Vestibüler Sistem Hastalıkları ve Tedavileri
Özet
Vestibüler sistem hastalıkları, dengenin sağlanmasında rol oynayan periferik vestibüler organlar ile santral sinir sistemi arasındaki uyumsuzluktan kaynaklanır ve temel olarak periferik ve santral olmak üzere iki kategoride incelenir. Bu bozuklukların ana semptomu, boşlukta olma hissinden şiddetli dönme yanılsaması olan vertigoya kadar uzanan geniş bir dengesizlik hissidir. Periferik nedenler arasında iyi huylu paroksismal pozisyonel vertigo (BPPV), Meniere hastalığı ve vestibüler nörit öne çıkarken; santral nedenler vestibüler migren, beyin sapı iskemisi ve multipl skleroz gibi durumları içerir. Teşhis sürecinde semptomların süresi, karakteri, nistagmusun yönü ve tetikleyici faktörler (örneğin ses veya basınç) periferik ve santral patolojilerin ayırt edilmesinde kritik rol oynar. Tedavi yaklaşımları hastalığın türüne göre değişmekte olup; yaşam tarzı değişiklikleri, diüretikler ve betahistin gibi medikal tedavileri, repozisyon manevralarını, vestibüler rehabilitasyonu ve dirençli vakalarda cerrahi müdahaleleri (endolenfatik kese cerrahisi veya labirentektomi gibi) kapsar.
Vestibular system disorders arise from a lack of coordination between the peripheral vestibular organs in the inner ear and the central nervous system, which are essential for maintaining balance. These disorders are classified into peripheral and central causes, with dizziness and vertigo (the illusion of motion) serving as the primary symptoms. Peripheral conditions frequently involve benign paroxysmal positional vertigo (BPPV), Meniere's disease, and vestibular neuritis, whereas central conditions encompass vestibular migraine, brainstem ischemia, and multiple sclerosis. Accurate diagnosis relies heavily on clinical history, including symptom duration, associated findings like nausea or hearing loss, and specific nistagmus characteristics to differentiate between locations. Treatment strategies are tailored to the specific diagnosis and range from conservative measures—such as lifestyle adjustments, low-salt diets, and repositioning maneuvers—to medical therapies involving vestibular suppressants, diuretics, or intratympanic injections, and ultimately surgical interventions like vestibular neurectomy for treatment-resistant cases.
Referanslar
Necdet FA. Vertigo. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Kitabı. Ed. Kara CO. 1. Edisyon, Logos Yayıncılık, Sayfa (505-515).
Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006; 37:2484.
Lee H, Yi HA, Lee SR, et al. Drop attacks in elderly patients secondary to otologic causes with Meniere's syndrome or non-Meniere peripheral vestibulopathy. J Neurol Sci 2005; 232:71.
Ishiyama G, Ishiyama A, Jacobson K, Baloh RW. Drop attacks in older patients secondary to an otologic cause. Neurology 2001; 57:1103.
Evaluation of the Dizzy Patient. Pasha. Raza. and Justin S. Golub, eds. Otolaryngology-ead and neck surgery: clinical reference guide. Plural publishing, 2021, Sayfa (411-425)
Dallan I, Bruschini L, Nacci A, et al. Drop attacks and vertical vertigo after transtympanic gentamicin: diagnosis and management. Acta Otorhinolaryngol Ital 2005; 25:370.
Cumminsten Evaluation of the Patient With Dizziness Timothy E. Hullar, David S. Zee, Lloyd B. Minor
Vassiliou A, Vlastarakos PV, Maragoudakis P, Candiloros D, Nikolopoulos TP. Ménière’s disease: Still a mystery disease with dufcult diferential diagnosis. Ann Indian Acad Neurol. 2011;14(1):12-8
Foster CA, Breeze RE. Endolymphatic hydrops in Ménière's disease: cause,consequence, or epiphenomenon? Otol Neurotol. 2013;34(7):1210-4.
Van Esch BF, van der Zaag-Loonen HJ, Bruintjes TD, van Benthem PP. Interventions for Ménière’s disease: protocol for an umbrella systematic review and a network meta-analysis. BMJ Open. 2016;6:e010269.
Patel M. Intratympanic corticosteroids in Ménière's disease: A mini-review. J Otol. 2017;12(3):117-2
Casani AP, Guidetti G, Schoenhuber R; Consensus Conference Group. Report from a Consensus Conference on the treatment of Ménière's disease with betahistine:rationale, methodology and results. Acta Otorhinolaryngol Ital. 2018;38(5):460-7.
Nevoux J, Barbara M, Dornhoffer J, Gibson W, Kitahara T, Darrouzet VM. International consensus (ICON) on treatment of Ménière's disease. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(1S): S29-S32.
