11/22/2023 0 Comments Vestibular and auditory system![]() Restriction of salt, caffeine and alcohol intake for the treatment of Menière’s disease or syndrome Positive pressure therapy for Menière’s disease or syndrome Intratympanic steroids for Menière’s disease or syndrome Intratympanic gentamicin for Menière’s disease or syndrome Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV)īetahistine for Menière’s disease or syndromeĭiuretics for Menière’s disease or syndrome The Epley (canalith repositioning) manoeuvre for treatment of benign paroxysmal positional vertigo Vestibular rehabilitation for unilateral peripheral vestibular dysfunction Unilateral peripheral vestibular dysfunction The three major differential diagnoses are:Ĭorticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis) On the basis of the history and physical findings, an acute unilateral vestibulopathy on the right is diagnosed. As neither the history nor the physical examination give any reason to suspect a central disturbance-in particular, a stroke in the brainstem or cerebellum-no neuroimaging is necessary (and, in any case, the MRI findings are often normal in the first 24 h in patients who present with spinning vertigo or dizziness as their main symptom of a brainstem stroke). The gain of the rightward horizontal vestibulo-ocular reflex (VOR) is reduced to 0.3 eFigure, (below, b) values less than 0.7 indicate a clinically relevant unilateral deficit and obviate the need for caloric testing. The Romberg test reveals instability, with a tendency to fall to the right, that is much worse with the eyes closed. The Rinne and Weber tuning fork tests are normal. There are no signs of central ocular motor disorders: in particular, the alternating cover test reveals no skew deviation, nor is there any gaze-evoked nystagmus on rightward gaze, i.e., in the direction opposite to the rapid phase of the spontaneous nystagmus. The head-impulse test is pathological toward the right. When the patient wears M glasses, the intensity of the spontaneous nystagmus increases markedly. On central gaze, there is a low-amplitude spontaneous nystagmus with the fast phase beating to the left and a clockwise torsional component (from the examiner’s point of view). Photophobia and phonophobia are likewise absent, and he does not suffer from migraine. On questioning, he states that his hearing is normal, and he has neither tinnitus nor fullness in the ears. ![]() When he tries to fixate on a target, everything seems to move in front of his eyes. ![]() The vertigo arose suddenly it is accompanied by instability of stance and gait, with a tendency to fall to the right, and nausea. A 46-year-old engineer reports that he has been suffering from severe, persistent spinning vertigo for the past 24 h. ![]()
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