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Posttraumatic Vertigo Treatment & Management

  • Author: Brian E Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Feb 24, 2016
 

Medical Care

The treatment is individualized to the diagnosis, as follows:

  • Brainstem concussion - Vestibular rehabilitation
  • Labyrinthine concussion – Vestibular suppressants and vestibular rehabilitation
  • Benign paroxysmal positional vertigo – The Epley maneuver and vestibular rehabilitation (See the image below.)
    Posttraumatic vertigo. The Epley maneuver. Posttraumatic vertigo. The Epley maneuver.
  • Posttraumatic Ménière disease - The same therapy as for the idiopathic type of the disease is used for a duration of 3 months, as follows:
    • Salt restriction
    • Diuretic
    • Niacin
    • The Meniett device, created by Xomed, is an FDA-approved class II device used for treatment of vertigo. It is a portable, low intensity, alternating pressure generator that is applied to the external auditory canal. It transmits pressure to the round window via a tympanostomy tube.
    • Transtympanic/intratympanic gentamicin injection by means of multiple delivery methods including low-dose therapy, titration, multiple daily dosing is also used. Chia et al performed a meta-analysis of different modalities of delivery for transtympanic gentamicin injections in 2004.[12] They found that low-dose therapy was the least effective in controlling symptoms, which is not surprising because of the lower amount of gentamicin used. However, hearing preservation was no better in this group than any other. The titration method exhibited the best results, and had the best hearing outcomes. Hearing loss was greatest for multiple daily dosing, but vertigo symptoms were not more improved in this group. Chia recommended titration therapy as a very useful method.
  • Perilymphatic fistula – Bed rest for at least 5 days and the avoidance of the Valsalva maneuver
  • Cervical vertigo - Vestibular rehabilitation and anti-inflammatory medications
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Surgical Care

See the list below:

  • BPPV: Surgery is not a first-line treatment because it can have serious risks such as hearing loss and facial nerve damage. Surgical options include labyrinthectomy, posterior canal occlusion, singular neurectomy, vestibular nerve section. All have a high chance of vertigo control.
  • Brainstem concussion: No surgical options are available.
  • Labyrinthine concussion: Labyrinthectomy or vestibular nerve section are options.
  • Ménière disease: Endolymphatic shunt (success rate between 75-80%) and labyrinthectomy (success rate between 75-80%) are options.
  • Perilymphatic fistula: Middle ear exploration and tympanotomy and placement of soft tissue graft over the fistula are options.
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Consultations

An otolaryngologist should be consulted when conservative management fails. In addition, a neurologist should be consulted if vertigo of central origin is suspected.

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Contributor Information and Disclosures
Author

Brian E Benson, MD Chief, Division of Laryngeal Surgery and Voice Disorders; Director, The Voice Center at Hackensack University Medical Center; Clinical Assistant Professor, Department of Otolaryngology/Head & Neck Surgery, UMDNJ, New Jersey Medical School

Brian E Benson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Soly Baredes, MD Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School; Director of Otolaryngology-Head and Neck Surgery, University Hospital

Soly Baredes, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Association, The Triological Society, American Medical Association, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society, New York Head and Neck Society, New York Laryngological Society, New Jersey Academy of Otolaryngology-Head and Neck Surgery, The New Jersey Academy of Facial Plastic Surgery, International Skull Base Society

Disclosure: Nothing to disclose.

Monika I Sidor, MD Resident Physician, Department of Surgery, University of Michigan at Ann Arbor Medical School

Monika I Sidor, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Peter S Roland, MD Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Clinical Center for Auditory, Vestibular, and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Chief of Pediatric Otology, Children’s Medical Center of Dallas; President of Medical Staff, Parkland Memorial Hospital; Adjunct Professor of Communicative Disorders, School of Behavioral and Brain Sciences, Chief of Medical Service, Callier Center for Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Auditory Society, The Triological Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, American Neurotology Society, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Otological Society

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Jack A Shohet, MD President, Shohet Ear Associates Medical Group, Inc; Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, School of Medicine

Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, American Medical Association, California Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Envoy Medical <br/>Received consulting fee from Envoy Medical for medical advisory board member. for: Envoy Medical .

