Best Doctor for Dizziness Near Me

FAQs

Dizziness Care

What happens during a dizziness/ vertigo evaluation?

Audiologists perform these evaluations to get a sense of your balance and determine possible factors causing vertigo symptoms. During a dizziness/ vertigo evaluation, you will be asked about your medical history, any medication you may be taking, and your experience with vertigo symptoms.

After this preliminary consultation, peripheral assessments and balance testing will be conducted. Depending upon the results generated, a recommendation for additional follow-up testing or referral to a specialist (such as a neurologist or otolaryngologist) may be provided.

What is an audiologist?

Audiologists are health care professionals who specialize in diagnosing and treating conditions related to hearing loss, balance disorders, and other auditory problems. Audiologists usually obtain and bachelor’s degree and a master’s degree in audiology from an accredited university. Most then earn a Doctor of Audiology (AuD) degree. After receiving their doctoral degree, audiologists obtain licensure from the state in which they practice and accreditation from the American Speech-Language-Hearing Association (ASHA). ASHA awards a Certificate of Clinical Competence in Audiology (CCC-A)to qualified professionals.

What conditions do audiologists treat?

Audiologists can diagnose and treat conditions related to hearing disorders, balance problems, and the impairment of certain neural systems. Some examples of services audiologists provide include:

• Hearing tests: Audiologists can perform hearing tests using listening devices and scoping tools to help determine the cause of hearing loss and the degree of hearing impairment.

– Hearing impairment/ loss: Audiologists are trained to diagnose and treat hearing disorders such as hearing loss, tinnitus (ringing in the ears), and hearing impairment due to damage to the inner ear. Depending on the level of hearing loss they find, audiologists may recommend treatment plans. These could include hearing aids, devices that help patients recover hearing ability.

• Hearing assistance devices: If your audiologist uncovers signs of hearing impairment, they may recommend hearing assistance devices such as hearing aids, cochlear implants, and audiologic therapy to help repair or lessen hearing loss.

• Balance disorders and dizziness treatment: Audiologists don’t just treat hearing loss – they are also experts in balance disorders, which are often caused by conditions in the ear. Some examples of these conditions include inner ear damage, neurological disorders, and head injuries. Audiologists will perform tests to determine the cause of the balance disorders and work with you to create a treatment plan that can help improve balance. Audiologists are also trained to perform vestibular rehabilitation, a series of exercises that can help reposition the head and body.

How do audiologists treat balance disorders?

Audiologists receive special training to help assess and diagnose balance problems caused by conditions in the ear. Common symptoms of balance disorders include:

Balance problems can result from a number of underlying conditions – including hearing disorders. An audiologist will first test your hearing and examine your ears to determine if they are the cause of the problem.

If your audiologist finds that an ear disorder is causing your balance problems, they may recommend vestibular rehabilitation, a program of exercises that helps patients improve balance and reduce dizziness. Some common types of vestibular rehabilitation exercises are:

• Posture training

• Walking training

• Neck mobility and stretching

• Vision stability training

• Strengthening exercises

Depending on your condition, vestibular rehabilitation can usually take somewhere between 6-8 weeks, with sessions taking place once or twice a week. Vestibular rehabilitation has been shown to be very effective in reducing dizziness and correcting balance problems.

Should I see a doctor in-person or online?

It depends. Telehealth platforms like Sesame make it easier than ever to see a doctor online from the comfort of your home through virtual visits. These are real-time video chats with doctors and providers that are used to address symptoms, discuss prescriptions, and screen for health care conditions. Telehealth (also known as telemedicine) is a convenient way to see a health care provider without requiring the commute and waiting rooms of office visits.

In-person visits, however, are vital health services. Certain conditions and specialty care services cannot be diagnosed or performed via a telehealth visit. Lab testing, for instance, often requires an in-person appointment at a doctor’s office. Similarly, some physical exams, chronic condition consultations, and urgent care needs require in-person care. Some patients feel more comfortable receiving their care through in-person doctor visits, and many telehealth services require in-person visits before a condition can be definitively diagnosed.

