Vertigo Treatment- Ear Nose And Throat (ENT), Neurology

Vertigo is a sensation of dizziness and having problems with balance. If you have those dizzy spells, you may feel like you are turning or that your surroundings are spinning around you.

Treatment for vertigo relies upon what is causing it. Most of the time, vertigo resolves on its own with no treatment. This is because your brain can adjust to changes in the inner ear to maintain balance.

For some people with vertigo, treatment is required and may include vestibular rehabilitation, repositioning, medications and surgery.

Why is vertigo treatment required?

When medical treatment cannot control vertigo, surgery may be done. The type of procedure performed relies on an individual's medical condition. 

Surgeries for peripheral vestibular disorders are classified as either corrective or destructive. The objective of the corrective procedure is to fix or balance inner ear functioning. The objective of the destructive procedure is to stop the generation of sensory information or hinder its transmission from the inner ear to the brain.

Which doctor to consult?

Talk to a otolaryngologist/ENT specialist, who will explain to you about the treatment and the risks.

What to expect during vertigo treatment?

Labyrinthectomy

A labyrinthectomy is a destructive procedure that is utilized for Ménière's disease. The organs for balance are removed so that the brain cannot get signals from the parts of the inner ear that sense gravity and movement changes. The cochlea, a hearing organ, is additionally relinquished with this procedure.

Vestibular Nerve Section

A vestibular nerve area is a destructive procedure that is utilized for Ménière's disease. The vestibular part of the vestibulo-cochlear nerve is incised in one ear to stop the transmission of information from that ear to the brain. The brain will just use the opposite ear for balance.

Chemical Labyrinthectomy

A chemical labyrinthectomy is otherwise called transtympanic or intratympanic treatment, or gentamicin infusion. This is a destructive procedure that is utilized for Ménière's disease. The antibiotic gentamicin is given into the middle ear and retained through the round window. The medication obliterates the vestibular hair cells to prevent signals from getting transmitted to the brain.

Endolymphatic Sac Decompression

Endolymphatic sac decompression is a stabilizing procedure utilized for Ménière's disease or secondary endolymphatic hydrops to ease endolymphatic pressure within the cochlea and vestibular system. One strategy enables the sac to decompress by removing the mastoid bone that surrounds it. Different strategies include embedding a shunt or a tube into the endolymphatic sac so that excess fluid can drain out into the mastoid cavity or other areas.

Oval Or Round Window Plugging

Oval or round window plugging is a balancing method used to fix perilymph fistulas. Openings in the oval as well as the round windows are fixed with tissue that is obtained from the external ear or from behind the ear so that perilymph liquid does not spill through the fistulas.

Pneumatic Equalization (PE) Tubes

Pneumatic equalization is a balancing method utilized for treating perilymph fistulas. A tube is embedded through the tympanic membrane or the eardrum with one end in the ear channel and the other in the middle ear, to even out the pneumatic pressure on the opposite sides of the eardrum.

Canal Partitioning (Canal Plugging)

Canal partitioning is a balancing technique utilized for treating BPPV or superior semicircular canal dehiscence. The affected semicircular canal is divided or plugged with little bone fragments and human fibrinogen glue to prevent the movement of endolymph and particles inside the canal so it never again sends false signals to the brain.

Microvascular Decompression

Microvascular decompression is a technique that is performed to relieve abnormal pressure of the blood vessel on the vestibulo-cochlear nerve.

Stapedectomy

Stapedectomy is a balancing procedure that may be utilized for otosclerosis. It is done by supplanting the stapes with a prosthesis.

Acoustic Neuroma (Vestibular Schwannoma) Removal

This procedure removes a benign tumor that is located in the vestibular branch of the vestibulo-cochlear nerve.

Cholesteatoma Removal

This is the removal of a skin growth from the middle ear which often secretes enzymes that can destroy bones and the surrounding areas.

Ultrasound Surgery

Ultrasound is done to the ear to destroy the organs of balance so that the brain cannot get signals from the parts of the ear that can sense gravity and movement changes.

Cochlear Dialysis

Cochlear dialysis is a balancing procedure that is used to enhance movement of abundant fluid in the inner ear, by filling the scala tympani with a solution.

Post-operative care

You will stay in the hospital for 2-3 days. You can come home after the procedure with an incision located behind or over your ear, and a big dressing placed over your ear and head.

Complications

Complications are rare with this procedure. Patients are usually given drugs for vomiting post-operatively to prevent nausea and vomiting. Doctors will usually fix abnormalities when they see it during the procedure.

To learn more about Vertigo Treatment, please check our blog on CAN VERTIGO BE STRESS-RELATED? LEARN HOW TO MANAGE IT.

References

• Surgical Procedures for Vestibular Dysfunction. Vestibular Disorders Association. https://vestibular.org/understanding-vestibular-disorders/treatment/vestibular-surgery. Published 2019. Accessed January 14, 2019.
• What is Labyrinthectomy: Overview, Benefits, and Expected Results | Medical tourism information | DocDoc. Docdoc.com.sg. https://www.docdoc.com.sg/info/procedure/labyrinthectomy/. Published 2019. Accessed January 14, 2019.
• Uwhealth.org. https://www.uwhealth.org/healthfacts/miscellaneous/7867.pdf. Published 2019. Accessed January 14, 2019.
• Vertigo: Causes, Symptoms, and Treatment. WebMD. https://www.webmd.com/brain/vertigo-symptoms-causes-treatment#1-4. Published 2019. Accessed January 14, 2019.

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