Abnormalities of the vestibular system often result in vertigo, which is associated with significant disability, including loss of work time and interruption of daily activities . Vestibular vertigo may arise from peripheral lesions (eg, labyrinth or vestibular nerve) or central lesions (eg, brainstem or cerebellum). Appropriate management of vertigo requires the correct diagnosis. This includes identifying the origin of dizziness as a problem with the vestibular system and then determining the site and origin of that problem.
This topic will review the management of the patient with vertigo. Distinguishing vertigo from other types of dizziness, determining the cause of vertigo, and the differential diagnosis of vertigo are discussed separately. (See "Approach to the patient with dizziness" and "Evaluation of the patient with vertigo" and "Benign paroxysmal positional vertigo".)
Vertigo treatment can be divided into three categories: those specific to the underlying vestibular disease, those aimed at alleviating the symptoms of vertigo, and those aimed at promoting recovery.
DISEASE SPECIFIC TREATMENTS
Vertigo is caused by a number of conditions affecting either the peripheral vestibular apparatus in the inner ear or the central nervous system (table 1). (See "Pathophysiology, etiology, and differential diagnosis of vertigo".) In some cases, treatment of the underlying condition improves vertigo. In others, treatment does not improve symptoms but may be otherwise important for the patient's overall prognosis.
Treatment of the underlying disease may diminish the symptoms of vertigo or alter the disease course in the following conditions: