Peripheral vestibular disorders
Last updated date: 14-Jun-2023
Originally Written in English
Peripheral Vestibular Disorders
Dizziness is not an illness; it is a symptom. The term dizziness refers to the sensation of being woozy, inebriated, unstable, or giddy. It is a term that is used to broadly define the experience of unbalance. People frequently use the words vertigo, dizziness, lightheadedness, and motion sickness to describe balance issues. A condition known as vertigo is a particular type of dizziness marked by the sensation of spinning or whirling. This typically happens as a result of an imbalance issue. Vertigo is a term that can also be used to express unsteadiness, faintness, and dizziness. Vertigo and dizziness will be used interchangeably throughout this article. One of the most prevalent medical conditions among adults is vertigo. About 40% of Americans experience dizziness at least once in their lifetime, according to the National Institutes of Health (NIH). The prevalence rises with age and is a little higher in women. While the majority of people who feel dizziness have mild to moderate symptoms, 10% of patients are thought to have severe symptoms that result in disability. The vestibular system, which controls balance, may be affected by drugs and trauma which can cause vertigo. Age also increases a person's susceptibility to vestibular problems like vertigo.
What is Peripheral Vestibular Dysfunction?
Peripheral vestibular disorders involve disease of the vestibular part of the eighth cranial nerve as well as the inner ear vestibular structures. Such a disease reduces the sensory data that can be used to determine head movement and position. Neuritis, labyrinthitis, bilateral vestibular loss, Meniere's disease, BPPV, and vestibulopathy following surgical operations (such as labyrinthectomy and acoustic neuroma) are some of these conditions.
Peripheral Balance Disorder Causes
Both peripheral and central sources of vestibular dysfunction, which can manifest either abruptly or persistently, can be attributed to the etiology of the condition. The membranous labyrinth, along with the superior and inferior vestibular nerves, is referred to as the vestibular system's peripheral components. The word central describes a pathology that affects the physical central nervous system (CNS). The symptoms of the acute vestibular syndrome include vertigo, nausea, vomiting, intolerance to head motion, unsteady gait, and postural instability. Except in situations of paroxysmal positional vertigo, the symptoms must last for at least 24 hours to satisfy the criteria for an acute vestibular syndrome.
A mechanical condition of the inner ear called paroxysmal positional vertigo causes brief episodes of transitory vertigo that are frequently accompanied by autonomic symptoms. At least 20% of people who experience moderate to severe vertigo or dizziness have benign paroxysmal positional vertigo (BPPV), which is also the most frequent cause of short, episodic peripheral vestibular dysfunction. The most frequently affected are women and people over fifty.
Meniere disease is another prevalent peripheral vestibular disease that causes vertigo attacks that last anywhere from minutes to hours and are accompanied by hearing loss and ringing tinnitus. Endolymphatic hydrops, which cause distortion and distention of the endolymph sections of the labyrinthine system, is likely to be the cause of this disorder. Numerous hypothesized causes have been put out; however, it has been difficult to pinpoint the exact origin of excessive fluid in the inner ear.
Vestibular neuritis, a third typical peripheral cause of vertigo, is thought to be brought on by an acute viral or post-viral inflammatory condition. The eighth cranial nerve's vestibular branch is affected by inflammation, which can lead to hypofunctional vestibulopathy and vertigo that can last for days at a time. The condition is known as labyrinthitis if the inflammation also damages the cochlea and results in hearing loss.
Peripheral vestibulopathy can also be caused by a variety of other conditions, such as autoimmune diseases like Cogan syndrome and autoimmune inner ear disease, neoplasms like vestibular schwannoma, temporal bone fractures, perilymph fistulas, and semicircular canal dehiscence syndrome, as well as medications that are toxic to the inner ear, such as gentamicin and streptomycin. In the end, peripheral vertigo can result from any process that inflames the membranous labyrinth, abnormally stimulates the vestibular apparatus or structurally weakens it.
Peripheral Vestibular Disorders Symptoms
Vertigo is the term used to describe the feeling of spinning or the sense that things around you are moving or spinning. A feeling of being pushed toward the floor or one side of the room has been reported by some people. Vertigo is frequently made worse by turning while lying down, shifting positions, and moving the head.
A peripheral vestibular disorder, such as benign paroxysmal positional vertigo, Meniere's disease, or vestibular neuritis, is usually suggested by the abrupt onset of vertigo.