Health care marketplaces like Sesame offer both in-person and virtual care options. If you’re unsure whether or not you need to see a provider face-to-face, we recommend that you book a video doctor visit to discuss your concerns and talk through any symptoms you may be experiencing. If an in-person doctor appointment is required, you can easily book a visit through Sesame’s scheduling platform.

How does booking care on Sesame work?

Sesame makes it easier than ever to find and pay doctors online directly – allowing you to book an in-person or telehealth appointment in less than two minutes. To get care today, follow these easy steps:

• Search for telehealth or in-person appointments by specialty, condition, or doctor
• Choose a doctor at the right price and time for you.
• Pay for your appointment online at direct-discount prices.
• Before your appointment begins, complete a brief medical history form.
• If you’re seeing a doctor online, click the link sent to your email to join a secure online telehealth appointment. If you’re seeing a doctor in person, go to their office at the time of your appointment.
• If you are prescribed medication and choose medication delivery, it is usually delivered to your home within 2-3 business days. Otherwise, you can select a local pharmacy often with same-day pick-up. Providers on Sesame can prescribe anything medically appropriate, except for the limited set of controlled substances (as defined under the Controlled Substances Act).

What is telehealth?

Telemedicine (also sometimes called “telehealth”) is a form of virtual care that healthcare professionals offer patients looking for efficient, flexible care. With telemedicine, you can speak with a doctor about your symptoms and work to develop a treatment plan that’s right for you – without the hassle of having to drive to different doctors’ offices or navigate confusing insurance copays. If you’ve already seen a doctor and need a second opinion or more clarity on your condition, you can schedule a quick and easy telemedicine appointment to get your questions answered on your own time.

What is a telehealth appointment?

Telehealth appointments also called telemedicine are medical visits that take place over face-to-face real-time video with fully licensed medical professionals including doctors or nurse practitioners.

What types of telehealth care can I book through Sesame?

It is up to the provider to determine what services they offer through a virtual appointment. Examples of care you can find on marketplaces like Sesame include:

• Primary care
• Urgent care (for conditions such as rashes, sore throat, migraines, UTIs, and more)
• Sexual health consultations
• Mental health consultations
• Chronic condition management
• Dermatology consultations
• Prescription refills
• Pediatric care

If you are experiencing a medical emergency, do not use telehealth. Instead, call 9-1-1 or go to your nearest emergency room immediately.

What are the benefits of telehealth and video visits?

Over the past few years, telehealth has transformed the healthcare landscape giving patients better access to quality doctors and providers. Still, some may be unfamiliar with telehealth and its benefits.

In the simplest terms, telehealth is a means of managing your health with the use of digital platforms, video, and virtual consults with online doctors and providers. This includes:

– Virtual appointments: the ability to see your doctor virtually with video consultations. This is perfect for both new patients and those with ongoing appointments that don’t require an in-person visit. Despite what you may have heard, many conditions can actually be treated over video, including toothaches, moles, warts, UTIs and other vaginal infections, and more.

– Correspondence between doctors: By promoting faster, more efficient means of communication, telehealth allows for doctors to better coordinate and address patient needs.

– Virtual health records: Apps, sometimes called personal health record systems (PHRs) allow for the viewing of health care records from a web-enabled device.

– Remote Monitoring: Apps that upload medical information, such as lung function, blood pressure, and blood glucose readings, so that your doctor can monitor you virtually.

How do I access my telehealth appointment?

After you book a video appointment, you will receive both an initial confirmation and a reminder via email and text.

There are three ways in which a video visit can be accessed:

• Select “Join virtual appointment” from the booking confirmation email.
• If you have an existing account or created one at purchase, log in at sesamecare.com, navigate to ‘My appointments,’ and select “Join virtual appointment.”
• Click the link in the text message sent to you 15 minutes prior to your scheduled appointment time.

We suggest using Google Chrome, Firefox, or Safari to connect to your visit.

How do I book a telehealth appointment?

To book a virtual visit through Sesame, visit Sesamecare.com. Use our search bar to look up the issue you may need addressed (such as “Prescription Refill”, “Sore Throat”, or “Urgent Care”). From there, you can browse relevant providers and our transparent prices to find the clinician or doctor that you want to see – at the price you want to pay. You can look at that provider’s availability to schedule a virtual visit that works for your schedule. Finally, pay for your appointment upfront and wait for the booking confirmation email to get the link to your appointment.

