From the Guidelines
Peripheral vestibulopathy is a disorder affecting the peripheral vestibular system, causing symptoms like vertigo, dizziness, and imbalance, often due to damage or dysfunction to the vestibular nerve or inner ear structures, such as in benign paroxysmal positional vertigo (BPPV) 1.
Causes and Symptoms
The causes of peripheral vestibulopathy can vary, including viral infections, BPPV, Meniere's disease, labyrinthitis, and certain medications that are toxic to the ear. Symptoms can include vertigo, dizziness, imbalance, nausea, and sometimes hearing changes.
- Vertigo is a common symptom, described as a spinning sensation, which can be triggered by position changes in BPPV 1.
- Dizziness and imbalance can also occur, affecting daily activities and increasing the risk of falls, especially in seniors 1.
- Nausea and vomiting may accompany vertigo episodes, particularly in severe cases 1.
Diagnosis and Treatment
Diagnosis of peripheral vestibulopathy, including BPPV, often involves simple bedside testing, such as the Dix-Hallpike test or supine roll test, to confirm the diagnosis 1.
- Treatment for BPPV can include bedside repositioning exercises, like the Epley maneuver, which have high success rates and can be performed by a healthcare professional or learned through self-repositioning with supervision 1.
- Vestibular rehabilitation therapy is crucial for long-term recovery from peripheral vestibulopathy, helping the brain compensate for vestibular deficits through specialized exercises.
- Medications like meclizine or diazepam may be used for acute symptom relief, such as vertigo and nausea, but are not a primary treatment for BPPV 1.
Prognosis and Recovery
Most cases of peripheral vestibulopathy, including BPPV, improve with time as the brain adapts through neuroplasticity, though complete symptom resolution may take weeks to months 1.
- During recovery, patients should gradually increase activity levels while avoiding sudden head movements that trigger symptoms.
- It's essential for patients, especially seniors, to take precautions to prevent falls and seek professional help if symptoms persist or worsen 1.
From the Research
Definition and Types of Peripheral Vestibulopathy
- Peripheral vestibulopathy refers to a group of disorders that affect the peripheral vestibular system, which is responsible for balance and equilibrium 2, 3, 4, 5.
- The most common peripheral vestibular end-organ disease is Benign Paroxysmal Positional Vertigo (BPPV) 2.
- Other types of peripheral vestibulopathy include bilateral vestibulopathy, vestibular neuritis, Menière's disease, and vestibular paroxysmia 3, 4, 5.
Diagnosis of Peripheral Vestibulopathy
- Diagnosis of peripheral vestibulopathy can be established through clinical history, diagnostic maneuvers, and ancillary testing such as videooculography and audiometry 3, 4, 5.
- The Dix-Hallpike maneuver and supine roll test can be used to diagnose BPPV 2.
- The head-impulse test, caloric irrigation, and vestibular-evoked myogenic potentials can be used to diagnose bilateral vestibulopathy 3.
Treatment of Peripheral Vestibulopathy
- Treatment of peripheral vestibulopathy includes physical training such as repositioning maneuvers and multimodal balance training, as well as pharmacological approaches such as corticosteroids and antiepileptics 4, 5.
- The particle repositioning maneuver is an effective way to treat posterior canal BPPV 2.
- Canal occlusion can be considered for patients with intractable BPPV 2.
- High-level evidence from prospective controlled trials is lacking for most treatments, and more state-of-the-art randomized controlled treatment trials are needed 3, 5.