Medical Management of Vestibular System Disorders

• Vestibular diagnostic tests


  Assess vestibular system function and rule out alternative causes of symptoms
• Purpose of vestibular function testing

  Determine whether there is any insult to the vestibular portion of the inner ear
• Dizziness not caused by the inner ear

  May be indicative of a disorder occurring in the brain, which can be physiological or psychological in nature
• Medical treatment for vestibular disorders


  May be directed to treat the etiology, control the symptoms, accelerate central compensation or diminish the psychological comorbidity
• When medical treatment isn't effective

  • Surgery may be considered
  • Type of surgery depends on diagnosis and physical condition
• Electronystagmography (ENG)


  A battery of eye movement tests that look for signs of vestibular dysfunction or neurological problems
• Videonystagmography (VNG)


  Uses an infrared video camera mounted inside Frenzel lenses to record eye movements
• Frenzel lenses


  • Magnify the patient's eyes and prevent them from suppressing nystagmus by focusing on targets
• ENG and VNG tests

  Measure oculomotor function, positional testing, and the caloric test
• Caloric test


  Warm or cold water/air is circulated in the ear canal to test horizontal semicircular canal function
• Unilateral weakness percent


  • Calculated from the peak slow component eye velocity or slow phase of nystagmus during caloric testing
  • A difference of ≥26% is usually indicative of a clinically significant unilateral weakness
• Rotational chair testing


  Evaluates both horizontal semicircular canals at more physiologically natural head movement frequencies
• Vestibular-evoked myogenic potential (VEMP)

  Tests otolith function by measuring the latency, amplitude, and threshold of a muscle contraction
• Cervical VEMP


  Evaluates the saccule and inferior vestibular nerve
• Ocular VEMP


  Evaluates the utricle and superior vestibular nerve
• Video head impulse test


  Evaluates the vestibulo-ocular reflex and identifies which ear is affected in cases of peripheral vestibular loss
• Subjective visual vertical and horizontal tests

  Assess otolith function and central pathways that convey gravitational information
• Computerized dynamic posturography (CDP)


  Provides information about motor control or balance function under varying environmental conditions
• Sensory Organization Test


  Assesses a patient's ability to integrate visual, proprioceptive, and vestibular inputs to maintain balance
• Motor Control Test


  Assesses the latency, weight distribution, and amplitude of postural responses to sudden displacements of the support surface
• Adaptation Test


  Determines the ability to adapt to repeated perturbing stimuli
• Audiometry


  Measures hearing function, an important part of vestibular diagnostics
• Neuroimaging


  • MRI can reveal tumors, strokes, and other soft-tissue abnormalities
  • CT scans can locate fractures
• Pharmacologic management of vestibular disorders

  • Antiemetics
  • Anti-inflammatories
  • Anti-Meniere's
  • Anti-migrainous
  • Antidepressants
  • Anticonvulsants
• Vestibular suppressants


  Drugs that reduce the intensity of vertigo and nystagmus, including anticholinergics, antihistamines, and benzodiazepines
• Surgical procedures for peripheral vestibular disorders

  • Corrective (repair/stabilize inner ear function)
  • Destructive (stop sensory information or prevent transmission to brain)
• Surgical procedures for Meniere's disease

  • Endolymphatic sac decompression
  • Vestibular neurectomy
  • Labyrinthectomy
  • Oval or round window plugging
• Surgical procedures for BPPV

  • Canal partitioning
  • Canal plugging
• Acoustic neuroma surgery


  Surgical resection of the tumor
• Vestibular implant


  Can facilitate walking, relieve dizziness and improve quality of life in patients with bilateral vestibular hypofunction