No abstract

Labyrinth of the inner ear consists of two parts: semicircular canals and vestibulum. Vestibular disorders predominantly associated with vertigo – the feeling of moving of the surrounding objects and oscillopsia. However, vertigo is a result of the damage of ampullar receptors in semicircular canals and their connections with vestibular nuclei in brainstem. At the same time the dysfunction of otoliths system is much more mysterious and unpredictable. Elaboration of new methods of objective assessment of vestibular system provides a wonderful opportunity of the analysis of different components of the peripheral vestibular system including saccular and utricular parts. As a result of such analysis, it was demonstrated that otolithic dysfunction is a common consequence of the most frequent vestibular disorders like Meniere’s disease, benign paroxysmal positional vertigo and vestibular neuritis. It is not clear yet what is the clinical presentation of otolithic dysfunction and how otolithic dysfunction influence the prognosis of common vestibular disorders. It is unknown whether isolated otolithic dysfunction exists, for example in patients with unspecific disequilibrium or dizziness.

Acute vertigo is a severe condition that requires urgent treatment. Vertigo can be caused by peripheral or central vestibular disorders of various etiopathology. Whatever the reason of vestibular dizziness, it is characterized by severe attacks with imbalance, nausea and vomiting in the acute period. Symptomatic treatment consists of vestibular suppressants and antiemetic drugs. There are several key principles regarding management of patients with vertigo that includes combined use of vestibular suppressants and antiemetics, which allows potentiation of their effects, limitation the use of symptomatic therapy to 2–3 days and perhaps earlier initiation of vestibular rehabilitation which effectiveness can be improved with agents that stimulate central vestibular adaptation.

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. The prevalence of the disease increases with age. Course of the disease, clinical manifestations, and treatment approaches at older ages have their own characteristics. Frequent predominance of persistent instability over classic episodes of positional vertigo as well as tendency to chronicity are among the main clinical features of BPPV at advanced age. BPPV in the older adults has a higher frequency of relapses, which is explained by the continuing degenerative processes in the otolith membrane and concomitant diseases that limit physical activity of older patients. The BPPV treatment in the older can be difficult due to the technical problems during canalith repositioning procedures, concomitant diseases and insufficient mobility of patients. Nevertheless, in most cases, the treatment of BPPV in the older adults remains highly effective, which makes early-stage disease detection of great value, even with atypical clinical manifestations. Therefore, it is especially important to perform positional tests in any cases with complaints of dizziness and instability.