The prerequisites for successful pharmacological treatment of vertigo and dizziness are the “4 D’s” 2: correct diagnosis, correct drug, appropriate dosage and sufficient duration (Table 2). Prerequisites for pharmacological treatment Correct Diagnosis As in all cases and particularly with these medications, vestibular patients should be informed before starting treatment of the balance between risks and benefits. This is because only a few medications have proven, in controlled trials, to be effective for treating vestibular disorders. Many of these drugs are still used in off-label manners (i.e., are used in a way not specified in the FDA’s approved label). While vestibular diagnosis has tremendously evolved with the development of new instruments – vHIT (video Head Impulse Test) and VEMP (vestibular evoked myogenic potentials), just to mention a few examples – the treatment of vestibular pathology has undergone many changes not so much by the discovery of new medications, but rather by the use of medications originally used for non-vestibular pathologies. Prerequisites for Pharmacological Treatments With this paper we aim to introduce the reader to the complexity of decision-making when treating vestibular disorders, as well as to analyze the most used pharmacologic strategies for the most common etiologies of vertigo and dizziness. Vertigo and Dizziness Treatment Options Pharmacological vestibular schwannoma) some drugs (namely gentamicin and dexamethasone) may also be applied transtympanically as a simple procedure under topical anesthesia. Surgical treatments – in less frequent lesions such as semicircular canal dehiscence, where there is a lack of bone covering one or more semicircular canals and ear tumors (e.g.Psychotherapeutic measures (particularly important in psychogenic vertigo).exercises for eye and head stabilization, proprioceptive training or habituation exercises) Liberatory and repositioning maneuver for BPPV treatment (specific maneuvers according to the location(s) of the otoconial debris Epley and Semont maneuvers are common examples for repositioning debris located in the posterior semicircular canal).The use of medications in treating vestibular disorders depends on these distinctions.ĭepending on their etiology, treatment options of vestibular disorders may be summarized as (Table 1): If it is more chronic, dizziness and/or disequilibrium may be the manifest symptoms. If this process is acute, vertigo, nausea and vomiting may result. These produce asymmetric input into the central vestibular apparatus or asymmetrical central processing. They are symptoms of a variety of disorders that involve the peripheral (otologic vertigo) and/or the central vestibular (brain-induced vertigo) systems. Vertigo and dizziness are among the most common complaints, having a lifetime prevalence of about 30% 1. Can the use of Medications Improve vestibular symptoms?
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