Dizziness is actually an illusion of movement. In fact, there is nothing rotating. Even though there is no moving object around, the person feels that he or the objects around him are in motion. Dizziness actually results from a disorder in the balance system. Balance is a complex mechanism provided by the brain. The balance organ in the inner ear, eyes and receptors in the musculoskeletal system are the most important elements of the balance system. These three systems constantly transmit information to the brain about the position of our head and body. The brain evaluates this information and ensures our balance. Any disorder in this complex mechanism appears as dizziness and imbalance.
CAUSES THAT CAUSE VERTIGO
Approximately 70% of dizziness occurs in the ear. It is caused by damage to the balance organ in the inner ear. Approximately 15% of it is neurological in origin and results from damage to the balance pathways and balance centers in the brain. The remaining 15% is caused by the cardiovascular system, metabolic reasons and other reasons.
The most common diseases that cause dizziness are:
1.Ear Originating Diseases
- BPPV (benign positional vertigo)
- Meniere's disease
- Vestibular Neuronitis
- Perlymph fistula
- Labyrinthitis
- Superior Canal Dehiscence
2.Diseases of Neurological Origin
- Vestibular Migraine
- Multiple Sclerosis
- Stroke
- Brain hemorrhage
BPPV (Benign POSITIONAL VERTIGO)
It is the most common cause of dizziness, especially in the elderly. It is also popularly known as shifting or shifting balance crystals. The reason is that the molecules in the crystal structure, which we call otolith, in the balance organ, break off and fall into the semicircular canals. In whichever semicircular canal the crystals have fallen, when the head is moved in the axis of that canal, short-term, very severe dizziness occurs. Dizziness is generally short-lived, lasting 20-30 seconds. Typical movements that trigger BPPV are lying down in bed, turning over in bed, getting out of bed, looking up and leaning forward.
Positional tests are performed to diagnose the disease. with this test Typical movements called nystagmus that occur in the eyes during surgery are investigated. To detect nystagmus during the test, Frenzel glasses should be used or, ideally, a VNG recording should be made. Because the shape of nystagmus varies depending on the affected semicircular canal. If the affected semicircular canal cannot be identified correctly, it may not be possible to treat the disease.
After the affected semicircular canal is detected in the treatment, specific healing maneuvers are performed for that canal, that is, allowing the crystals to be removed from that canal again.
MENIERE'S DISEASE
It is a disease characterized by severe dizziness that occurs in seizures, hearing loss, ear fullness and ringing. The cause of the disease is a sudden increase in the amount and pressure of inner ear fluid. During dizzy spells, the dizziness is very severe and lasts for about an hour or two. Meanwhile, nausea and vomiting are usually present. While dizziness attacks are rare at first, they gradually become more frequent and can even be seen every day in some patients.
Hearing loss gradually increases with increasing dizziness attacks. There are various steps in the treatment of the disease. Initially, the disease is controlled with diet and medication. In patients who do not improve despite drug treatment, steroid or gentamicin injections can be administered to the ear. If there is no improvement despite these, surgery may be considered. If intra-ear injection or surgery is planned in these patients, all balance tests must be performed and it must be ensured that the other ear is intact.
VESTIBULAR NEURINITIS (INFECTION OF THE BALANCE NERVE)
It occurs with viral infection of the balance organ and balance nerve. Patients experience sudden onset of very severe dizziness. Patients have difficulty maintaining their balance. There is no hearing loss. Dizziness usually lasts for 2-3 days and then gradually subsides. It usually gets better in 3-4 weeks.
Medications that calm the balance system and cortisone are used in the treatment. Patients should start balance exercises early.
VESTIBULAR MIGRAINE
Patients complain of dizziness and imbalance due to migraine. dizziness headache pain It may occur simultaneously with the disease and in this case it is easy to diagnose. However, dizziness can also occur independently of the headache. In this case, diagnosis is more difficult and requires experience. The treatment is migraine treatment.
HOW TO DIAGNOSE DITIGIN (VERTIGO DIAGNOSIS)
The most important step in diagnosing dizziness is to take a very good disease history from the patient. . For this, sufficient time must be allocated to the patient. All complaints of the patient should be listened to carefully and questions should be asked regarding the cause of the disease. A complete ENT examination and, if necessary, a neurological examination should then be performed. Afterwards, it is useful to perform all balance tests. When necessary, imaging tests such as computed tomography and MRI and blood tests should also be performed.
It is very important to make the correct diagnosis in order to treat the disease.
BALANCE TESTS
Balance tests are very important in the evaluation of a patient with vertigo. Since the balance system is a very complex structure, unfortunately there is no single test that evaluates the entire system. Many tests can evaluate only part of the balance system. For this reason, many tests should be performed on the patient and their results should be evaluated together. Another important issue is that the tests are performed by competent people and interpreted correctly. This is something that requires a lot of experience. In addition, the physician must have experience with all tests and have the knowledge and experience to evaluate the results. Only then can the results of the tests be evaluated accurately. Ideally, balance tests should be performed under the supervision of a physician and the physician should perform the test himself and evaluate it when necessary. Because some results are based on interpretation. The most commonly applied balance tests are:
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VNG (videonystagmography): It is the most standard test method used in the evaluation of patients with dizziness for many years. The test is actually a battery and includes many tests. This test usually gives very serious information about whether the disease originates from the ear or the brain. It also allows comparing both balance organs with a caloric test. It is also very important in the diagnosis of BPPV.
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VEMP (vestibular evoked Myogenic Potentials): While high intensity sound is injected into the patient's ear, muscle activity is measured with electrodes placed around the neck and eyes. Thanks to this test, the function of the lower and upper balance nerves is tested.
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V-HİT (video head-impulse Test): This test is performed on each semicircle. It allows the function of the channel to be tested individually.
When the results of these three tests are evaluated together, almost the entire balance system is tested. If the physician has sufficient experience in dizziness, he can reach a diagnosis as a result of these tests.
DISTIGO TREATMENT (VERTIGO TREATMENT)
In order to treat dizziness, first of all, the diagnosis must be made correctly. must. Because dizziness is not a single disease. Dizziness is a symptom of many diseases. The basic steps in the treatment of dizziness are as follows:
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First of all, the acute dizziness attack should be terminated and the patient should be relieved. For this purpose, drugs that suppress and anesthetize the balance system are generally used.
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Then, the disease causing dizziness must be identified and specific treatment must be applied to cure the disease.
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In order to reduce the effects of damage to the balance system, vestibular rehabilitation should be performed with exercise.
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