Expert opinions regarding neuro-microcirculatory, vestibular and labyrinthine dynamics in benign paroxysmal positional vertigo

Abstract

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder and a leading cause of peripheral vertigo in adults. The current treatment with repositioning maneuvers still leaves some residual dizziness in a significant proportion of patients with BPPV. The role of neuro-microcirculatory, vestibular, and labyrinthine dynamics needs to be evaluated. Eighty leading neurologists and otolaryngologists from across India participated in advisory board meetings to debate on altered neuro-microcirculatory, vestibular, and labyrinthine dynamics in BPPV. Betahistine when used in conjunction with Epley maneuver was considered to be a safe treatment. Betahistine can be used as monotherapy in patients with BPPV who are deemed unfit to undergo canalolith repositioning maneuvers. Betahistine provides short-term relief from acute symptoms associated with BPPV by improving microcirculation in the labyrinth and improves vestibular compensation, thereby providing long-term benefit. Betahistine also improves outcomes in combination with canalolith repositioning maneuvers. Experts unanimously agreed upon the role of betahistine in providing better vestibular health and in-turn, recovery from vertigo.

Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers

“…† Betahistine also facilitates central vestibular compensation by enhancing the rebalancing of the neuronal activity of the vestibular nuclei complexes on both sides (50, 64) † and (67). ‡ Betahistine also improves brain arousal, a crucial factor for functional recovery/behavioral adaptation, through general upregulation of histamine (15,50,58). † Gaze stabilization and vestibular rehabilitation exercises facilitate central compensation and reduce symptoms of dizziness and vertigo (1,61).…”

“…Betahistine † ‡ Brain arousal, a crucial factor for functional recovery/behavioral adaptation, through general upregulation of histamine (15,50,58). †…”

“…Incomplete repositioning during CRM can result in residual otoconial debris that is sufficient to cause mild positional vertigo or less specific chronic or positional dizziness, but insufficient to deflect the cupula to the degree required to provoke overt nystagmus (58,85,86). This suggests a problem in the utriculus in which small particles increase the density of the canal endolymph and interfere with the precision of head motion and tilt detection (including spatial disorientation which might manifest itself as a specific dizziness).…”

“…Patients with co-existing Meénière's disease Betahistine • Rebalancing of the vestibular system; brain arousal favoring sensorimotor activity (47,50,58,63,64,67).…”