Benign paroxysmal positional vertigo (BPPV) symptoms frequently come and go and last anywhere from a few seconds to a few minutes. They may also include dizziness, unsteadiness, and nausea, frequently brought on by a change in position (such as when rolling over in bed or getting out of bed). Vertigo, hearing loss, tinnitus, and ear pressure are among the symptoms of Meniere's disease and vestibular neuritis. These symptoms frequently continue for hours or days.
The main symptoms of peripheral vestibular disorders may also occur including reduced cognitive performance (including thinking and memory), sensitivity to flashing lights and noise, increased sweating, blurred vision, fatigue and decreased stamina, headache, heart palpitations or arrhythmias (rapid fluttering of the heart), imbalance, and a higher risk of motion sickness. Other symptoms include nausea and vomiting, muscle aches, particularly in the neck and back, and nausea.
A central vestibular disease usually causes slow development of vertigo. Normal causes of central vestibular disturbances include stroke or migraine as well as underlying medical diseases. These central vestibular diseases may present with symptoms such as weakness, nausea, vomiting, dysarthria, double vision (diplopia), headache (which could be severe), decreased consciousness, and dysarthria, the inability to speak owing to muscle weakness.
Peripheral Vestibular Disorder Diagnosis
To rule out dangerous illnesses like cardiovascular disease, stroke, hemorrhage, or tumor, a doctor must identify the source of vertigo (dizziness) as soon as feasible.
A doctor may inquire as to whether the patient experiences any of the following symptoms to pinpoint the source of their vertigo: a sensation that the room is spinning or moving; a sense of faintness or lightheadedness; or a loss of balance.
Measurements of heart rate and blood pressure are part of a physical examination. Strength, coordination, balance, facial and vestibular nerves and muscles, as well as walking (gait), are all tested during a neurological examination.
To assist distinguish between peripheral and central vestibular diseases, the positional vertigo test is employed. The subject of this test is seated on a table with their head tilted to the side. The patient is then made to lie back as the doctor supports the head and slowly lowers it below the table. The patient complains of vertigo symptoms as the doctor checks for rotating eye movement (called nystagmus). Nystagmus that appears later than the feeling of vertigo is typically a sign of peripheral vestibular disease. A central vestibular dysfunction may be indicated by the absence of a delay. With the head turned the other way, the test is repeated.
Electronystagmography (ENG). A neurological procedure to evaluate the vestibular system using electronystagmography (ENG). Testing eye movements, assessing responses to changes in posture and position, and testing hearing in both ears are all parts of ENG. Recording electrodes are positioned close to the eyes in a dark environment. Each ear canal is softly filled with warm and cool air or water. Since the neurological system allows the eyes and ears to work together, measuring eye movements can be used to examine the balance system. The affected ear's capacity for balance is diminished in roughly 50% of people. To assess the balance system, rotational testing or a balance platform may also be used.
Blood test. To rule out systemic problems, blood tests include a complete blood count (CBC), kidney, and thyroid panels (such as kidney disease or thyroid disorders). Drug levels are measured to determine whether the person is taking any drugs, such as anticonvulsants or aminoglycosides.
Imaging tests. Brain abnormalities (such as stroke or tumor) may be discovered using imaging techniques. A magnetic field and radio waves are used in an MRI scan to produce cross-sectional scans of the head and body. A clinician can identify and diagnose a wide range of illnesses that may induce vertigo using these precise, clear images.
Peripheral Vestibular Disorder Treatment
The underlying cause of vertigo or dizziness must be identified and eliminated before treatment can be effective. Vertigo may be resolved by reducing dosage or stopping a certain medication if it is the cause of the symptom.
Endolymphatic sac procedures. Endolymphatic sac procedures are surgical treatments that lessen swelling brought on by an accumulation of endolymph (an inner ear fluid). A portion of the bone around the inner ear is removed during endolymphatic sac decompression. Decompression of the endolymphatic sac may occasionally be followed by the insertion of an endolymphatic shunt, a tube that removes extra fluid from the inner ear. A permanent, tack-like device that permits endolymph to leak out of the inner ear whenever pressure builds up is inserted during a procedure known as a sacculotomy.
The person shouldn't drive if they suddenly develop vertigo. The person and others may be in danger if the car is not controlled. Avoiding balance-demanding activities like climbing ladders, scaffolding, and swimming (due to the possibility of drowning) is also advised.
Labyrinthectomy. During a labyrinthectomy, the entire inner ear sensory organ (vestibular labyrinth) is removed. If antibiotic injections are ineffective and the patient has total or nearly complete hearing loss in the afflicted ear, surgery may be an option.
