Vertigo medical therapy: Difference between revisions

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Revision as of 19:29, 23 December 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S [2]


Treating Peripheral Vertigo
Ménière’s disease	Treatment is focused on preventing acute attacks and controlling the excess fluid build-up. Non-invasive: Low-sodium diet, hearing aid, positive pressure therapy. Medications: Meclizine, diazepam, promethazine, diuretics Steroid^[1] or gentamicin^[2] injections in middle ear. Surgery: Decompress endolymphatic sac, labyrinthectomy, Vestibular nerve section^[3].
Acoustic neuroma		Benign positional paroxysmal vertigo
Acute labyrinthitis
Acute vestibular neuritis		Cholesteatoma	Otosclerosis	Perilymphatic fistula
Treating Central Vertigo
Orbital and locoregional retinoblastoma	Chemotherapy Radiation therapy
CNS disease	Systemic chemotherapy and CNS-directed therapy Systemic chemotherapy followed by myeloablative chemotherapy and stem cell rescue
Trilateral retinoblastoma	Systemic chemotherapy followed by surgery and myeloablative chemotherapy with stem cell rescue Systemic chemotherapy followed by surgery and radiation therapy
Extracranial metastatic retinoblastoma	Systemic chemotherapy followed by myeloablative chemotherapy with stem cell rescue and radiation therapy
Progressive or recurrent extraocular retinoblastoma	Systemic chemotherapy and radiation therapy for orbital disease Systemic chemotherapy followed by myeloablative chemotherapy with stem cell rescue, and radiation therapy for extra-orbital disease

↑ Phillips, John S; Westerberg, Brian (2011). "Intratympanic steroids for Ménière's disease or syndrome". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008514.pub2. ISSN 1465-1858.
↑ Postema, Rolf J.; Kingma, Charlotte M.; Wit, Hero P.; Albers, Frans W.J.; Van Der Laan, Bernard F.A.M. (2009). "Intratympanic gentamicin therapy for control of vertigo in unilateral Menière's disease: a prospective, double-blind, randomized, placebo-controlled trial". Acta Oto-Laryngologica. 128 (8): 876–880. doi:10.1080/00016480701762458. ISSN 0001-6489.
↑ Syed, I.; Aldren, C. (2012). "Meniere's disease: an evidence based approach to assessment and management". International Journal of Clinical Practice. 66 (2): 166–170. doi:10.1111/j.1742-1241.2011.02842.x. ISSN 1368-5031.

[PhillipsWesterberg2011-1] Phillips, John S; Westerberg, Brian (2011). "Intratympanic steroids for Ménière's disease or syndrome". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008514.pub2. ISSN 1465-1858.

[PostemaKingma2009-2] Postema, Rolf J.; Kingma, Charlotte M.; Wit, Hero P.; Albers, Frans W.J.; Van Der Laan, Bernard F.A.M. (2009). "Intratympanic gentamicin therapy for control of vertigo in unilateral Menière's disease: a prospective, double-blind, randomized, placebo-controlled trial". Acta Oto-Laryngologica. 128 (8): 876–880. doi:10.1080/00016480701762458. ISSN 0001-6489.

[SyedAldren2012-3] Syed, I.; Aldren, C. (2012). "Meniere's disease: an evidence based approach to assessment and management". International Journal of Clinical Practice. 66 (2): 166–170. doi:10.1111/j.1742-1241.2011.02842.x. ISSN 1368-5031.

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[2]

