Materiały źródłowe

• #1 Causes of vertigo – UpToDate

  https://www.uptodate.com/contents/causes-of-vertigo

  Vertigo is a symptom of illusory movement. […] It arises because of asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem or cerebellum. […] The pathophysiology, etiology, and differential diagnosis of vertigo will be reviewed here. […] Important to the pathogenesis of vertigo is the fact that there is a vestibular labyrinth on each side of the body. […] The spurious left-right differences that result from an acute unilateral peripheral vestibular disorder are also interpreted by the central nervous system as motion or vertigo.

• #1 Peripheral Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430797/

  Approximately 80 percent of vertigo is peripheral, whereas approximately 20 percent is central. […] Peripheral vertigo is most commonly due to a benign process; benign paroxysmal positional vertigo (BPPV) is by far the most common cause of peripheral vertigo. […] The etiology of vertigo is typically due to a disturbance of the vestibular system, semicircular canals, or cranial nerve VIII. This disturbance could be related to damage to one of these organs or simply confused neuronal input. […] A disturbance of the vestibular system, semicircular canals, or cranial nerve 8 is the underlying issue. This disturbance could be related to damage to one of these organs or simply confused neuronal input. […] Usually, peripheral vertigo is, although not always, due to a benign process, whereas central vertigo often indicates a more serious pathology.

• #1 Benign paroxysmal positional vertigo – UpToDate

  https://www.uptodate.com/contents/benign-paroxysmal-positional-vertigo

  Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo, accounting for nearly one-half of patients with peripheral vestibular dysfunction. It is most commonly attributed to calcium debris within the posterior semicircular canal, known as canalithiasis. […] Pathophysiology – BPPV is commonly attributed to canalithiasis (ie, calcium debris within the semicircular canal). This debris likely represents loose otoconia (calcium carbonate crystals) originating from the utricular sac. […] The semicircular canals normally detect angular head accelerations. Heavy debris in the canal causes inappropriate movement of the endolymph with linear accelerations, such as gravity, and causes the erroneous sensation of spinning when the head shifts with respect to gravity.

• #1 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2010.6.2.51

  The detached otolith debris could be either attached to the cupula (cupulolithiasis) or may be free-floating in the semicircular canals (canalolithiasis). Pathological studies have shown that both of these conditions exist. The otolithic debris deflects the cupula and gives rise to a spinning sensation via a direct gravitational effect on the cupula or by inducing endolymph flow during head motion in the direction of gravity. According to the cupulolithiasis theory, a cupular deposit (heavy cupula) would induce a gravitational effect on the crista. However, the action of free-floating debris is the currently accepted pathophysiologic mechanism of typical BPPV. According to the canalolithiasis theory, the free-floating particles move under the influence of gravity when changing the position of the canal in the earth-vertical plane. The hydrodynamic drag of the particles induces endolymphatic flow, resulting in cupular displacement and leading to the observed typical responses.

• #1 Vertigo – Wikipedia

  https://en.wikipedia.org/wiki/Vertigo

  Mnire’s disease is an inner ear disorder of unknown origin, but is thought to be caused by an increase in the amount of endolymphatic fluid present in the inner ear (endolymphatic hydrops). However, this idea has not been directly confirmed with histopathologic studies, but electrophysiologic studies have been suggestive of this mechanism. […] Vestibular neuritis presents with severe vertigo with associated nausea, vomiting, and generalized imbalance and is believed to be caused by a viral infection of the inner ear, although several theories have been put forward and the cause remains uncertain. […] Vestibular migraine is the association of vertigo and migraines and is one of the most common causes of recurrent, spontaneous episodes of vertigo. The cause of vestibular migraines is currently unclear; however, one hypothesized cause is that the stimulation of the trigeminal nerve leads to nystagmus in individuals with migraines.

• #1 Central Vertigo: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/794789-overview

  Central vertigo is vertigo due to a disease originating from the central nervous system (CNS). In clinical practice, it often includes lesions of cranial nerve VIII as well. Individuals with vertigo experience hallucinations of motion of their surroundings. […] Central vertigo may be caused by hemorrhagic or ischemic insults to the cerebellum, the vestibular nuclei, and their connections within the brain stem. Other causes include CNS tumors, infection, trauma, and multiple sclerosis. […] The brainstem, cerebellum, and peripheral labyrinths are all supplied by the vertebrobasilar arterial system. Thus, the central and peripheral ischemic vertigo syndromes overlap. […] Arterial occlusion and ischemic infarction can result from cardioembolism, embolism of plaque from a vertebral artery, or local arterial thrombosis. One or both vertebral arteries, the basilar artery, or any of the smaller branches may be occluded.

