Peripheral vertigo is defined as the sensation of spinning, caused by an abnormality in the nerve of balance or the inner ear itself. Treatment is directed at the cause, of which there are many. Vestibular suppressants (meclizine, dramamine, benzodiazepines - used with extreme caution, etc.) may be helpful on a short term basis, while vestibular rehabilitation (physical therapy directed toward the balance system) and directed medical treatment for other chronic conditions (such as Meniere's disease), may be recommended for long term management. Surgery is rarely indicated but may be helpful in select cases.
Central vertigo is defined as the sensation of spinning, caused by an abnormality in the brain (brain, cerebellum, or brainstem). Treatment is directed at the cause, of which there may be many. Vestibular suppressants (meclizine, dramamine, benzodiazepines - used with extreme caution, etc.) may be helpful on a short term basis, while vestibular rehabilitation (physical therapy directed toward the balance system) and directed medical treatment for other chronic conditions, may be recommended for long term management. Surgery generally has no role in treatment. Referral to a neurologist may be indicated.
Benign paroxysmal positional vertigo is a condition in which small calcium crystals (otoconia), normally found in the semicircular canals of the inner ear, become loose, and move abnormally within the inner ear, elicting a sensation of room spinning, precipitated by head movement and position change. The most commonly affected canal is the posterior semicircular canal. A smaller percentage of patients have a disorder of the lateral canal, or rarely, the anterior canal, which both may be treated differently. The standard of care treatment for posterior canal disease is an Epley maneuver - a series of motions with the head and body to reposition the crystals into a region of the inner ear where they can no longer move and cause symptoms. A barbecue roll (another maneuver) may be offered for cases of lateral canal disease. Exercises (Brant-Daroff exercises) may lessen the severity of symptoms and may result in resolution of the disorder over time. Rare, severe cases may warrant surgery to open the semicircular canal and occlude it to prevent movement of the crystals.
