, with the vertebrogenic effect of the rotational movements of the patient’s head, it led to an infarction of the inner ear with a decrease in vestibular and auditory function by the type of hemodynamic insufficiency. And other variants of the anomaly, such a rare anomaly as the persistent primitive trigeminal artery, a rare variant of the development of the vessels of the vertebrobasilar system, as the cause of central vertigo in a patient.

Damage to the vestibular nerve in the cerebellopontine angle can be caused by a vascular loop – neurovascular set, vascular disorders in the form of insufficient blood flow (peripheral ischemic syndrome), eighth nerve neurinoma, arachnoiditis of the cerebellopontine angle and neuritis. Here it is important to dwell on the neurovascular conflict in the event that the patient clearly notes an attack of dizziness against the background of a rise in blood pressure. Most likely, the reason for this situation is not just a change in blood flow, cerebral blood flow against the background of arterial hypertension, but a possible compression of the nerve by the vascular loop.

In this case, an audiogram is presented, that is, the patient has hearing loss in the left ear, as well as the results of measuring blood pressure, showing that the patient has not so much high blood pressure, because she is taking antihypertensive therapy, but a decrease in heart rate, which is also undesirable for patients with dizziness. Bradycardia is also the cause of the development of circulatory failure and irritation of the inner ear, and if it is possible to treat hypertension without using beta-blockers, then it is necessary to start with drugs from other groups.

This slide clearly shows the vascular loop that overlaps or covers the VIII nerve on the right. This is very clearly visible and is the cause of the development of dizziness in a patient with arterial hypertension.

Examining the parameters of central hemodynamics in patients with hypertension, we found that all these patients have high blood pressure, mean pressure 142, and a large spread of stroke volume from 43 to 104, as well as a decrease in heart rate 48, which is most likely is the result of antihypertensive therapy.

Central vestibular syndrome. Vertigo is clearly of a different nature and other structures suffer in this case, the central pathways of the brain and the vestibular nuclei in the trunk. Therefore, dizziness only in the acute period can resemble peripheral, be systemic, and in all other cases and later – dizziness by the type of imbalance. Auditory symptoms, on the contrary, are not expressed. The patient never complains of hearing loss or unilateral deafness, although the examination of these patients may reveal auditory symptoms. As a rule, only in 50% of cases there are no neurological symptoms, but central vertigo is accompanied by neurological symptoms. This may be double vision, any other oculomotor disorders, it may be a violation of sensitivity, weakness in the limbs. And already a completely different anatomy of the vessels at the same time: anatomical changes and structural changes in the vessels. As for vertebrates, these are stenoses, occlusions, dissections and, as a rule, bilateral deformity.

Thus, a clinical example: a 65-year-old patient, after a long forced position of the head, developed an attack of systemic dizziness followed by ataxia. An otoneurological examination revealed symptoms of the central vestibular syndrome in the form of bilateral spontaneous nystagmus, hyperreflexia, and experimental nystagmus. And on MRI, a focus was found in the pons Varolii: in the trunk in the pons Varolii during angiography, bilateral deformation of the vertebral arteries and a decrease in blood flow velocity through the vertebral arteries during functional tests.

Here on this slide, in the left half of the slide, you see the tortuosity of the vertebral arteries, which led, you see, to a mild occlusion of the stenosis, but nevertheless led to the development of an infarction.

Patients who suffer from arterial hypertension and are not always treated correctly, sharply reducing their blood pressure, suffer from reduced brain perfusion and ischemic disorders in the inner ear, with the development of ataxia dizziness. In these patients, computed tomography revealed foci of leukoaraiosis and changes in the type of deep lacunar infarcts. The main diseases that lead to the central vestibular syndrome are the differential diagnosis of the tumor, multiple sclerosis, degenerative diseases of the cerebellum, brain injury, arteriovenous malformations.

Of great importance for the development of acute disorders of cerebral circulation, as can be seen on this slide, are acute inflammatory processes that occur in the ENT organs too. So, the patient developed an acute violation of cerebral circulation against the background of exacerbation of chronic maxillary etmoiditis.

Central vestibular syndrome in a patient with arterial hypertension and atherosclerosis with the following description of the condition of the vascular wall. These are, as a rule, mild manifestations of atherosclerosis in the form of thickening up to 1.1 mm of the intima-media complex on both sides of the common carotid arteries and hemodynamically insignificant atherosclerotic plaque in the bifurcation of the left common carotid and internal carotid arteries (stenosis up to 30%), tortuosity of both internal carotid arteries because, as it is really a patient with arterial hypertension, this is a frequent pathology, and the left vertebral artery later enters the canal at the C5 level, increasing the level of hemoglobin.

Structural change – central dizziness against the background of arterial hypertension and occlusion of the vertebral artery in a patient with the development of a heart attack in the brain stem is clearly represented by ultrasound, where you can see almost no blood flow in the vertebral artery.

In addition to the main arteries, which are the cause of heart attacks in arterial hypertension, the state of the intracranial vertebral artery is important. It is clearly seen here that in the case of normal extracranial sections of the vertebral artery, stenosis in the intracranial section led to a pronounced ischemic lesion of the posterior and medial sections of the cerebellum, the cerebellar hemisphere.

We should not forget that young people can suffer ischemic strokes, and most often these are cardioembolic disorders caused by damage to the heart and its valves. Thus, a 25-year-old young woman developed a heart attack at the border of the pons Varolii and the medulla oblongata with the presence of cardiac pathology. A heart attack of the Wallenberg-Zakharchenko type with clear neurological symptoms, severe dizziness, bilateral spontaneous nystagmus, impaired sensitivity and ataxia.

The basic principles for the treatment of cochleovestibular disorders should be based on the following provisions. The first is the treatment of the underlying disease, as well as the treatment of vestibular disorders of the peripheral and central levels. We should not forget that very often in recent times the treatment of dizziness is carried out surgically. This is the treatment of stenosis of the main arteries and neurovascular conflict.

If we recall pharmacotherapy or those drugs that we use in the treatment of insufficient blood supply to the vertebrobasilar system, then the group of drugs is the most diverse. These are drugs that optimize cerebral circulation, and antioxidants, neuroprotectors, hemoangiocorrectors and other groups.

I must say that today we will talk about Betaserk. The drug is included in the group of optimizing cerebral circulation. We will dwell on it in more detail. Betahistine has a histamine-like pharmacological action, improves microcirculation of the inner ear, enhances blood flow in the inner ear and vestibular compensation in the brain, since histamine is a fairly good neurotransmitter.

Betahistine – pharmacological action is histamine-like, improves microcirculation. Its synonyms are betaserc, betaver, vestibo.

Blocker of H ₃ receptors, which are located in the brain, mainly in the structures of the inner ear – H ₁ , H ₂ receptors, and H ₃ – in the trunk, in the cerebellum and in the hypothalamus. Here on this slide is what I said.

Betaserc (24 mg), betahistine hydrochloride, excipients: mannitol. We must remember that it is not in generics. It has a direct agonistic effect on H ₁ receptors and mediated on H ₃ -receptors, improving microcirculation, capillary permeability, normalizes endolymph pressure, increases blood flow in the basilar artery.

Comparative evaluation of betaserc and cinnarizine showed the effectiveness of cinnarizine.

A large number of patients were treated with betaserc, observed in the scientific center of neurology with dizziness, noise and hearing loss, vascular pathology, arterial hypertension, atherosclerosis, osteochondrosis. 58 of them – recovery, 35 – improvement.