new aspects on epidemiology, classification, differential diagnosis and therapy of recurrent vertigo disorders

Doctoral thesis German OPEN
Radtke, Andrea (2012)
  • Publisher: Freie Universität Berlin Universitätsbibliothek, Garystr. 39, 14195 Berlin
  • Subject: 610 Medizin und Gesundheit | 610 Medical sciences; Medicine | epidemiology | differential diagnosis | benign paroxysmal positional vertigo | therapy | Menière's disease | vestibular vertigo
    • ddc: ddc:610
    mesheuropmc: otorhinolaryngologic diseases | sense organs

This work presents new data on the epidemiology, classification, differential diagnosis and therapy of recurrent vestibular vertigo disorders: M. Menière, vestibular migraine and benign paroxysmal positional vertigo (BPPV). Epidemiological assessment of a nationwide, representative sample of the German adult population by means of a neurotological telephone interview revealed a low lifetime prevalence of Menière’s disease of less than 0.12% when the diagnostic criteria of the American Acadamy of Otolaryngology were applied. Thus, Menière’s disease is less common than vestibular migraine which constitutes the main differential diagnosis and has an estimated lifetime prevalence of nearly 1%. A case-control study revealed an association of Menière’s disease and migraine. Prevalence of migraine was more than two-fold increased in 78 patients with Menière’s disease according to the diagnostic criteria of the American Academy of Otolaryngology (1995) compared to a sex- and age-matched control group. Nearly half of the Menière patients regularly had accompanying migrainous symptoms during the vertigo attacks. A possible explanation is a common pathophysiological mechanism of both disorders. Alternatively, the current diagnostic criteria for Menière’s disease and vestibular migraine with cochlear involvement are not sufficiently discriminative. Although vestibular migraine is frequent in the general population, it remains a largely under-diagnosed vestibular disorder. One of the main reasons for under-recognition is the lack of internationally accepted diagnostic criteria for vestibular migraine. Because of its specific clinical features, vestibular migraine is not well represented in the current classification of headache disorders of the International Headache Society (ICHD). Therefore, our group has developed clinical diagnostic criteria for diagnosis of vestibular migraine that are based on the ICHD-criteria and include two distinct categories of definite (dVM) and probable (pVM) vestibular migraine. The results of a neurotological long-term follow-up study in 47 patients with an initial diagnosis of dVM and 28 patients with pVM showed a high validity of the criteria for dVM with a positive predictive value of 85% in patients with vestibular migraine without cochlear symptoms. Half of the patients with an initial diagnosis of pVM fulfilled the more specific criteria of dVM in the course of the disorder. However, since in a subgroup of patients with vestibular migraine, vertigo and migrainous symptoms occur dissociated even at longer follow-up, the category of pVM should be maintained in a classification of vestibular migraine to allow for greater sensitivity of the diagnostic tool. However, the results of this study also indicate that the present diagnostic criteria for dVM and Menière’s disease are not sufficiently discriminative in a subgroup of patients with cochlear symptoms and hearing loss. The results of two controlled studies show that self-treatment with a self-administered modified Epley- and Sémont-manouevre effectively cures benign paroxysmal positional vertigo in the majority of patients. Self-treatment with the modified Epley manoeuvre relieved 64% and 95% of patients from positional vertigo within one week and was more effective than self-treatment with the Brandt-Daroff- or Sémont-manouevre. Correct performance of self-treatment is essential for its efficacy. Therefore, patients should be carefully instructed before starting treatment. Self-treatment constitutes an effective complementary treatment option for benign paroxysmal positional vertigo, which may reduce the number of consultations and enable patients to efficiently treat recurrences.
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