• #1 The Role of Calcium in the Pathophysiology of Vertigo and its Tre

  https://www.itmedicalteam.pl/articles/the-role-of-calcium-in-the-pathophysiology-of-vertigo-and-its-treatment-with-flunarizine-107691.html

  The CACNA1A gene analysis in BPPV patients showed increased risk of BPPV occurrence correlated with TT mutation of rs2074880 in the CACNA1A gene, indicating that CACNA1A was involved in the occurrence and pathogenesis of BPPV through calcium channel regulation, but the exact molecular mechanisms remain unknown and require further investigation. […] The current hypotheses of cortical spreading depression (CSD), trigeminovascular pathway and ion channel defect, especially calcium ion channel defect, maybe the underlying aetiology of VM. […] CSD may explain the onset of transient vertigo. […] The most frequent cause of PCI is atherosclerosis, which can occur in the proximal portion of the VA in the neck, intracranial vertebral arteries, basilar artery and posterior cerebral arteries. […] Brain ischemia rapidly leads to the loss of glucose and oxygen and thus energy depletion in the affected core tissue.

• #1 Central Vertigo: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/794789-overview

  Multiple sclerosis is a demyelinating disease of the CNS. The course generally waxes and wanes, with varying neurologic symptoms and signs. Isolated vertigo may be the initial symptom in approximately 5% of cases. […] Acoustic neuromas are Schwann cell tumors that usually originate on the vestibular division of the eighth cranial nerve in the proximal internal auditory canal. […] Traumatic central vertigo may be caused by petechial hemorrhages in the vestibular nuclei of the brainstem. These may result from shearing forces on the brainstem.

• #1 Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482356/

  Vertigo is most often caused by a dysfunction in the vestibular system from a peripheral or central lesion. […] Asymmetry in the vestibular system accounts for the symptoms of vertigo. Asymmetry may result from damage or dysfunction in the peripheral system, such as the vestibular labyrinth or vestibular nerve, or a central disturbance in the brainstem or cerebellum. […] Though there may be a permanent vestibular disturbance, the symptom of vertigo is never permanent as the central nervous system adapts over days to weeks. […] Tumors can cause vertigo. Schwannoma is the most common lesion in the cerebellopontine angle. […] Meningioma is the most common extra-axial tumor in adults. It is the second most common lesion in the cerebellopontine angle. […] Infectious causes should be considered. Viral labyrinthitis is the most common example. […] Cholesteatoma can be acquired or congenital, occurring in the pars flaccida or pars tensa.

• #1 Vertigo – Wikipedia

  https://en.wikipedia.org/wiki/Vertigo

  The neurochemistry of vertigo includes six primary neurotransmitters that have been identified between the three-neuron arc that drives the vestibulo-ocular reflex (VOR). Glutamate maintains the resting discharge of the central vestibular neurons and may modulate synaptic transmission in all three neurons of the VOR arc. Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses. Gamma-Aminobutyric acid (GABA) is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections among the cerebellar Purkinje cells, the lateral vestibular nucleus, and the vertical VOR. […] Three other neurotransmitters work centrally. Dopamine may accelerate vestibular compensation. Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine is present only centrally, but its role is unclear. Dopamine, histamine, serotonin, and acetylcholine are neurotransmitters thought to produce vomiting. It is known that centrally acting antihistamines modulate the symptoms of acute symptomatic vertigo.

• #1 Benign Paroxysmal Positional Vertigo (BPPV) – Vestibular Disorders Association

  https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/

  Benign Paroxysmal Positional Vertigo (or BPPV) is the most common cause of vertigo, which is a false sensation of motion, often reported as a spinning sensation. […] It occurs when calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle become dislodged and migrate into one or more of the three fluid-filled semicircular canals, where they are not supposed to be. […] BPPV is a mechanical problem in the inner ear. It occurs when some of the calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle become dislodged and migrate into one or more of the three fluid-filled semicircular canals, where they are not supposed to be. […] When enough of these particles accumulate in one of the canals, they interfere with the normal fluid movement that these canals use to sense head motion, causing the inner ear to send false signals to the brain.