How can I prepare for my telehealth appointment?

After booking your telehealth appointment on Sesame, you will receive a link to test the phone, tablet, or computer where you will speak with your provider. Sesame will send you a unique and secure webpage for you to access your telehealth appointment directly from your web browser. In the rare case that you run into any technical issues, our friendly support team is available to walk you through any challenges.

Should I use my phone, tablet, or computer for my telehealth appointment?

You can use your phone, tablet, or computer for a telehealth appointment on Sesame. Sesame works on the web through your web browser – Google Chrome, Safari, Microsoft Edge or Firefox. It is easy to connect in just a few seconds with a quality Sesame provider who is ready to listen to your medical concerns.

Sesame supports face to face video communications, but turning on your video is not required if this makes you uncomfortable.

Is there anything doctors on Sesame won’t treat?

Any service listed on Sesame can be treated by doctors on the platform. Any specific exclusions to an appointment can be found in the service description. Telehealth appointments will not result in a prescription for controlled substances. If you are looking for a prescription for controlled substances, you should find a local clinician with whom you can establish an in-person relationship.

Can my provider prescribe medication?

Yes, physicians on Sesame can prescribe a wide range of medications, which can be useful for infections, allergies, and other acute ailments.
Please note that they will not prescribe certain drugs, such as narcotics or medications that have been designated controlled substances through telehealth.

Otherwise, many of the prescriptions available in an office setting or urgent care can be prescribed if your clinician deems it appropriate.

Do I need health insurance to book telehealth services?

Nope! Sesame connects patients directly to doctors through our easy-to-use booking platform. That means you can get great care with top-rated health care providers without involving insurance companies. Skip the costly co-pays and premiums when you book a doctor’s appointment through Sesame. Prices on Sesame are transparent, and payment is easy. In many cases, you can pay for your visit with a one-time upfront cash price – usually 60% less than what you’ll find through insurance networks. So, not only are you saving money, but you’re also getting the best care available from the comfort of your own home.

What is meclizine?

Meclizine (generic Antivert) is used to prevent and treat nausea, vomiting, and dizziness often caused by motion sickness. It can also be used to help prevent and treat the dizziness and lightheadedness caused by vertigo.

Motion sickness is incredibly common. It is caused by conflicting messages sent to your brain by motion-sensing parts of your body, such as your eyes, inner ears, joints, and muscles. Common activities that trigger motion sickness are riding in the car, amusement park rides, being on a boat, or flying in an airplane. The Mayo Clinic estimates that 1 out of 3 people will suffer from motion sickness at some point in their life.

Vertigo is a symptom, not a condition, of an inner ear problem (such as benign paroxysmal positional vertigo). Vertigo can make you feel off-balance or like the world is spinning around you. These feelings can last from a few minutes to a few hours.

What is meclizine used to treat?

Meclizine is used to prevent and treat the symptoms of motion sickness and vertigo.

How does meclizine work?

Meclizine is in the class of medicines called antihistamines. It is also sometimes called an antiemetic. Antihistamines help treat motion sickness and vertigo by blocking the signals sent to your brain that would cause you to be nauseous, dizzy, or need to vomit. Meclizine also has an anticholinergic action- it blocks a signal sent by your cells that may lead you to need to vomit. The combination of the antihistamine and anticholinergic effects reduces the contact of the vestibular system (structure in your ear that communicates with the brain about sensory information and spatial orientation) with the part of your brain that controls vomiting.

How long does it take for meclizine to work?

If you’re taking meclizine for motion sickness, it is recommended you take it an hour before the activity that may cause you to feel sick – like riding in a car or on a boat.

What are common side effects of meclizine?

While adverse reactions to Meclizine are uncommon, some patients who take the drug may experience mild side effects, including:

• Drowsiness
• Dry mouth
• Headache
• Fatigue
• Vomiting
  –
  If any of these side effects are serious or do not go away, tell your doctor.

On rare occasions, patients have reported blurred vision or allergic reactions after taking Meclizine. If any serious adverse reactions occur, talk to your doctor immediately.

