Vertigo is actually a feeling of imbalance in which a person either feels like they are spinning or the surrounding space is spinning around them. This unpleasant sensation of movement involves complex and diverse pathologies such as dysfunction of the labyrinth (inner ear), vestibular nerve, cerebellum, brain stem, or central nervous system.
Vestibular causes of BPPV (benign paroxysmal positional vertigo)
This type of vertigo occurs when tiny calcium deposits (canaliths) that have formed in the floor of the cochlea become dislodged. The inner ear plays a crucial role in maintaining balance, sending signals to the brain about head and body movements that help maintain balance. BPPV occurs for unknown reasons and may be associated with aging.
Meniere’s disease
is associated with increased pressure in the inner ear and possibly increased fluid secretion in the inner ear. In this disease, the person experiences attacks of vertigo along with a feeling of ringing in the ears and, over time, develops permanent hearing loss.
Vestibular neuritis or labyrinthitis is
often caused by an inner ear infection, especially inflammation and viral infection of the vestibular nerves.
Less common causes of dizziness
1- Head or neck injury, brain problems such as stroke or tumor, migraine headaches
2- Drugs that cause damage to the middle ear structures or vestibular nerves.
3- Vertigo attacks often begin with a change in head position, and the patient with vertigo describes their condition with words such as spinning themselves or their surroundings, staggering, swaying, losing balance, or being thrown to one side.
4- Symptoms associated with dizziness in individuals can include nausea, vomiting, nystagmus, headache, sweating, tinnitus, or even hearing loss. The duration of symptoms can vary from a few minutes to a few days.
Treatment
of vertigo is primarily aimed at eliminating the causative factor (if the factor is known or can be eliminated). Most of the time, attacks of vertigo restore the body’s balance after a short period of time and without the help of other balance-maintaining mechanisms, but if the compensatory mechanisms of the brain and organs related to maintaining balance cannot eliminate the patient’s dizziness, therapeutic interventions are performed.
Vestibular rehabilitation
In this treatment, we use physical maneuvers to engage other senses and balance organs to maintain balance.
Maneuvers to reset deposits in the middle ear: canalith repositioning
In this treatment, the doctor uses specific maneuvers to remove calcium deposits from the inner ear chamber, followed by absorption of the deposits and their elimination from the body. During this treatment, the patient’s dizziness and nausea temporarily increase, and symptoms often improve after a short period of time.
Drug treatment
If the cause of vertigo is an infection, treatment includes antibiotics and steroids. In Meniere’s disease, treatment is with diuretics to reduce the pressure of the fluid in the middle ear.
AFASERC
Betahistine or Afaserc is a drug used to reduce the recurrence of vertigo in Meniere’s syndrome. This drug, by acting on the H receptor, provides relief from vertigo and is used in the treatment of Meniere’s patients.
This drug helps treat the vertigo of Meniere’s syndrome in different ways and with different mechanisms. It seems that the disturbance of endolymphatic fluid homeostasis in the ear is the main pathophysiology in Meniere’s syndrome. Betahistine is an H1 receptor agonist that causes vasodilation of the vessels of the inner ear, which leads to increased permeability of blood vessels in the inner ear and a decrease in endolymphatic pressure, thereby preventing labyrinth rupture, a factor involved in the occurrence of Meniere’s syndrome and hearing loss.
On the other hand, by increasing the blood flow of the vestibulo-ocular vessels and reducing the asymmetry in the vestibular sensory function, dizziness improves. In addition to the agonist effect on the H1 receptor, betahistine, with its antagonistic effect on the H3 receptor, increases the rate of histamine changes in the postsynaptic histaminergic nerve receptors. The result of this action is an increase in the effects of histamine H1 and a decrease in the effects of histamine H3.
H3 receptor antagonism leads to the production of neurotransmitters such as serotonin in the brainstem, which reduces the activity of the vestibular nucleus, leading to restoration of balance and reduction of dizziness.
