Posttraumatic Vertigo Treatment & Management

Updated: Jul 11, 2018
  • Author: Brian E Benson, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Treatment

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. [13] 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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