To reduce your risk of side effects, you should not take Meclizine with alcohol.

This is not a complete list of Meclizine’s side effects. For more information on advice effects associated with Meclizine, please visit the National Institutes of Health’s DailyMed webpage.

Can I get meclizine online?

Yes! Sesame offers a fully integrated prescription service, which means you can get the medication you need delivered right to your door, starting at just $5 a month.

Talk to a provider on Sesame and get your online doctor prescription or refill ordered right away for fast and convenient pickup from a pharmacy of your choice.

Note that all prescriptions are at the discretion of your clinician.

Dizziness/Vertigo – Total ENT Care

Evaluation and Treatment of Dizziness/Vertigo

Diagnosis

If your doctor suspects you are having or may have had a stroke, are older or suffered a blow to the head, he or she may immediately order an MRI or CT scan.

Most people visiting their doctor because of dizziness will first be asked about their symptoms and medications and then be given a physical examination. During this exam, your doctor will check how you walk and maintain your balance and how the major nerves of your central nervous system are working.

You may also need a hearing test and balance tests, including:

• Eye movement testing. Your doctor may watch the path of your eyes when you track a moving object. And you may be given an eye motion test in which water or air are placed in your ear canal.
• Head movement testing. If your doctor suspects your vertigo is caused by benign paroxysmal positional vertigo, he or she may do a simple head movement test called the Dix-Hallpike maneuver to verify the diagnosis.
• Posturography. This test tells your doctor which parts of the balance system you rely on the most and which parts may be giving you problems. You stand in your bare feet on a platform and try to keep your balance under various conditions.
• Rotary chair testing. During this test you sit in a computer-controlled chair that moves very slowly in a full circle. At faster speeds, it moves back and forth in a very small arc.

In addition, you may be given blood tests to check for infection and other tests to check heart and blood vessel health.

Treatment

Dizziness often gets better without treatment. Within a couple of weeks, the body usually adapts to whatever is causing it.

If you seek treatment, your doctor will base it on the cause of your condition and your symptoms. It may include medications and balance exercises. Even if no cause is found or if your dizziness persists, prescription drugs and other treatments may make your symptoms more manageable.

Medications

• Water pills. If you have Meniere’s disease, your doctor may prescribe a water pill (diuretic). This along with a low-salt diet may help reduce how often you have dizziness episodes.
• Medications that relieve dizziness and nausea. Your doctor may prescribe drugs to provide immediate relief from vertigo, dizziness and nausea, including prescription antihistamines and anticholergenics. Many of these drugs cause drowsiness.
• Anti-anxiety medications. Diazepam (Valium) and alprazolam (Xanax) are in a class of drugs called benzodiazepines, which may cause addiction. They may also cause drowsiness.
• Preventive medicine for migraine. Certain medicines may help prevent migraine attacks.

Therapy

• Head position maneuvers. A technique called canalith repositioning (or Epley maneuver) usually helps resolve benign paroxysmal positional vertigo more quickly than simply waiting for your dizziness to go away. It can be done by your doctor, an audiologist or a physical therapist and involves maneuvering the position of your head. It’s usually effective after one or two treatments. Before undergoing this procedure, tell your care provider if you have a neck or back condition, a detached retina, or blood vessel problems.
• Balance therapy. You may learn specific exercises to help make your balance system less sensitive to motion. This physical therapy technique is called vestibular rehabilitation. It is used for people with dizziness from inner ear conditions such as vestibular neuritis.
• Psychotherapy. This type of therapy may help people whose dizziness is caused by anxiety disorders.

Surgical or other procedures

• Injections. Your doctor may inject your inner ear with the antibiotic gentamicin to disable the balance function. The unaffected ear takes over that function.

Divaza® – How to deal with weakness and dizziness?