• #1 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2010.6.2.51

  Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by changes in head position. BPPV is the most common etiology of recurrent vertigo and is caused by abnormal stimulation of the cupula by free-floating otoliths (canalolithiasis) or otoliths that have adhered to the cupula (cupulolithiasis) within any of the three semicircular canals. […] Schucknecht was the first to provide a pathophysiological concept of BPPV. In 1969 he proposed the theory of „cupulolithiasis” on the basis of pathological studies that demonstrated otolithic debris attached to the cupula. […] In 1979, Hall proposed the concept of „canalolithiasis”, which states that otolithic debris from the utricular macule migrates into the semicircular canal via the nonampullary portion, causing vertigo and nystagmus by moving freely inside the semicircular canal and inducing endolymph flow during positional changes.

• #1

  https://www.ijorl.com/index.php/ijorl/article/view/3838

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. […] The pathophysiology of BPPV is still unclear. The pathophysiology for BPPV is complex and the underlying mechanism is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These otolith/debris are originally accumulated after detachment from the neuroepithelium of the utricular macula secondary to degeneration. […] However, the pathophysiology is still obscure and is being critically discussed in this article, which reviews the details pathological mechanism for BPPV. This review article will discuss that aging, trauma, migraine, Menieres disease, vestibular neuronitis, and vitamin-D deficiency are the most commonly investigated etiopathological factors resulting in BPPV.

• #1

  https://step2.medbullets.com/ear-nose-throat/120131/benign-paroxysmal-positional-vertigo-bppv

  inner ear disorder leading to spinning sensation exacerbated by head movement […] Pathogenesis […] inner ear sensory hair cells detects endolymph movement with head or body motion […] this causes the brain to perceive motion or position […] rotation acceleration is detected by the semicircular canals […] linear acceleration is detected by the utricle and saccule […] canalithiasis (calcium debris) within the semicircular canal leads to improper motion of the endolymph, which results in a spinning sensation […] most common site of canalithiasis is in the posterior semicircular canal.

• #1 Benign Paroxysmal Positional Vertigo (BPPV) – Vestibular Disorders Association

  https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/

  Fluid in the semicircular canals does not normally react to gravity. However, the crystals do move with gravity, thereby moving the fluid when it normally would be still. […] This false information does not match with what the other ear is sensing, with what the eyes are seeing, or with what the muscles and joints are doing, and this mismatched information is perceived by the brain as a spinning sensation, or vertigo, which normally lasts less than one minute. […] The most common form of BPPV causes rotational, or torsional, nystagmus which is why most people with BPPV related vertigo report a spinning sensation. […] There are two types of BPPV: one where the loose crystals can move freely in the fluid of the canal (canalithiasis), and, more rarely, one where the crystals are thought to be hung up on the bundle of nerves that sense the fluid movement (cupulolithiasis).

• #1 Ears – Meniere’s disease | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ears-menieres-disease

  Menieres disease may develop slowly over time, with a gradual loss of hearing, or suddenly with a vertigo attack. […] The exact cause of Mnire’s disease is unknown but the mechanism causing the symptoms is thought to likely involve the fluid in the inner ear, which moves over the sensory cells that send information to the brain about the position of the head, and sound. […] Over time, the abnormal fluid concentration may cause irreparable damage to the sensory cells responsible for hearing and balance.

• #1 Hypothetical Mechanism for Vertigo in Meniere’s Disease | Ento Key

  https://entokey.com/hypothetical-mechanism-for-vertigo-in-menieres-disease/

  Past theories that have been proposed to account for the attacks of vertigo during the course of Meniere disease are reviewed. […] Recent research concerning the basic mechanisms of the inner ear anatomy and function cast doubt on these theories. […] Understanding the pathophysiological mechanism that causes the attacks of vertigo could provide the key to understanding the etiology of Menieres disease. […] The theory hypothesizes that endolymph draining too rapidly from the cochlear duct (pars inferior) causes attacks of vertigo. […] The rupture theory remained the most plausible explanation for several decades. […] As knowledge of the physiology and pathophysiology of the ear has developed over recent years, the original rupture theory hypothesis has seemed increasingly unlikely, and alternative theories have evolved to explain a sudden potassium contamination of the perilymph.

