Medical Care
The treatment is individualized to the diagnosis, as follows:
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Brainstem concussion - Vestibular rehabilitation
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Labyrinthine concussion - Vestibular suppressants and vestibular rehabilitation
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Benign paroxysmal positional vertigo - The Epley maneuver and vestibular rehabilitation (See the image below.)
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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 a US Food and Drug Administration (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, and multiple daily dosing, is also used. Chia et al performed a meta-analysis of different modalities of delivery for transtympanic gentamicin injections in 2004. [16] They found that low-dose therapy was the least effective in controlling symptoms, which is somewhat expected given of the lower amount of gentamicin used. Moreover, 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 and colleagues recommended titration therapy as a very useful method.
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Perilymphatic fistula - Bed rest for at least 5 days and the avoidance of the Valsalva maneuver
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Cervical vertigo - Vestibular rehabilitation and anti-inflammatory medications
Surgical Care
See the list below:
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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, endolymphatic shunt, singular neurectomy, and vestibular nerve section. All have a high rate of vertigo control.
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Brainstem concussion - Surgical options are not recommended; supportive care is considered a better approach.
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Labyrinthine concussion - Labyrinthectomy and vestibular nerve section are options.
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Ménière disease - Endolymphatic shunt, labyrinthectomy, and vestibular nerve section are options.
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Perilymphatic fistula - Middle ear exploration placement of a soft tissue graft over the fistula. This procedure may be diagnostic and therapeutic in patients with suspected PLF but no clear fistula site visualized on imaging. These patients should be cautioned regarding negative findings and that middle ear exploration does not always expose a clearly visualized fistula tract.
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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Posttraumatic vertigo. The Dix-Hallpike maneuver.
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Posttraumatic vertigo. The Epley maneuver.