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Causes of weakness and dizziness

Weakness and dizziness are symptoms that can indicate diseases of various organs and systems (regardless of age), but in most cases this is evidence of problems with the vessels of the brain. Weakness and dizziness (causes below) are most common in old age and are due to poor blood supply to the brain due to:

• age-related changes in the brain;
• unhealthy lifestyle and bad habits;
• excessive physical or mental stress;
• malfunction of the vestibular apparatus;
• psycho-emotional disorders;
• all kinds of curvature of the spine, osteochondrosis, etc. ;
• cardiovascular and other diseases – hypertension, atherosclerosis, diabetes, vegetative-vascular dystonia, thyroid disease

How to get rid of weakness and dizziness

If you are familiar with these symptoms – dizziness, weakness, then it is reasonable to visit a therapist, cardiologist, endocrinologist or neurologist, so that the doctor prescribes the appropriate tests and studies (blood test, cardiogram, TRT, CT scan, ultrasound of the brain, etc.), makes the correct diagnosis and prescribed treatment.

In addition to drug therapy, it is usually recommended to review the diet (to reduce excess weight, for example, or optimize blood sugar and cholesterol levels) and the level of physical activity, as well as to get rid of bad habits if possible. It is important to observe the sleep and wakefulness regimen, walk in the fresh air as much as possible, control blood pressure and the state of the musculoskeletal system.

Medicines for weakness and dizziness after 50

When the causes of weakness and dizziness are associated with old age, doctors, as a rule, build treatment tactics based on nootropics, vasoconstrictive, vasodilator drugs, vascular protection agents and brain cells. There are combined drugs for dizziness, which have a nootropic and vasoactive (increasing the strength and density of blood vessels) action. Such pills for dizziness not only relieve symptoms, relieve manifestations of weakness, fatigue, drowsiness, but are also aimed (more importantly) at eliminating problems with blood vessels, they improve blood supply and oxygen saturation of the brain.

The new drug “Divaza” – a cure for dizziness, reduces its intensity, removes the feeling of weakness. It is a vasoprotective nootropic that has a positive effect on brain activity in a wide range of diseases. “Divaza” is drunk in a course up to six months, suitable for people from 18 years old, works against headaches, sleep disorders, decreased activity, fatigue. Its purpose is determined by the attending physician.

Seven principles for the treatment of vestibular vertigo and study results

Vestibular vertigo (VV) is one of the most common syndromes: about 5% of people experience it every year [1]. The prevalence of V.G. increases with age. Women suffer from vestibular disorders 2-3 times more often than men. The most common causes of VH are benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular migraine, vestibular neuronitis, stroke, and transient ischemic attacks (TIA). VH is usually accompanied by severe instability, as well as nausea and vomiting. Seizures V.G. are difficult to tolerate by patients, and anxiety and expectation of new attacks often lead to the formation of emotional disorders that make vestibular compensation difficult. All this makes the use and search for the most effective methods of stopping VH particularly relevant.

The choice of modern methods of treatment of VH is quite wide. In this case, effective treatment is based on establishing the cause of vestibular disorders. In our country, the contribution of cerebrovascular pathology, arterial hypertension, or diseases of the cervical spine is often overestimated. Meanwhile, large studies conducted in recent years show that other diseases can be the most common causes of dizziness: disorders of the peripheral vestibular analyzer (BPPV, Meniere’s disease, vestibular neuronitis) and migraine.

Seven principles for improving the effectiveness of treatment for CH

1. In the most acute period of SH, vestibular suppressants are indicated . Classical vestibular suppressants include antihistamines and benzodiazepines. In addition to them, some other drugs can be used: calcium channel blockers and acetyleucine.

Antihistamines. Only those h2-blockers that penetrate the blood-brain barrier are effective in CHB. These drugs include dimenhydrinate (50-100 mg 2-3 times a day), promethazine (25 mg 2-3 times a day orally or intramuscularly), diphenhydramine (25-50 mg orally 3-4 times a day or 10-50 mg intramuscularly) and meclozine (25–100 mg/day orally) [2, 3]. Side effects of vestibular suppressants include drowsiness, dry mouth, and confusion.