• #1 Dizziness and Vertigo

  https://practicalneurology.com/articles/2019-mar-apr/dizziness-and-vertigo

  Recovery from vestibular neuritis may be suboptimal because of combined abnormal visual dependency and anxiety, despite objective vestibular function tests showing recovery of function. […] The inner ear is particularly susceptible to ischemic injury because it is supplied by an end artery, the internal auditory artery (IAA). […] The most common mechanism of IAA territory infarction is thrombotic stenosis of the parent vessel, usually the AICA, or the origin of the AICA in the basilar artery. […] Spells of vertigo associated with auditory symptoms (eg, tinnitus or unilateral hearing loss) that last for minutes can represent AICA TIAs that precede stroke. […] Fluctuating sensorineural hearing loss in the low-to-medium frequency (30 dB, 2000 Hz) range with tinnitus and aural fullness occur in association with spontaneous episodic vertigo in patients with Mnires disease.

• #1 The Interaction of Hypertension for Vertigo in Audiovestibular Medicine Clinic

  https://www.e-rvs.org/journal/view.php?doi=10.21790/rvs.2022.21.2.29

  Hypertension is a common vascular disorder in adulthood, characterized by high blood pressure in the vascular system. This high blood pressure if not controlled, can lead to inner ear hemorrhage, or ischemia. When this involves the anterior inferior cerebellar artery (AICA), or the labyrinthine artery (only artery that supplies the inner ear), it leads to a compromise of cochleovestibular function, and the patient can present with vertigo and/or hearing loss. […] Hypertension can affect both the central and the peripheral parts of balance, and these pathophysiological pathways can occur either in combination or in isolation to result in hypofunction or a complete failure of the vestibular system leading to vertigo. […] The effect of uncontrolled hypertension usually results in vascular aneurysms, and/or microvascular hemorrhage with its ischemic effect.

• #1 The Role of Calcium in the Pathophysiology of Vertigo and its Tre

  https://www.itmedicalteam.pl/articles/the-role-of-calcium-in-the-pathophysiology-of-vertigo-and-its-treatment-with-flunarizine-107691.html

  This mechanism of glutamate excitotoxicity is the primary mediator of acute neuronal death, and is largely caused by calcium overload. […] Flunarizine, as a calcium channel blocker, works by causing the sustained inhibition of extracellular calcium ions entering tissue cells when activated by high potassium ion levels, vasoactive substances or hypoxia, thereby preventing calcium overload that is cytotoxic to cells as excessive calcium leads to the overactivation of deleterious enzymes and signalling processes that impair neuronal function or lead to cell death. […] Flunarizine exhibits gradual onset and long duration of action, and the way it works on calcium ions is dose-dependent. […] Flunarizine was shown to be effective against vertiginous attacks and the associated symptoms caused by BPPV, VM and PCI with few serious adverse effects.

• #1 The Light Cupula: An Emerging New Concept for Positional Vertigo

  https://www.ejao.org/journal/view.php?doi=10.7874/jao.2017.00234

  Benign paroxysmal positional vertigo (BPPV) is the most common type of positional vertigo. […] The concept of light cupula has been introduced to explain persistent geotropic DCPN, although the mechanism behind it requires further elucidation. […] The pathophysiological mechanism behind light cupula remains controversial. […] It has been reported that geotropic DCPN can be observed in patients with central nervous system disorders. […] It was suggested that dysfunction of inhibitory GABAergic connections from the vestibulocerebellum to the vestibular nuclei may be the cause of persistent geotropic DCPN in VM patients. […] The lighter cupula theory originated from the concept of positional alcohol nystagmus (PAN). […] The heavier endolymph theory has been proposed on the assumption that the specific gravity of the endolymph may increase due to an acute insult on the inner ear such as labyrinthine hemorrhage, inner ear hypoperfusion, or inflammation. […] It has been suggested that light debris are attached on the LSCC cupula and make the cupula light based on the following observations. […] The pathophysiological mechanism underlying light cupula needs to be elucidated to establish a proper treatment protocol.

• #1 The Role of Calcium in the Pathophysiology of Vertigo and its Tre

  https://www.itmedicalteam.pl/articles/the-role-of-calcium-in-the-pathophysiology-of-vertigo-and-its-treatment-with-flunarizine-107691.html

  Vertigo is a complicated symptom caused mainly by a dysfunctional vestibular system, either central or peripheral. […] The mechanisms of BPPV, VM and PCI remain unclear, they are all related to a dysfunctional vestibular system, where calcium homeostasis is disrupted. […] Calcium metabolism is an essential etiological factor in BPPV development. […] Vitamin D plays an important role in keeping calcium ions at a normal level by regulating the expression of some calcium binding proteins; and its deficiency can change the structure of otoconia and disrupt calcium metabolism, resulting in BPPV attacks due to calcium deficiency-related degradation and fragmentation of otoconia. […] An interesting study using native thiol/disulfide (SH/SS) homeostasis as a novel marker of oxidative stress for the first time showed oxidative stress played a significant role in the disorder of calcium metabolism and the development of BPPV.