Acknowledgements

Rowley S Busino, MD Staff Physician, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Rowley S Busino, MD is a member of the following medical societies: American Society for Head and Neck Surgery

Disclosure: Nothing to disclose.

References
  1. Ernst A, Basta D, Seidl RO, Todt I, Scherer H, Clarke A. Management of posttraumatic vertigo. Otolaryngol Head Neck Surg. 2005 Apr. 132(4):554-8. [Medline].

  2. Hoffer ME, Gottshall KR, Moore R, Balough BJ, Wester D. Characterizing and treating dizziness after mild head trauma. Otol Neurotol. 2004 Mar. 25(2):135-8. [Medline].

  3. Dlugaiczyk J, Siebert S, Hecker DJ, Brase C, Schick B. Involvement of the anterior semicircular canal in posttraumatic benign paroxysmal positioning vertigo. Otol Neurotol. 2011 Oct. 32(8):1285-90. [Medline].

  4. Pulec JL. Meniere's disease: results of a two and one-half-year study of etiology, natural history and results of treatment. Laryngoscope. 1972 Sep. 82(9):1703-15. [Medline].

  5. Ylikoski J, Palva T, Sanna M. Dizziness after head trauma: clinical and morphologic findings. Am J Otol. 1982 Apr. 3(4):343-52. [Medline].

  6. Goodhill V. Traumatic fistulae. J Laryngol Otol. 1980 Jan. 94(1):123-8. [Medline].

  7. Pisani V, Mazzone S, Di Mauro R, Giacomini PG, Di Girolamo S. A survey of the nature of trauma of post-traumatic benign paroxysmal positional vertigo. Int J Audiol. 2015 May. 54 (5):329-33. [Medline].

  8. Yaremchuk K, Dobie RA. Otologic injuries from airbag deployment. Otolaryngol Head Neck Surg. 2001 Sep. 125(3):130-4. [Medline].

  9. Rambold H, Heide W, Sprenger A, Haendler G, Helmchen C. Perilymph fistula associated with pulse-synchronous eye oscillations. Neurology. 2001 Jun 26. 56(12):1769-71. [Medline].

  10. Bernstein DM. Recovering from mild head injury. Brain Inj. 1999. 13:151-172.

  11. Dispenza F, De Stefano A, Mathur N, Croce A, Gallina S. Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?. Am J Otolaryngol. 2011 Sep-Oct. 32(5):376-80. [Medline].

  12. Chia SH, Gamst AC, Anderson JP, Harris JP. Intratympanic gentamicin therapy for Ménière's disease: a meta-analysis. Otol Neurotol. 2004 Jul. 25(4):544-52. [Medline].

  13. Aron M, Lea J, Nakku D, Westerberg BD. Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review. Otolaryngol Head Neck Surg. 2015 Nov. 153 (5):721-30. [Medline].

  14. Prokopakis E, Vlastos IM, Tsagournisakis M, et al. Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo. Audiol Neurootol. 2013. 18(2):83-8. [Medline].

  15. Folmer RL, Griest SE. Chronic tinnitus resulting from head or neck injuries. Laryngoscope. 2003 May. 113(5):821-7. [Medline].

  16. Mallinson AI, Longridge NS. A new set of criteria for evaluating malingering in work-related vestibular injury. Otol Neurotol. 2005 Jul. 26(4):686-90. [Medline].

  17. Marzo SJ, Leonetti JP, Raffin MJ, Letarte P. Diagnosis and management of post-traumatic vertigo. Laryngoscope. 2004 Oct. 114(10):1720-3. [Medline].

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Posttraumatic vertigo. The Epley maneuver.
 
 
 
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