Dizziness of peripheral etiology
Dizziness[edit | edit source]
Dizziness is a subjective feeling of imbalance. It is accompanied by:
- an objective disorder of the interplay of position and movement – deviations and falls ,
- vegetative symptoms (nausea, vomiting, heart rate changes),
- possibly anxiety.
Division[edit | edit source]
- extravestibular – with eye disorders and proprioception
The most common etiology of vestibular vertigo[edit | edit source]
- overloading of the apparatus due to movement or an inappropriate gravitational field (weightlessness),
- inflammations, tumors, injuries, toxins, drugs...
Symptoms[edit | edit source]
Peripheral disorder – harmony of individual symptoms (nystagmus, falls, deviations…).
Central disorders – characterized by disharmony - there is no connection between nystagmus and falls hearing impairment is absent, often there are other neurological symptoms.
Characteristics of dizziness[edit | edit source]
- nature (turning, swaying, feeling of falling, weakness),
- prodromes of dizziness (pressure in the ear, headache, tinnitus),
- provoking factors (smoking, alcohol, drugs, position, movement, noise, optical sensations…),
- accompanying manifestations (hearing loss, tinnitus, vegetative symptoms, neuro symptoms),
- duration and intensity – vertigo primarily means spinning dizziness,
- symptoms – malaise, vomiting, sweating, palpitations, nystagmus and ataxia (gait disorder).
Peripheral vestibular syndrome[edit | edit source]
It is caused by impairment of the balance system and/or nerve. In general, the more peripheral the lesion, the more accurate the patient's sense of the condition.
Unilateral disability[edit | edit source]
There is rotational vertigo with nausea, usually hearing is also affected. Difficulty worsens with head movements.
Bilateral disability[edit | edit source]
The patient complains of gait disturbances and unsteadiness (so-called ataxia). Difficulties worsen in the dark and on an uneven surface, there is often blurred vision during rapid head movements (so-called oscillopsia). Paradoxically, a bilateral chronically progressing lesion does not have many symptoms.
Nystagmus[edit | edit source]
Spontaneous nystagmus is almost always present – horizontal or horizontal-rotational, unidirectional, often II-III degrees.
- the intensity of nystagmus increases when looking in the direction of the fast component (Alexander's law ),
- there is a positive correlation between the intensity of vertigo and nystagmus.
In this syndrome, vertigo without nystagmus and nystagmus without vertigo do not occur - eye fixation inhibits peripheral nystagmus (to prove it, we must avoid fixation - we use, for example, Frenzel glasses - thick glasses (+15D)...).
Nystagmus shows signs of fatigue – when the patient tries to stay longer with the eyes in one position, it disappears over time.
- to the side of the diseased labyrinth it is irritating, to the opposite side it is destructive.
Symptoms[edit | edit source]
The syndrome is harmonious – all deviations have the same direction (eyes, movements...), only the fast component of the nystagmus goes in the opposite direction.
- The intensity of the symptoms is determined by the size of the difference between the two apparatuses - tonic deviations are always directed to the side of the weaker apparatus (the stronger one pushes it...), i.e. to the side of the lesion - the slow component of the nystagmus goes to the side of the lesion, the fast component (given by the cerebral cortex's desire for correction) is in the opposite direction.
- The direction of standing deviation depends on the position of the head, it usually deviates behind the affected ear – if the right ear is affected and we turn our head to the right, we fall backwards.
Benign paroxysmal vertigo[edit | edit source]
This is one of the most common causes of peripheral vertigo. A typical example is paroxysmal vestibular dysfunction.
- the basis is the pathology of the posterior semicircular canal caused by the degeneration of the utricular macula - damage occurs after trauma, after surgery in the middle ear, after infection, aging.
Etiology[edit | edit source]
Small particles of cells containing minerals (otoconia) are released from the macula and travel into the canal - when moving the head, they affect the flow of endolymph, causing irritation.
Clinical picture[edit | edit source]
typical - with a certain position of the head, severe rotational vertigo occurs:
- the patient's position is always the same - dizziness usually disappears within a few seconds,
- other parts of the ear are not damaged (no tinnitus or hearing loss...).
Therapy[edit | edit source]
- maneuver according to Semont – the goal is to remove otoconia from the canal.
Vestibular neuronitis[edit | edit source]
- a common cause of vertigo - there is a sudden, complete, unilateral loss of vestibular function
- etiology – probably viruses
- symptom – sudden onset, severe rotational vertigo, nausea and vomiting, hearing loss and tinnitus are not
- within a few days the situation will be corrected
- treatment – corticoids
Meniere's disease[edit | edit source]
Links[edit | edit source]
Source[edit | edit source]
- BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2009]. <http://jirben2.chytrak.cz/materialy/orl_jb.doc>.
References[edit | edit source]
- KLOZAR, Jan, et al. Speciální otorinolaryngologie. 1. edition. Galén, 2005. 224 pp. ISBN 80-7262-346-X.