• #1 Relation between vitamin D deficiency and benign paroxysmal positional vertigo | Scientific Reports

  https://www.nature.com/articles/s41598-021-96445-x

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. Vitamin D deficiency may be one of the causes of its development. […] There is a relation between BPPV recurrence and low serum Vitamin D. […] Dislodgement of calcium carbonate crystals (otoconia) from the utricle into the semicircular canals (most commonly the posterior canal) is one of the accepted theories of pathogenesis of BPPV. Vitamin D plays a major role in Calcium metabolism which may affect the calcium carbonate crystals (otoconia) density and matrix. […] In osteoporosis, there is a disturbance in the metabolism of both vitamin D and calcium and this is probably the key element of the pathogenesis of BPPV. Vitamin D level and deposition of calcium crystals affect the otoconia matrix and density similar to its effect on bone structures.

• #1 Relation between vitamin D deficiency and benign paroxysmal positional vertigo | Scientific Reports

  https://www.nature.com/articles/s41598-021-96445-x

  Vitamin D insufficiency correlated with the severity of BPPV and its recurrence. […] The association between BPPV and osteoporosis was postulated in some studies. This relationship originates from the essential role of calcium metabolism in the homeostasis of otoconia metabolism which regulates the synthesis and absorption of otoconia, which mainly composed of calcium carbonate. […] Many researches have confirmed that vitamin D receptors are founded on calcium channel transport systems of the labyrinth and act to regulate proper calcium balance. This mechanism may help to explain the role of vitamin D in maintaining proper auditory function. […] Deficiency of vitamin D has been attributed to cochlear demineralization and cochlear deafness. […] The mean of recurrent attacks of BPPV in group A (0.20.4) was significantly lower than that in group B (1.50.7). There was a negative correlation between recurrence rate of BPPV episodes and Vitamin D deficiency which means that Vitamin D deficiency may have a role in recurrence of BPPV.

• #1 Geriatric benign paroxysmal positional vertigo: a single-center study | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-geriatric-benign-paroxysmal-positional-vertigo-S1808869423000459

  BPPV was more common in women. […] The proportion of men with BPPV increased with age. […] Geriatric BPPV patients often had risk factors associated with atherosclerosis. […] Horizontal canal-BPPV and multi-canal-BPPV were more common in geriatric patients. […] The effectiveness of canalith repositioning procedure may decrease with age. […] About 95% of cases of BPPV are idiopathic or degenerative, and aging and degenerative changes are responsible for the high incidence of BPPV in the elderly. […] With increasing age, there is a decrease in the amount of calcium carbonate crystals in the otoliths. […] This demineralization process weakens the fibrous connections between the otoliths, resulting in fissures or fragmentation, less stable otoliths, and dislodgement of otoconia in the utricles into the semicircular canals.

• #1 Dizziness and Vertigo – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/approach-to-the-patient-with-ear-problems/dizziness-and-vertigo

  Regardless of the diagnosis, dizziness, vertigo, or imbalance of any kind significantly increases the risk for falls and falls-related injuries, and should be taken seriously. […] The most common causes of peripheral dizziness or vertigo are listed in decreasing order of frequency: Benign paroxysmal positional vertigo (BPPV), Meniere disease, Vestibular neuronitis, Labyrinthitis, Presbyvestibulopathy. […] The most common causes of central dizziness or vertigo, in decreasing order of frequency, include the following: Vestibular migraine, Medication side effects, especially antihypertensives, Functional dizziness, Presbyvestibulopathy. […] Uncompensated peripheral vestibular weakness causes dysequilibrium rather than vertigo and often visual blurring with head turning. It can be the result of vestibular neuronitis, migraine with vertigo, Meniere disease, head trauma, or inner ear surgery. […] In older patients, dizziness is often multifactorial secondary to medication adverse effects and age-diminished visual, vestibular, and proprioceptive abilities. Two of the most common specific causes are disorders of the inner ear: BPPV and Meniere disease.

