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Saturday, 30 November 2013

Vertigo Treatments In conventional medicine perspective

Vertigo is defined as a condition of dizziness of feeling of spinning, or swaying when one is stationary. Dizziness is a general, non-specific term to indicate a sense of disorientation. Some researchers suggested that vertigo is a subtype of dizziness and refers to an erroneous perception of self- or object-motion or an unpleasant distortion of static gravitational orientation that is a result of a mismatch between vestibular, visual, and somatosensory systems, affecting approximately 20-30% of the general population(1) and about two to three times higher in women than in men.
Treatments
A. In conventional medicine perspective 
 1. Manoeuvres
The most common Epley maneuver is performed by a doctor, audiologist, physical therapist, or with a BPPV maneuver at home. Dr, and the research team at in the study of Diagnosis and treatment of 318 benign paroxysmal positional vertigo cases, suggested that 318 patients, 221 (69.5%) with posterior semicircular canal involvement, Epley repositioning maneuver was performed; 62 (19.5%) with horizontal semicircular canal involvement, Barbecue maneuver combined forced prolonged position maneuver were applied; 23 (7.2%) with anterior canal involvement were treated with Epley maneuver; 12 (3.8%) had the mixed type and were treated with corresponding repositioning maneuvers. After one week the total improvement rate was 82.1% (261/318) and 91.8% three months later (292/318)(58).

Some researchers suggested that Prevention begins by maintaining good hydration and avoiding rapid movements of the head can be helpful. Researchers at the Università degli Studi di Palermo, indicated that Gufoni's manoeuvre is effective in treating patients suffering from BPPV of LSC; it is simple to perform; there are not many movements to execute, it needs low time of positioning, and positions are comfortable to the patient(59). Others suggested that Vannucchi maneuver and Log Roll. For more information of the above. (60)

2. Postural restriction therapy
The treatment of benign paroxysmal positional vertigo (BPPV) consists of a repositioning maneuver in order to remove otoliths from the posterior semicircular canal and subsequent postural restrictions to prevent debris from reentering the canal.but researchers at Chonnam National University Medical School and other showed that Postural restriction therapy, practiced after the modified Epley repositioning maneuver, did not have a significant effect on the final outcomes of BPPV. Based on our results, we do not recommend this therapy since there was no significant benefit for the patients who utilized postural restrictions(61).

3. Vestibular training (VT)
In the  study on treatment effects of vestibular training (VT) for benign paroxysmal positional vertigo was performed. The VT was compared with courses of patients in three different groups: patients treated by medication, by VT, and by VT with medication during 8 weeks. Dr. Fujino A and the team of reserachers at Kitasato University found that  In the groups treated by VT, the effects were not influenced by time since onset of disease or by patient age. It is therefore assumed that VT can be used as a first-choice treatment in patients with benign paroxysmal positional vertigo, even in long-term cases or older patients(65).

3. Medication
Certain medication are used in treating vertigo depending to the underlying cause. Dr Hain TC, and Dr. Uddin M. at the , Northwestern University indicated that therapy of vertigo is optimised when the prescriber has detailed knowledge of the pharmacology of medications being administered as well as the precise actions being sought. There are four broad causes of vertigo, for which specific regimens of drug therapy can be tailored. Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV) and bilateral vestibular paresis. In both Ménière's disease and vestibular neuritis, vestibular suppressants such as anticholinergics and benzodiazepines are used. In Ménière's disease, salt restriction and diuretics are used in an attempt to prevent flare-ups. In vestibular neuritis, only brief use of vestibular suppressants is now recommended. Drug treatments are not presently recommended for BPPV and bilateral vestibular paresis, but physical therapy treatment can be very useful in both. Central vertigo includes entities such as vertigo associated with migraine and certain strokes. Prophylactic agents (L-channel calcium channel antagonists, tricyclic antidepressants, beta-blockers) are the mainstay of treatment for migraine-associated vertigo. In individuals with stroke or other structural lesions of the brainstem or cerebellum, an eclectic approach incorporating trials of vestibular suppressants and physical therapy is recommended. Psychogenic vertigo occurs in association with disorders such as panic disorder, anxiety disorder and agoraphobia. Benzodiazepines are the most useful agents here(62).
 Other researchers suggested that treatment by medication together with two maneuvers-the particle repositioning maneuver (PRM) reported by Parnes and Price-Jones and the liberatory maneuver (LM) reported by Semont et al.-were compared with treatment by medication alone. The most important benefit of these maneuvers seemed to be the speedier recovery than with medication alone, as there was no significant difference in the late success rate after 3 months between the maneuvers and medication alone(63).
 
4. Surgery (Tenotomy)
In the study to compare the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Meniere's disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective, Dr. Loader B, and the research team at Medical University of Vienna showed that a statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013)(64)

5. Etc.
 
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22377855
(58) http://www.ncbi.nlm.nih.gov/pubmed/22509688
(59) http://www.ncbi.nlm.nih.gov/pubmed/19239952
(60) http://www.dizziness-and-balance.com/disorders/bppv/lcanalbppv.htm
(61) http://www.ncbi.nlm.nih.gov/pubmed/15378315
(62) http://www.ncbi.nlm.nih.gov/pubmed/12521357
(63) http://www.ncbi.nlm.nih.gov/pubmed/9186970
(64) http://www.ncbi.nlm.nih.gov/pubmed/22201453