Benzodiazepines. The inhibitory mediator of the vestibular system is GABA, and benzodiazepines enhance the inhibitory effects of GABA, which explains the effect of these drugs in V. G. Benzodiazepines, even in small doses, significantly reduce dizziness and associated nausea and vomiting. The risk of drug dependence, side effects (drowsiness, increased risk of falls, memory loss), and slowing of vestibular compensation limit their use in vestibular disorders. The most commonly prescribed lorazepam, which at low doses (eg, 0.5 mg 2 times a day) rarely causes drug dependence and can be used sublingually (at a dose of 1 mg). Diazepam at a dose of 2 mg 2 times a day can also effectively reduce G.G. Clonazepam has been less studied as a vestibular suppressant but appears to be as effective as lorazepam and diazepam. Usually it is prescribed at a dose of 0.5 mg 2 times a day. Long-acting benzodiazepines, such as phenazepam, are not effective in SH [4]. A recent comparative study of the efficacy of lorazepam and promethazine demonstrated greater efficacy of the latter as a drug for the relief of CH [5].

Other vestibular suppressants . Less common vestibular suppressants include acetyleucine and calcium channel blockers. The effectiveness of acetyleucine (currently not registered in the Russian Federation) is due to its interaction with phospholipids of cell membranes and the ability to regulate the membrane potential of neurons in the vestibular nuclei and Purkinje cells [6]. Calcium channel blockers – nimodipine, verapamil, flunarizine (not registered in the Russian Federation) and cinnarizine – block voltage-gated calcium channels of inner ear labyrinth neurons. These drugs are inferior in effectiveness to antihistamines and benzodiazepines [7]. Sometimes anticholinergics (scopolamine, platyfillin) are used as vestibular suppressants. These drugs inhibit the activity of the central vestibular structures, thereby reducing dizziness [3]. However, some side effects of these drugs, in particular drowsiness and visual impairment due to accommodation disorders, superimposed on vestibular symptoms, in some cases only worsen the condition of patients, which significantly limits their use in recent times. As a result, these drugs are more often used to prevent motion sickness than to treat CH.

2. Antiemetics enhance and complement the effect of vestibular suppressants in the acute period of CH. They do not affect the severity of SH, but reduce the autonomic symptoms that often accompany it: nausea and vomiting. The most common antiemetics include phenothiazines, in particular prochlorperazine (5-10 mg 3-4 times a day). Metoclopramide (10 mg intramuscularly) and domperidone (10–20 mg 3–4 times a day, orally), peripheral D2 receptor blockers, normalize gastrointestinal motility and thus also have an antiemetic effect [8]. Ondansetron, a serotonin 5-HT3 receptor blocker, also reduces vomiting in vestibular disorders [9]. Side effects of antiemetics are dry mouth, drowsiness, extrapyramidal disorders.

3. The duration of administration of vestibular suppressants and antiemetics should not exceed 2-3 days. Vestibular suppressants and antiemetics depress the CNS and thus slow down vestibular compensation [10, 11]. Animal studies have shown that drugs such as phenobarbital, chlorpromazine, diazepam, and ACTH antagonists slow vestibular compensation and delay recovery [12]. These data served as a reason to recommend limiting the use of vestibular suppressants in acute VH (2-3 days). Moreover, this period is reduced as much as possible. In practice, the reason for the abolition of vestibular suppressants is the cessation of vomiting. Instead of vestibular suppressants, vestibular exercises and drugs that stimulate central vestibular compensation are prescribed.

4. Vestibular gymnastics stimulates vestibular compensation and speeds up recovery. Among the methods of treatment of diseases of the vestibular system, rehabilitation occupies a special place. There are several reasons for this, first of all, its high efficiency and sometimes the absence of a serious alternative from drug therapy. As a result, today, in accordance with international recommendations, vestibular gymnastics occupies almost the main place in the complex treatment of almost any disease of the vestibular system, whether it be central or peripheral vestibulopathy.

Gymnastics for vestibular disorders consists of four groups of exercises: for gaze stabilization, for training postural stability and gait, for sensory substitution and for habituation. Vestibular gymnastics should start as early as possible (no later than the 1st week of the disease) [13]. Postponing the start of rehabilitation to a later time is likely to slow down vestibular compensation and prolong the period of disability. In addition to an early start, there are several other rules of vestibular rehabilitation that can increase its effectiveness: do not use monotonous exercises and select them according to the needs of the patients’ daily activity, take into account the patient’s cognitive functions and comorbidities that affect balance, take measures to reduce anxiety and depression, since these conditions impede vestibular compensation [14].