• #1 A genome-wide association study identifies novel loci of vertigo in an Asian population-based cohort | Communications Biology

  https://www.nature.com/articles/s42003-024-06603-w

  The contributing genetic factors of vertigo remain poorly characterized, particularly in individuals of non-European ancestries. […] This study identified novel genomic loci for vertigo in an Asian population-based cohort, which may help identifying high risk subjects and provide mechanistic insight in understanding the pathogenesis of vertigo. […] The implicated genes from the lead SNPs may provide novel mechanistic insights to better understand the pathophysiology of the common types of vertigo. […] However, how these genes may affect cerebellar function is unclear. […] The loci with suggestive significance of association with vertigo might also be functionally relevant to the pathogenesis of vertigo. […] Although our findings provide genetic evidence to support prevailing theories of vertigo pathogenesis, there were limitations in our study.

• #1 BPPV — Benign Paroxysmal Positional Vertigo

  https://dizziness-and-balance.com/disorders/bppv/bppv.html

  BPPV is caused by crystals dislodged from the utricle of the inner ear. […] Physically, BPPV results when the otoconia are dislodged from the utricle, become loose within the labyrinth, and fall backwards into one of the canals (usually the posterior). […] Otoconia may be dislodged due to wear/tear, trauma, disease. Usually it is blamed on wear/tear. […] In older people, the most common cause is degeneration of the vestibular system of the inner ear — „wear and tear” involving the otoliths. […] The most common cause of BPPV in people under age 50 is head injury. […] Between 8% and 20% of BPPV is attributed to trauma. […] There is also a strong association of BPPV with migraine. […] Viruses affecting the ear such as those causing vestibular neuritis and Meniere’s disease are significant causes.

• #1 The Role of Oxidative Stress and Inflammatory Mediators in Benign Paroxysmal Positional Vertigo

  https://advancedotology.org/en/the-role-of-oxidative-stress-and-inflammatory-mediators-in-benign-paroxysmal-positional-vertigo-13892

  Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid changes in head position associated with a characteristic paroxysmal positional nystagmus. The aim of this study was to search for the possible role of oxidative stress and inflammatory mediators in the pathogenesis of BPPV. […] Our findings suggested that IL-1 and oxidative stress contributed to the pathogenesis of BPPV.

• #1 Dizziness and Vertigo

  https://practicalneurology.com/articles/2019-mar-apr/dizziness-and-vertigo

  Other inflammatory disorders that may involve the inner ear include polyarteritis nodosa, systemic lupus, Sjgren syndrome, Vogt-Koyanagi-Harada syndrome, granulomatosis with polyangiitis, and relapsing polychondritis. […] In addition to nonischemic causes of a lower motor neuron facial palsy discussed, the presence of vertigo and a 7th nerve palsy should also raise suspicion for an AICA territory infarction involving the root entry zone and 7th nerve fascicle. […] In patients with a recent temporal bone fracture, barotrauma, or stapes surgery, co-occurrence of episodic vertigo and unilateral hearing loss may suggest a perilymphatic fistula. […] The approach to the vestibular and ocular motor examination will be discussed in Part 2 in the next issue of Practical Neurology.

• #1 Vertigo due to Eustachian Tube Dysfunction – SciTeMed Publishing Group

  https://scitemed.com/article/172/scitemed-aohns-2017-00017

  Eustachian tube dysfunction (ETD) can lead to a loss of vestibular function and eventually give rise to peripheral vestibular loss. […] Vertigo caused by ETD is a distinct clinical entity; therefore, a comprehensive understanding of the mechanism underlying vertigo is essential to elucidate the reciprocal causal relationship between laryngopharyngeal reflux and Eustachian tube obstruction. […] Vertigo from ETD can be explained by a pressure increase that occurs within a vestibular organ. Specifically, negative pressure in the middle ear can cause the tympanic membrane to retract, which in-turn causes the stapes to push against the oval window. […] It is very likely that dysfunction of the Eustachian tube disturbs the air pressure in the middle ear cavity and stimulates the perilymph, which interferes with balance, which is normally maintained by the labyrinthine mechanism.

