Medical management of common peripheral vestibular diseases.

PURPOSE OF REVIEW: Review of office-based medical management options for common vestibular diseases.

RECENT FINDINGS: Basic science studies have defined the ionic homeostasis of the inner ear stria vascularis as a central principle in the understanding of inner ear disorders. New molecular channels for water homeostasis have been identified in the inner ear structures. Office-based history, neurotological physical examination and judicial use of audiovestibular testing have increased our ability to manage vestibular patients more cost-effectively. Clinical studies supported the use of gentamicin and steroids intratympanic perfusion of the inner ear to augment traditional treatments of common vestibular disorders.

SUMMARY: The molecular biology and ionic transport between the stria vascularis and endolymph provided further understanding to the pathology and treatment of inner ear disorders. The history, physical examination and judicial use of laboratory tests are very critical and cost-effective in managing patients with vestibular diseases. Treatments such as inner ear perfusion with gentamicin and steroids have helped control and stabilize vertigo and hearing loss in Meniere's disease. Canalith repositioning treatments and home-based vestibular rehabilitation have improved our abilities to effectively manage patients with benign paroxysmal positional vertigo, uncompensated peripheral vestibular loss and multisensory deficit and age-related balance disorders.