5. The effectiveness of vestibular gymnastics can be increased with the help of drugs that stimulate vestibular compensation. Some substances have the property of stimulating central vestibular compensation. Animal studies have shown that amphetamine, caffeine, and ACTH accelerate vestibular adaptation [12]. Among drugs, the ability to stimulate vestibular compensation was found in betahistine dihydrochloride (betaserc), piracetam, and ginkgo biloba extract [15–17]. The effectiveness of these drugs is due to their effect on CNS neuroplasticity and, in some cases, has been confirmed not only by experimental studies, but also by clinical studies. Thus, the results of a placebo-controlled study [17] showed that betahistine dihydrochloride accelerates the onset of vestibular rehabilitation effects by 3 times in patients with unilateral non-progressive peripheral vestibulopathy resulting from labyrinthectomy in Meniere’s disease.

The duration of the use of these drugs is not completely clear, apparently determined by the nature of the vestibular damage and, therefore, the expected timing of vestibular compensation. If with unilateral peripheral vestibulopathy compensation occurs approximately after 2 months, then with bilateral, as well as with central vestibular disorders, it is much slower: within several months or years [18].

6. Pathogenetically substantiated treatment is based on finding out the cause of VH. The high frequency of diagnostic errors in VH, resulting from an overestimation of the role of vascular and cervicogenic mechanisms in the development of vestibular dysfunction, significantly reduces the effectiveness of vertigo treatment in general. The consequence of inadequate diagnosis is the widespread use of vasoactive and nootropic drugs, the value of which in the treatment of the most common causes of VH (peripheral vestibular disorders and vestibular migraine) is small. At the same time, the possibilities of pathogenetically substantiated drug and non-drug treatment of vestibular diseases have recently expanded due to the emergence of new drugs and the improvement of vestibular gymnastics.

Treatment of BPPV mainly consists of the use of therapeutic repositioning maneuvers. Maneuvers are designed to treat canalolithiasis of the various semicircular canals; their efficiency is high and approaches 100%. Medical or surgical treatment of BPPV is not required in most cases [19].

Treatment of Meniere’s disease consists of several stages. At the first stage, conservative approaches are applied, which are reduced to a salt-free diet, the use of diuretics and betahistine dihydrochloride. If no results are achieved within six months and attacks of VH continue, transtympanic injections of corticosteroids or gentamicin are performed. Finally, if these measures are ineffective, they resort to surgical treatment — labyrinthectomy, or selective neurectomy of the vestibular part of the vestibulocochlear nerve [20–23].

Treatment of vestibular neuronitis is reduced to the use of symptomatic agents (vestibular suppressants and antiemetics) in the acute period of the disease, followed by the selection of vestibular rehabilitation exercises in combination with drugs that stimulate vestibular compensation [24].

For vestibular migraine, the same drugs are given to prevent vertigo as for normal migraine: β-blockers (propranolol or metoprolol), antidepressants (tricyclics or SSRIs), antiepileptics (eg, topiramate, lamotrigine, or valproic acid drugs), blockers calcium channels (eg flunarizine). To stop attacks of vestibular migraine, in addition to vestibular suppressants and antiemetics, triptans and NSAIDs are used [25, 26].

Symptomatic agents aimed at reducing oscillopsia and unsteadiness are used for the treatment of central vestibular disorders, which have arisen, for example, due to stroke, trauma or MS [27]. These drugs include baclofen, memantine, gabapentin, aminopyridine, and acetyleucine [28].

7. According to study VIRTUOSO , betahistine dihydrochloride may reduce the frequency of SH attacks, regardless of the cause. Betahistine was first registered in Canada in 1968 and has since been widely used throughout the world for the treatment of diseases manifested by VG. Betahistine is a strong h4 receptor antagonist and a weak h2 agonist [29]. By acting on the h2 receptors of the inner ear, betahistine has a pronounced vasodilating effect [30]. The decrease in the number of vertigo attacks in the treatment with betahistine is apparently due to an increase in blood flow in the inner ear, which reduces the increased endolymphatic pressure in it, restoring the balance between production and reabsorption of endolymph [31]. In addition, various animal studies have shown that betahistine is able to improve vestibular compensation, showing a direct histaminergic effect; the drug accelerates the release and metabolism of histamine by blocking presynaptic h4 histamine receptors (in the vestibular and tuberomamillary nuclei) [30].

