Otogenic Vertigo (耳源性眩暈)

Testing:

Otogenic vertigo is an hallucination or a false sensation of movement. Disease affecting the vestibular apparatus may produce rotatory vertigo accompanied by horizontal nystagmus.

Caloric testing:

Involves stimulating the vestibular apparatus by irrigating the external meatus with water at varying temperatures; the duration of induced nystagmus is recorded, allowing comparison between the two sides.

Positional testing:

Vertigo provoked by head movements may be a feature of inner ear disease, cervical spondylosis or disease affecting central vestibular pathways in the brainstem.

Meniere’s disease

Aetiology:

Unknown. Maybe due to imbalance between production and absorption of inner ear endolymph or disturbance of inner ear immunity.

Clinical features:

Episodic rotatory vertigo, tinnitus and sensorineural deafness may be present. Unilateral in early stages.

Management:

Vestibular sedatives for acute attacks. Surgery may be conservative (endolymphatic sac decompression) or destructive (labyrinthectomy or vestibular neurectomy). Intratympanic gentamicin is also an option.

Sudden unilateral vestibular failure

Aetiology:

Unknown aetiology. Viral infection, ischaemia and inner ear membrane rupture have been postulated.

Clinical features:

Presents with sudden onset of vertigo. Recovery takes place by central compensation.

Management:

Vestibular sedatives are useful in the acute phase.

Other causes of vertigo are syphilis, suppurative labyrinthitis, temporal fractures and ototoxic drugs.