Lifestyle changes. Healthcare providers advise people with vertigo-causing disorders to refrain from consuming stimulants like caffeine, alcohol, and tobacco; get enough sleep; eat a nutritious diet that limits meat and fatty meals; and stay clear of foods that contain MSG, also known as monosodium glutamate. MSG, which contains sodium, is found in prepackaged food items as well as in Chinese cuisine. MSG might exacerbate symptoms and contribute to fluid retention. Vertigo may worsen under stress. Counseling or the avoidance of stress may be recommended.
Medications. In some people, a low-sodium diet plus a prescription diuretic, or water pill (such as hydrochlorothiazide), may lessen the frequency of dizzy attacks. Diuretic drugs make the patient urinate more frequently, which can lead to a depletion of minerals like potassium in the body. A potassium supplement or consuming three to four extra servings of potassium-rich foods per week, including bananas, may be advised by healthcare professionals.
A medical expert administers gentamicin (a toxic antibiotic) via the eardrum and into the inner ear as part of a middle ear injection. Now gentamycin can be taken in. As a result, the person's ear's role in maintaining balance is diminished, and their other ear substitutes it. The procedure, which can be carried out in a doctor's office under local anesthesia, frequently lessens the frequency and intensity of vertigo spells.
Some people may benefit from middle ear injections of a steroid such as a dexamethasone, which may help reduce vertigo attacks. Dexamethasone injections are less likely to further damage hearing than gentamicin, even though they may be slightly less effective.
Vertigo may be temporarily relieved by anti-vertigo drugs like meclizine. Sometimes doctors will give anti-nausea drugs like prochlorperazine. If the person develops vertigo as a result of anxiety, anti-anxiety medications like alprazolam may also be employed. Medication for vertigo, nausea, and anxiety may make you sleepy. Alprazolam belongs to the benzodiazepine drug subclass. These drugs may lead to psychological and physical addiction. Anticholinergic drugs can also be used to lessen vertigo. Among these medicines are scopolamine patches.
Surgery. If medical treatments are ineffective and the vertigo attacks are severe and debilitating, surgery may be a possibility. An operation called a myringotomy can be performed to treat recurrent ear infections. An eardrum incision is made during this treatment, and a tiny tube is inserted into the opening to stop fluid and bacteria from accumulating inside the ear.
Vestibular neurectomy. Cuts are made to the nerve (vestibular nerve) that regulates balance during a vestibular neurectomy. A vestibular neurectomy may be performed to surgically remove the entire inner ear when severe vertigo is present. The balance is then controlled by the person's other ear.
Vestibular rehabilitation therapy. A form of physiotherapy called vestibular rehabilitation therapy (VRT) is used to treat vertigo. By re-establishing the vestibular system's normal function, therapy aims to reduce dizziness, enhance balance, and avoid falls. In VRT, the patient engages in exercises that are intended to help the brain adjust to whatever is causing vertigo and compensate for it. The success of this therapy is dependent on several factors, such as the patient's age (younger patients respond better to treatment), cognitive function (such as memory and the capacity to follow instructions sequentially), coordination and motor skills, general health (including the central nervous system), and physical stamina.
Peripheral Vestibular Disorder Complications
The consequences of severe vertigo, which include irritation, loss of self-worth, depression, detrimental impacts on job performances and quality of life, and injuries from falls, can be debilitating. The most common serious injury among those over 65 is a fall. Driving a car or using heavy machinery while feeling queasy increases the risk of an accident. Vomiting and sickness can also result from dizziness.
Peripheral Vestibular Disorder Prevention
According to healthcare authorities, if a person is prone to vertigo (dizziness), they should be aware of the danger of losing their balance, which could result in a fall and significant harm. Patients are advised to sit or lie down right away if they feel dizzy, to avoid driving a vehicle or operating heavy machinery if they experience dizziness frequently, to use adequate lighting when getting out of bed at night, to walk with a cane for stability, to abstain from caffeine, alcohol, and tobacco, and to avoid using them altogether. Use of these products in excess can narrow blood vessels and exacerbate signs and symptoms. To properly manage symptoms, consult a doctor frequently. The patient can also get advice from a doctor or pharmacist regarding certain drugs that can make them dizzy.
The inner ear is the source of peripheral vestibular diseases. The most frequent cause of peripheral vertigo is BPPV. Common symptoms include tinnitus, fever, ear discomfort, hearing loss, nausea, and vomiting. Maintaining a healthy eating pattern significantly benefits the treatment of peripheral vestibular diseases in addition to prescription drugs, hearing aids, physiotherapy, and exercises.