[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Vertigo}}
-{{CMG}}
+{{CMG}} {{AE}} {{ZMalik}}
-==Medical Therapy==
+:*
-===Central Disorders===
+{| class="wikitable"
-* Treat underlying disease
+|+
-* Reassurance and time important for treatment of vertigo
+! colspan="2" |Treating Peripheral Vertigo
-* Vertebrobasilar [[ischemia]]
+|-
-# Vertigo usually resolves on its own
+![[Ménière’s disease]]
-# Risk factor modification to decrease recurrence
+|
-# Revascularization or anticoagulation
+*Treatment is focused on preventing acute attacks and controlling the excess fluid build-up.
-* [[Migraine]]:  Adequate treatment of [[headache]] improves vertigo in 90%.
+**Non-invasive: Low-sodium diet, hearing aid, [[positive pressure therapy]].
-* [[Multiple sclerosis]] (MS):  Therapy for MS alleviates vertiginous symptoms as well
+**Medications: [[Meclizine]], [[diazepam]], [[promethazine]], [[diuretics]]
-* Drugs:  Discontinue offending agents
+**Steroid<ref name="PhillipsWesterberg2011">{{cite journal|last1=Phillips|first1=John S|last2=Westerberg|first2=Brian|title=Intratympanic steroids for Ménière's disease or syndrome|journal=Cochrane Database of Systematic Reviews|year=2011|issn=14651858|doi=10.1002/14651858.CD008514.pub2}}</ref>
+ or [[gentamicin]]<ref name="PostemaKingma2009">{{cite journal|last1=Postema|first1=Rolf J.|last2=Kingma|first2=Charlotte M.|last3=Wit|first3=Hero P.|last4=Albers|first4=Frans W.J.|last5=Van Der Laan|first5=Bernard F.A.M.|title=Intratympanic gentamicin therapy for control of vertigo in unilateral Menière's disease: a prospective, double-blind, randomized, placebo-controlled trial|journal=Acta Oto-Laryngologica|volume=128|issue=8|year=2009|pages=876–880|issn=0001-6489|doi=10.1080/00016480701762458}}</ref> injections in middle ear.
-===Peripheral Disorders===
+**Surgery: Decompress [[endolymphatic]] sac, [[labyrinthectomy]], [[Vestibular nerve section]]<ref name="SyedAldren2012">{{cite journal|last1=Syed|first1=I.|last2=Aldren|first2=C.|title=Meniere’s disease: an evidence based approach to assessment and management|journal=International Journal of Clinical Practice|volume=66|issue=2|year=2012|pages=166–170|issn=13685031|doi=10.1111/j.1742-1241.2011.02842.x}}</ref>.
-* General management
+|-
-* Physical therapy
+![[Acoustic neuroma]]
-# Beneficial in patients with permanent peripheral vestibular dysfunction
+|
-# Unknown benefit in patients with central disorders
+*
-# Vestibular rehabilitation
+!Benign positional paroxysmal vertigo
-* Activity enables CNS adaptation to loss of vestibular input
+|
-* Visual compensation during head motion
+*
-* Balance shown to improve in randomized controlled trials of vestibular exercises
+|-
-* Unclear if long-term benefits or if decreased fall risk
+!Acute labyrinthitis
-* Avoidance of inactivity
+|
-* Avoid deconditioning and loss of postural reflexes
+*
+|-
-=== Acute Pharmacotherapies ===
+![[Acute vestibular neuritis]]
-==== Peripheral Disorders====
+|
-* Specific management
+*
-# BPPV
+![[Cholesteatoma]]
-# Epley maneuver --> in a randomized controlled trial, symptoms resolved in 50% vs. 19% sham therapy by mean 10 days
+|
-# [[Meclizine]] (12.5-50 mg every 6 hours as often as necessary) or [[promethazine]] (25 mg every 6 hours as often as necessary) for severe symptoms
+*
-# Meniere’s disease:  low-salt diet and [[diuretic]]s to reduce endolymph production
+![[Otosclerosis]]
-* [[Anticonvulsants]] such as [[topiramate]] or [[valproic acid]] for vestibular migraines
+|
+*
-*General management
+![[Perilymphatic fistula]]
-=====Pharmacologic Therapy=====
+|
-*For acute episodes:
+*
-#Avoid long-term therapy if symptoms last > few days (will reduce CNS adaptation)
+|+
-#[[Anticholinergics]]
+! colspan="2" |Treating Central Vertigo
-#[[Scopolamine]]: Side effect [[urinary retention]], [[dry mouth]]
+|-
-#[[Antihistamines]] such as betahistine, dimenhydrinate, [[diphenhydramine]], or meclizine, which may have antiemetic properties (anti-Ach effects)
+![[Orbit (anatomy)|Orbital]] and locoregional retinoblastoma
-#Meclizine is drug of choice in pregnancy. Side effect: sedation
+|
-#[[Phenothiazines]]
+* [[Chemotherapy]]
-#[[Prochlorperazine]], promethazine (anti-Ach effects): More sedating, but also have antiemetic effects. Risk: extrapyramidal side effect (second-line)
+* [[Radiation therapy]]
-#[[Benzodiazepine]]s
+|-
-#[[Diazepam]], [[lorazepam]], [[clonazepam]] (GABA-ergic effects): For patients with contraindications to anti-Ach prescription ([[benign prostatic hypertrophy]])
+![[CNS disease]]
-#[[Calcium channel blocker|Calcium channel antagonists]], specifically [[Verapamil]] and [[Nimodipine]]
+|
-#[[Beta blockers]] such as [[metoprolol]] for vestibular migraine
+*[[Systemic]] [[chemotherapy]] and [[CNS]]-directed [[therapy]]
-#GABA modulators, specifically [[gabapentin]] and [[baclofen]]
+*[[Systemic]] [[chemotherapy]] followed by myeloablative [[chemotherapy]] and [[stem cell]] rescue
-#Neurotransmitter reuptake inhibitors such as [[SSRI|SSRI's]], [[Serotonin-norepinephrine reuptake inhibitor|SNRI's]] and [[Tricyclics]]
+|-
-#[[Diuretic]]s for [[Meniere's Disease]]
+!Trilateral retinoblastoma
+|
-==References==
+*[[Systemic]] [[chemotherapy]] followed by [[surgery]] and myeloablative [[chemotherapy]] with [[stem cell]] rescue
-{{Reflist|2}}
+*[[Systemic]] [[chemotherapy]] followed by [[surgery]] and [[radiation therapy]]
-{{WH}}
+|-
-{{WS}}
+![[Extracranial]] [[metastatic]] retinoblastoma
+|
-[[Category:Neurology]]
+*[[Systemic]] [[chemotherapy]] followed by myeloablative [[chemotherapy]] with [[stem cell]] rescue and [[radiation therapy]]
-[[Category:Otolaryngology]]
+|-
-[[Category:Needs overview]]
+!Progressive or recurrent extraocular retinoblastoma
+|
+*[[Systemic]] [[chemotherapy]] and [[radiation therapy]] for [[orbital disease]]
+*[[Systemic]] [[chemotherapy]] followed by myeloablative [[chemotherapy]] with [[stem cell]] rescue, and [[radiation therapy]] for extra-[[Orbital Disease|orbital]] [[disease]]
+|}

Vertigo medical therapy: Difference between revisions

Revision as of 19:29, 23 December 2020

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