Conditions - what do we treat?
A very common condition especially in the middle aged and elderly population, where a short intense vertigo is induced by certain positions of head. It is quite easy to treat by positional manoeuvres.
Vestibular neuritis/ labyrinthitis
Manifests as sudden onset of intense vertigo (sometimes with hearing loss) due to an insult to balance organ. Treated by vestibular rehabilitation with good effect
Bilateral Peripheral vestibulopathy
Conditions where peripheral organs of balance have failed or have been underperforming due to various reasons. Treated by vestibular rehabilitation
Persistent Postural Perceptual Dizziness (3PD)
Another common condition, which can come as a sequel from other causes, where a person feels persistent dizziness and unsteadiness exacerbated by posture and complex visual surrounding, causing significant functional impairment to one's life. Treated with intense vestibular rehabilitation exercises and relaxation modalities. (sometimes with psychotherapy).
A very common condition especially in young female patients who have a history or family history of migraine. Treatment is by medications to prevent migraine and if required vestibular rehabilitation exercises including exercises for motion sensitivity.
'Central' causes of vertigo and dizziness
Multitude of causes of 'central' vestibular abnormality ranging from a stroke to genetic disease. Brain stem, cerebellum or cerebrum is at fault here. Luckily, it comprises of only about 5-15% of overall vestibular patients. Management depends on cause, including further investigations, neurology referral, vestibular rehabilitation etc.
Another cause of dizziness, where symptoms classically are sudden onset of intense vertigo with fluctuating hearing loss, ear pressure and ringing sounds (tinnitus) in ear. Treatment consists of salt restriction, medications and vestibular rehabilitation.
Other uncommon causes
Mal de Debarquement (MDD) Disease.
Vestibular Schwanomma (Acoustic neuroma)
Non vestibular causes like peripheral neuropathy.
Other causes of lightheadness - like anaemia, anxiety, thyroid abnormalities