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While the vestibular (balance system) system-originated-vertigo is described as the spinning of the individual or the objects around them, with the other types of vertigo, that are originated from causes other than vestibular system, patients consult to the physicians with complaints such as blackout or fainting. In vestibular-originated-vertigo other complaints in the picture are, nausea, vomiting and imbalance. Physician should learn about the patient’s history after listening to their complaints. The points, that should be taken into consideration with patient’s history are, patient’s age, current illnesses, medications they are taking, past surgeries, family history, whether they had any ear related disease or procedure before or not, whether they had dizziness before or not, type and length of current dizziness, whether they have nasuea-vomiting, humming, decreased hearing, ringing complaints as well or not. After a thorough ear, nose and throat examination, physician might also ask for internal medicine, neurology and/or cardiology consultations. When it comes to dizziness within ear, nose and throat triangle, it means situation is serious.  Therefore the patient must be placed under observation primarily, should be calmed down and then the symptomatic treatment needs to be arranged.

Which ENT disesases cause dizziness?
Benign Paroxysmal Positional Vertigo (BPPV): It is a very severe dizziness condition that emerges with head movements and only lasts for seconds usually; the situation occurs when the crystals – what we call otoconia - in the inner ear become dislodged from where they were and displaced to someother places. In the eyes, fast adaptation movements, which are called nystagmus, are viewed. Diagnosis is made by performing Dix-Hallpike test; and treated with Epley Maneuver.

Dix-Hallpike Maneuver
Epley Maneuver

Vestibular Neuritis:
It is believed to be triggered by viruses, therefore it is inflammation of vestibular nerve which shows itself by an upper respiratory system follow-up. Dizziness starts suddenly and usually accompanied by nasuea and vomiting. Hearing is completely normal. While the severity phase improves within weeks, recovery might take months.

Meniere’s Disease (Endolymphatic Hydrops):
It is a disease that occurs by excessive endolymph fluid accumulation in the endolymphatic sac in the inner ear and follows a course of attacks. Even though it is accompanied by humming in the ears, fullness sensation, ringing and decreased hearing, all the symptoms might not be present all at once in every case. Every attack causes decrease of hearing. Over the years sensorineural hearing loss settles down. There is usually low frequency loss. Patient is sedated during the attacks for treatment and medications are administered. And as for intractable patients that are resilient to medications and/or have firmly fixed hearing loss, surgical treatment is always an option. Endolymphatic sac surgeries, labyrinthectomy and vestibular neurectomy are other treatment options.

Acoustic Neuroma:
It is a benign tumor that generates from myelin forming cells of vestibular nerve. Although in cellular level it is not malignant, over the years it grows and pressures on acoustic (auditory) nerve, subsequently causing hearing loss. Therefore, it is important to suspect this disease and examine with MRI, when encountered dizziness and high-pitched sound (high frequency) evidencing  hearing loss or sudden hearing loss. Treatment options include follow-up, gamma knife treatment, and surgery.

Chronic Otitis Media Complication:
In chronic middle ear inflammations, dizziness is a possible outcome, since the inflammatory condition causes destruction of the structures in the middle ear. Its treatment is comprised of middle ear inflammation treatment and inner ear opening repair, if any.

What are the most commonly used diagnostic methods for dizziness?
Audiogram
Electronystagmography
Elektronistagmografi
Caloric Reflex
MRI

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