• #1 New Research Pinpoints Mechanism Behind Sound-Induced Vertigo | The Hearing Review

  https://hearingreview.com/hearing-loss/vestibular-care/new-research-pinpoints-mechanism-behind-sound-induced-vertigo

  For some people, certain sounds like a trumpet blowing a particular tone can make them dizzy, and its not because theyre giddy from a Wynton Marsalis melody. […] It has been estimated that 1 in 100 people around the world have a congenital inner ear condition known as semicircular canal dehiscence, a thinning of the bone enclosing the inner ear that can lead to vertigo in response to certain sounds, changes in atmospheric pressure, or coughing. […] This condition causes the eyes to rotate through an automatic reflex that normally would stabilize the image in the eye during head movements. But if the signal from the ear is wrong, the eyes movements are also wrong, causing the patient to feel dizzy. […] What our paper is about is the biophysics of how that happens. How does sound excite the inner ear balance organs causing them to send the wrong head-motion signals to the brain?

• #1 Vertigo – Introduction to Sensation and Perception

  https://pressbooks.umn.edu/sensationandperception/chapter/vertigo/

  Vertigo is a condition in which a person has the sensation of moving or of surrounding objects moving when they are not. […] The most common disorders that result in vertigo are benign paroxysmal positional vertigo (BPPV), Mnires disease, and labyrinthitis. […] Alcohol-induced spins are a form of vertigo. Elevated blood alcohol content causes an increase in the density of the endolymph in the semi-circular canals, which throws the mechanics of the inner ear off. The cupula floats a bit, stimulating neurons that normally signal rotation. Thus, the sensation of spinning. […] This extra movement of the cupula is what causes alcohol induced spins.

• #1 What is the mechanism of Betahistine Hydrochloride?

  https://synapse.patsnap.com/article/what-is-the-mechanism-of-betahistine-hydrochloride

  The elevated levels of histamine improve neuronal excitability and neurotransmission, which are crucial for maintaining balance and reducing vertigo symptoms. […] Betahistine’s capacity to enhance blood flow in this area helps in the normalization of endolymph production and absorption, thereby alleviating the pressure buildup that can lead to vertigo and hearing loss. […] Research suggests that Betahistine facilitates this compensatory mechanism by promoting neuronal plasticity and enhancing the synaptic activity of vestibular nuclei in the brainstem. […] In summary, the mechanism of Betahistine hydrochloride involves a multifaceted approach, including the modulation of histamine receptors, improvement of inner ear blood flow, and facilitation of central vestibular compensation. Through these combined actions, Betahistine effectively reduces the symptoms associated with Mnire’s disease and other vestibular disorders, providing relief to patients suffering from vertigo, tinnitus, and hearing loss.

• #2 Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482356/

  Vertigo is most often caused by a dysfunction in the vestibular system from a peripheral or central lesion. […] Asymmetry in the vestibular system accounts for the symptoms of vertigo. Asymmetry may result from damage or dysfunction in the peripheral system, such as the vestibular labyrinth or vestibular nerve, or a central disturbance in the brainstem or cerebellum. […] Though there may be a permanent vestibular disturbance, the symptom of vertigo is never permanent as the central nervous system adapts over days to weeks. […] Tumors can cause vertigo. Schwannoma is the most common lesion in the cerebellopontine angle. […] Meningioma is the most common extra-axial tumor in adults. It is the second most common lesion in the cerebellopontine angle. […] Infectious causes should be considered. Viral labyrinthitis is the most common example. […] Cholesteatoma can be acquired or congenital, occurring in the pars flaccida or pars tensa.

• #2 Dizziness and Vertigo – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/approach-to-the-patient-with-ear-problems/dizziness-and-vertigo

  Regardless of the diagnosis, dizziness, vertigo, or imbalance of any kind significantly increases the risk for falls and falls-related injuries, and should be taken seriously. […] The most common causes of peripheral dizziness or vertigo are listed in decreasing order of frequency: Benign paroxysmal positional vertigo (BPPV), Meniere disease, Vestibular neuronitis, Labyrinthitis, Presbyvestibulopathy. […] The most common causes of central dizziness or vertigo, in decreasing order of frequency, include the following: Vestibular migraine, Medication side effects, especially antihypertensives, Functional dizziness, Presbyvestibulopathy. […] Uncompensated peripheral vestibular weakness causes dysequilibrium rather than vertigo and often visual blurring with head turning. It can be the result of vestibular neuronitis, migraine with vertigo, Meniere disease, head trauma, or inner ear surgery. […] In older patients, dizziness is often multifactorial secondary to medication adverse effects and age-diminished visual, vestibular, and proprioceptive abilities. Two of the most common specific causes are disorders of the inner ear: BPPV and Meniere disease.

