VERTIGO

VERTIGO

• It is defined as a false sense of orientation of the

patient with respect to his environment, Visual
hallucination

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 Causes of Vertigo

Otological causes Non otological causes

Vertigo Vertigo
With deafness without deafness

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Otological Causes
- Vertigo associated with deafness & other Aural
symptoms
- Vertigo without deafness

• Non Otological Causes

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 OTOLOGICAL CAUSES
Vertigo with deafness
• Meniere’s Disease
• Labyrinthitis
• Middle Ear Disease
- O.M.E. - A.S.O.M. - CSOM
• Trauma to Labyrinth
- Operative - Non operative
• Miscellaneous
- Acoustic Neuroma - Otosclerosis
- Ototoxic Drugs - Syphilis
- Wax - E.Tube Block
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Vertigo without Deafness

• Vestibular Neuronitis

• Benign Positional Vertigo

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 NON OTOLOGICAL CAUSES
• Cervical Spondylosis
• Vertebro Basilar Insufficiency
• Ageing
• Transient Ischaemic Attacks
• Head injury
• Epilepsy
• Cerebellar Disease
• Multiple Sclerosis
• Tumors of brain stem & Floor of IV Ventricle
• Cervical Vertigo
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 V E R T I G O

V- Vascular

• Hyper or hypotension

• Anaemia

• Vertebrobasilar insufficiency

• Thromboembolic phenomenon
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• E - Endocrinal - Diabetes, hypothyroidism

- Epilepsy

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• R- Remedial drugs

– Streptomycin

– Sedatives

– Antihypertensives

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T- Trauma

• Accidental

• Iatrogenic

- Tumors

• Acoustic neuroma
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I - Infections

Viral, bacterial, syphilitic, labyrinthitis

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G- Glial disease
• Disseminated sclerosis

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O - Occular diseases

• High refractive error and diplopia

- Others
– Meniere’s disease
– Vestibular neuronitis
– B.P.P.V
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 DIAGNOSIS
• History
Imbalance: Terminology & Aetiology
Term Symptom Cause
Vertigo An illusion of rotary Peripheral vestibular disease,
movement worse in the dark rarely central vestibular pathology
Lightheadedness A feeling of fainting Cardiovascular (postural
hypotension, antihyperlensives),
Ototoxic drugs, Psychiatric
conditions
Unsteadiness Difficulty with galt, a tendency Ageing process with general
to fall or veer to one side incordination, rarely neurological
Loss of conciou- Usually a clear-cut history Neurological (epilepsy), cardiac
sness, blackouts arrythmias
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 Duration of symptoms of imbalance in relation
to aetiology

Duration Aetiology
Seconds Cervical spondylosis, postural
hypotension, Benign paroxysmal
positional vertigo

Minutes to hours Meniere’s disease, Labyrinthitis,

Hours to days Labyrinthine failure (without

compensation) Ototoxicity, Central
vestibular disease
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Clinical Examination
• Otological examination
• General examination
• C.V.S examination
• Neurological examination
– Gait
– Rombergs
– Posturography
– Past pointing

• Audiological Tests

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Vestibular Function Tests
– Caloric tests
– Elecrto Nystagmography (ENG)

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• Laboratory Investigations
C.B.P
C.U.E
Blood sugar
Lipid profile

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• Radiological examination
– Plain X ray
• Mastoids
• C.Spine

– C.T Scan
– M.R.I

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 NON PATHOLOGICAL VERTIGO

• Physiological- Heights
- Fun games
- Sudden changes in floor texture
• Functional

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 TREATMENT OF VERTIGO

Treat the cause

• Reassurance

• General measures – Avoid tobacco, alcohol,

intoxicating substances

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• Medical treatment
– Labyrinthine sedatives
• Promethazine (Phenergan)

• Dimenhydrinate (Dramamine)

• Prochlorperazine (Siquil)

• Chlorpromazine (Largactil)

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- Vasodilators
• Chinnarazine
• Betahistrdine
• Ncotinic Acid

– Vitamins B1,B6,B12
– Low salt diet, diuretics
– Tranquilizers and antidepressants

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• Surgical – Mainly for Menier’s

– Endolymphatic sac decompression and shunts

– Vestibular nerve section

– Destructive surgery on labyrinth

• Labyrinthine exercises
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THANK YOU