Abstract
This article discusses conservative and surgical treatments of vertigo, dealing with vertiginous patients visiting the emergency room (ER), the pharmacotherapy for balance disorders, and major and minor surgical approaches for intractable Meniere's disease. Triage that does not overlook dangerous vertigo is very important in the ER, for which basic general check-ups including the character of the balance disorder, vital signs and neurological assessment are essential. The pharmacotherapy for balance disorders in Japan is not largely different from that in the US or Europe. However, there are some anti-vertigo drugs that are approved and used only in Japan, the efficacy of which may have to be re-evaluated for appropriate management of patients with balance disorders. Although it has been the focus of debate for a long time, endolymphatic sac surgery (ESS) remains the first-line surgical treatment for intractable Meniere's disease. More destructive procedures such as vestibular neurectomy may be selected when vertigo attacks fail to be cured by less destructive treatments. Less invasive minor surgeries including ventilation tube insertions or tenotomy of the middle ear muscles have been reported to reduce vertigo attacks significantly in Meniere's disease patients, although the efficacy should be confirmed by further studies.