The clinical efficacy of betahistine has been evaluated in several studies. At the same time, in a number of studies, the effectiveness of betahistine was confirmed [17, 32, 33], while the results of others did not differ from the effectiveness of placebo [34].

The aim of the recently completed international observational program VIRTUOSO was to evaluate the effects of betahistine dihydrochloride (betaserc) at a dose of 48 mg/day in the form of tablets in routine clinical practice in outpatients with VG. At the same time, not only the overall clinical response was assessed during the period of therapy, but also the delayed effects of treatment, determined by the frequency of attacks of CH within 2 months after the completion of betahistine [35].

Study design. The study was a prospective, multicentre, non-comparative, post-marketing observational program that included 23 medical centers and 309 patients; 305 patients completed the observational program. The program included patients who were prescribed betahistine in accordance with the instructions for use of the drug and clinical recommendations for the treatment of a disease manifested by paroxysmal V.G. Betahistine was administered at a dose of 48 mg/day. The treatment lasted 1-2 months; the follow-up period after discontinuation of treatment was 2 months.

The study included men and women aged 18 years and older suffering from attacks of CH of known or unknown etiology, who were treated with betaserc (betahistine dihydrochloride) at a daily dose of 48 mg. All patients consented to the use and processing of personal data. Enrolled patients could not take betahistine for 5 or more days prior to obtaining written consent and enrollment in the study.

The number and proportion of patients with a clinical response at the end of therapy during program follow-up, assessed by the CHS severity and clinical response scale (SVVSLCRE), were assessed as treatment outcome measures. In addition, a change in the incidence of CH episodes at the end of therapy during program follow-up compared with inclusion visit was observed among patients treated with betahistine dihydrochloride. The overall clinical response was also assessed separately by the doctor and the patient, determined on a 4-point scale, where 4 is a marked improvement, 3 is a significant improvement, 2 is a slight improvement, and 1 is worsening. We analyzed the change in the frequency of CH episodes within 2 months after the end of therapy compared with the end of the therapy period. Finally, regression of vertigo-related symptoms (ringing in the ears, hearing loss, nausea, vomiting, weakness, and headache) was determined during treatment as judged by the clinician and patient.

Research results. Clinical efficacy of treatment on the SVVSLCRE scale was assessed as significant improvement, marked improvement or very marked improvement in 74.1% of cases ( p <0.001). The number of vertigo attacks per month while taking betahistine decreased from an average of 8.0 to 3.0 ( p <0.001). During the 2-month follow-up period after discontinuation of the drug, the number of seizures continued to decrease until complete disappearance by the end of the 1st month of follow-up ( p <0.001). This effect persisted by the end of the 2nd month of observation.

The overall clinical response to treatment with betahistine (by the end of the 2nd month of taking the drug) according to the doctor was assessed as a marked improvement or significant improvement in 94.4% of cases, and according to the patient – in 95.4% of cases.

Betahistine also had an effect on the symptoms associated with dizziness. The effectiveness of the treatment of concomitant symptoms was assessed as a marked improvement or a significant improvement in 71. 4% of cases by the end of the 1st month of taking the drug and in 90.5% of cases by the end of the 2nd month according to both the doctor and the patient.

An observational program has demonstrated the high safety of betahistine dihydrochloride and the low incidence of side effects. Only one patient dropped out of the study early due to the lack of efficacy of treatment and an increase in the frequency of dizziness attacks. Serious N.Ya. was not registered.

Thus, the observational program VIRTUOSO confirms the results of previous studies that indicated the effectiveness of betahistine at a dose of 48 mg / day in VG. The study demonstrated a significant reduction in the frequency of CH attacks, regardless of the etiology of the disease. An important result of the study was the discovery of a delayed effect of treatment with betahistine: the number of seizures continued to decrease within 2 months after discontinuation of the drug. This result may indirectly testify in favor of stimulation under the influence of betahistine of central vestibular compensation.