Multidisciplinary approach with dietary and lifestyle modifications in vertigo: a therapeutic challenge

Abstract

Vertigo/dizziness is a subjective sensation of rotation, usually peripheral in origin, which could be physiological or pathological. It needs to be differentiated from imbalance or disequilibrium, which usually has a central or cervicogenic etiology, and also from other vertigo mimics like presyncope or seizure disorder. Vertigo/dizziness is a symptom whose etiology can be multifactorial with various clinical overlaps among different vertigo syndromes due to multiple levels of involvement in the vestibular pathway. Hence, an otolaryngologist faces a great challenge in finding the etiology. Localization of the exact site of vertigo can be challenging for many specialists. Meniere disease, migraine, or benign paroxysmal positioning vertigo are the most common causes of recurrent vertigo. Posterior circulation ischemia or stroke can also cause vertigo or imbalance. This review discusses the role of thorough history, and clinical examination, which includes Dix-Hallpike test, other vestibular and auditory function tests and audiograms, imaging comprising of MRI of brain and spine, and high-resolution computed tomography scan of temporal bone. The current review also describes cervicogenic vertigo, which is treated and studied mainly by physiotherapists, with lack of clarity of this entity among otolaryngologists and other specialists. The multidisciplinary approach for vertigo entails active participation of a team comprising of otolaryngologists, physiotherapists, general physicians, neurologists, orthopedician, and neurosurgeons, based on clinical features and investigations, is described in the review.