Vertigo (Dizziness)

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Treatment

Treatment for vertigo, or dizziness, depends on identifying and eliminating the underlying cause. If a particular medication is responsible for the condition, lowering the dosage or discontinuing the drug may eliminate vertigo.

Vestibular Rehabilitation Therapy
Vestibular rehabilitation therapy (VRT) is a type of physical therapy used to treat vertigo. The goal of treatment is to minimize dizziness, improve balance, and prevent falls by restoring normal function of the vestibular system.

In VRT, the patient performs exercises designed to allow the brain to adapt to and compensate for whatever is causing the vertigo. The success of this treatment depends on several factors including the following:

• Age of the patient
• Cognitive function (e.g., memory, ability to follow directions in order)
• Coordination and motor skills
• Overall health of the patient (including the central nervous system)
• Physical strength

Vestibular rehabilitation therapy is designed by a physical therapist under the direction of a physician. In most cases, patients visit the therapist on a limited basis and perform custom-designed exercises at home, several times a day. As the patient progresses, difficulty of the exercises increases until the highest level of balance is attained during head movement, eye movement (i.e., tracking with the eyes), and walking.

According to the American Academy of Neurology, the most effective treatment for benign paroxysmal positional vertigo (BPPV) caused by ear crystals in the posterior semicircular canal, is a technique called the canalith repositioning procedure, or the Epley maneuver.

In this procedure, a physician or physical therapist assists the patient in performing a series of head and body movements, which move the calcium crystals out from the posterior semicircular canal and into another inner ear canal, where it is absorbed by the body. Another technique (called the Semont maneuver) also may be effective, but additional studies are needed.

Medication
Ear infections (e.g., otitis media, labyrinthitis) caused by bacteria may be treated using antibiotics (e.g., amoxicillin, ceftriaxone). Myringotomy is a surgical procedure that may be used to treat chronic ear infections. In this procedure, which is performed under anesthesia, an incision is made in the eardrum and a small tube is placed in the opening to prevent fluid and bacteria from building up inside the ear.

BPPV that does not respond to canalith repositioning may be treated with meclizine (Antivert®), an oral antiemetic that can be taken up to 3 times a day, or only as needed. Meclizine may cause drowsiness, dry mouth, and blurred vision.

If meclizine is ineffective, benzodiazepines such as clonazepam (Klonopin®) or antihistamines such as promethazine (Phenergan®) may be prescribed. Side effects of clonazepam include drowsiness, lack of coordination (ataxia), and confusion. Promethazine may cause drowsiness, fatigue, insomnia, and tremors.

Ménière disease may be treated by reducing sodium (salt) intake and with diuretic medications. A short, tapered course of corticosteroids (e.g., prednisone) may be prescribed early in the disease to reduce inflammation and stabilize hearing. Antibiotics (e.g., gentamicin) may be administered into the middle ear (called intratympanic perfusion) to treat severe vertigo caused by Ménière disease.

Vertigo caused by migraine can often be treated with medication.

Cerebrovascular disease (stroke), tumors, and multiple sclerosis may require treatment with medication, radiation, or surgery.

Prognosis

Prognosis depends on the cause of the vertigo and how well the underlying condition responds to treatment. Severe vertigo can be permanently disabling, especially in elderly patients. Peripheral vestibular disorders may cause progressive hearing loss.

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