Strupp M, Brandt T. Vestibular neuritis. Semin Neurol. 2009;29(5):509-19
Baloh RW. Vestibular Neuritis. N Engl J Med 2003; 348:1027-32.
Choi KD, Oh SY, Kim HJ, Koo JW, Cho BM. Kim JS. Recovery of vestibular imbalances after vestibular neuritis. Laryngoscope. 2007; n7(7):1307-12.
Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M et al. Methylprednisolone, valacyclovir or the combination for vestibular neuritis. N Engl J Med.341: 354-361, 2004.
Strupp M, Arbusow V, Maag KP, Gall C, Brandt T. Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis. Neurology. 1998;51(3):838-44.
Minor LB, Solomon D, Zinreich JS, Zee DS. Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg. 1998;124(3):249-58.
Carey JP, Minor LB, Nager GT. Dehiscence or thinning of bone overlying the superior semicircular canal in a temporal bone survey. Arch Otolaryngol Head Neck Surg. 2000;126(2):137-47.
Özgirgin N. Superior semicircular canal dehiscence. Turkiye Klinikleri J E.N.T.-Special Topics. 2015;8(3):40-4.
Minor LB, Carey JP, Cremer PD, Lustig LR, Streubel SO, Ruckenstein MJ. Dehiscence of bone overlying the superior canal as a cause of apparent conductive hearing loss. Otol Neu- rotol. 2003;24(2):270-8.
Minor LB. Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope. 2005;115(10):1717-27
Bi WL, Brewster R, Poe D, Vernick D, Lee DJ, Corrales E, et al. Superior semicircular canal dehiscence syndrome. J Neurosurg. 2017; 127:1268-76.
Kaya E, Gümüş B. Benign paroksismal pozisyonel vertigo. İncesulu ŞA, Erbek HS, editörler. Vertigoya Güncel Yaklaşım: Tanıdan Tedaviye. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.118-23.
Von Brevern M, Radtke A, Lezius F. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710–5
Neuhauser HK, Lempert T. Vertigo: epidemiologic aspects. Semin Neurol. 2009;29(5): 473-81
Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003;169: 681Y93.
Imai T, Ito M, Takeda N, Uno A, Matsunaga T, Sekine K, et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology. 2005;64(5):920‐1
Bhattacharyya n, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (update). Otolaryngol Head neck Surg. 2017;156(3_suppl): S1-S47.
Kozuka M, Nakashima T, Fukuta S, Yanagita N. Inner ear disorders due to pressure change. Clin Otolaryngol Allied Sci 1997; 22:106
Maitland CG. Perilymphatic fistula. Curr Neurol Neurosci Rep 2001; 1:486.
Furman, Joseph M., and Daniel G. Deschler. "Causes of vertigo." UpToDate. UpToDate. https://www-uptodate-com. ezproxy. lib. monash. edu. au/contents/causes-of-vertigo (2020).
Hoffer ME, Gottshall KR, Moore R, et al. Characterizing and treating dizziness after mild head trauma. Otol Neurotol 2004; 25:135.
Brandt T, Bronstein AM. cervical vertigo. Journal of Neurology, Neurosurgery, and Psychiatry. 2001;71:8-
Özmen ÖA. Servikojenik baş dönmesi. İncesulu ŞA, Erbek HS, editörler. Vertigoya Güncel Yaklaşım: Tanıdan Tedaviye. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.144-50.
Luzeiro I, Luis L, Goncalves F, Pavao Martins I. Vestibular migraine: Clinical challenges and opportunities for multidisciplinarity. Behavioural neurology. 2016;2016:6179805.
Cho SJ, Kim BK, Kim BS, Kim JM, Kim SK, Moon HS, et al. Vestibular migraine in multicenter neurology clinics according to the appendix criteria in the third beta edition of the International Classification of Headache Disorders. Cephalalgia: An International Journal of Headache. 2016;36:454-62.
Batu ED, Anlar B, Topcu M, Turanli G, Aysun S. Vertigo in childhood: a retrospective series of 100 children. Eur J Paediatr neurol. 2015; 19:226-32.
Furman JM, Marcus DA, Balaban CD. Migrainous vertigo: development of a pathogenetic model and structured diagnostic interview. Curr Opin Neurol 2003; 16:5
Murdin, Louisa, and Linda M. Luxon. "Vestibular Migraine." Scott-Brown’s Otorhinolaryngology Head and Neck Surgery. CRC Press, 2018. 855-861
Fısher Cm, Karnes We, Kubık Cs. Lateral medullary infarction-the pattern of vascular occlusion. J Neuropathol Exp Neurol 1961; 20:323
Frohman EM, Kramer PD, Dewey RB, et al. Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques. Mult Scler 2003; 9:250.