• #2 Benign Paroxysmal Positional Vertigo (BPPV) for ophthalmologists – EyeWiki

  https://eyewiki.org/Benign_Paroxysmal_Positional_Vertigo_(BPPV)_for_ophthalmologists

  Benign paroxysmal positional vertigo (BPPV) is commonly attributed to calcium debris within the semicircular canals (SCC), which normally detect angular head accelerations. Debris in the SCC causes inappropriate endolymph movement with changes in position, and therefore causes the sensation of vertigo with positional movement. […] Two theories exist for the mechanism of action of BPPV. They differ with respect to how the debris influences cupular dynamics: Canalithiasis proposes that free-floating particles, otoconia, have moved from the utricle and collect near the cupula of the affected SCC. Gravity pulls the otoconia through the endolymph canal, creating a plunger-like effect which causes ipsidirectional cupular displacement. […] Cupulolithiasis proposes that the otoconial debris is attached to the cupula of the affected SCC instead of free-floating in the endolymph. Resulting alterations in cupular deflection lead to pathological perceptions of motion.

• #2 Epidemiology of benign paroxysomal positional vertigo (BPPV) and risk factors for secondary BPPV: a population-based study | The Egyptian Journal of Otolaryngology | Full Text

  https://ejo.springeropen.com/articles/10.1186/s43163-023-00456-6

  BPPV is caused by two mechanismcanalithiasis and cupulolithiasis. Canalithiasis describes free floating particles within the semicircular canal. These particles are degenerated otoconia which are made up of otoconia proteins like Oc90, otolin, SC1, which binds with Calcium carbonate. They are crystalline structure with triangular in cross section. Different causes that lead to its degenerations are age, ototoxicity, trauma etc. Hall, Ruby, and McClure first described this theory in 1979. It is now known to be major mechanism of all subtypes of BPPV. […] The term cupulolithiasis describes particles deposition onto the cupula. This theory was first proposed by Schuknecht in 1968 and thought to play a more significant role in lateral canal BPPV. […] BPPV is the most common cause of peripheral vertigo. One has to understand the anatomy, physiology and pathophysiology of vestibular system to provide better patient care in these patients. Particle repositioning maneuver (PRM) is the treatment for BPPV.

• #2 Ears – Meniere’s disease | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ears-menieres-disease

  Menieres disease may develop slowly over time, with a gradual loss of hearing, or suddenly with a vertigo attack. […] The exact cause of Mnire’s disease is unknown but the mechanism causing the symptoms is thought to likely involve the fluid in the inner ear, which moves over the sensory cells that send information to the brain about the position of the head, and sound. […] Over time, the abnormal fluid concentration may cause irreparable damage to the sensory cells responsible for hearing and balance.

• #2 Dizziness: Approach to Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p154.html

  The underlying pathology is excess endolymphatic fluid pressure leading to inner ear dysfunction; however, the exact cause is unknown. […] The HINTS examination is highly sensitive and specific in identifying stroke in patients with acute vestibular syndrome, and it is superior to diffusion-weighted magnetic resonance imaging in ruling out stroke. […] Common peripheral causes of dizziness/vertigo include BPPV, vestibular neuritis (i.e., vestibular neuronitis), and Meniere disease. […] Vestibular neuritis, the second most common cause of vertigo, is thought to be of viral origin. […] Meniere disease causes vertigo and unilateral hearing loss.

• #2 Vertigo – Wikipedia

  https://en.wikipedia.org/wiki/Vertigo

  A stroke (either ischemic or hemorrhagic) involving the posterior fossa is a cause of central vertigo. Risk factors for a stroke as a cause of vertigo include increasing age and known vascular risk factors. Presentation may more often involve headache or neck pain, additionally, those who have had multiple episodes of dizziness in the months leading up to presentation are suggestive of stroke with prodromal TIAs.

• #2 Central Vertigo: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/794789-overview

  Multiple sclerosis is a demyelinating disease of the CNS. The course generally waxes and wanes, with varying neurologic symptoms and signs. Isolated vertigo may be the initial symptom in approximately 5% of cases. […] Acoustic neuromas are Schwann cell tumors that usually originate on the vestibular division of the eighth cranial nerve in the proximal internal auditory canal. […] Traumatic central vertigo may be caused by petechial hemorrhages in the vestibular nuclei of the brainstem. These may result from shearing forces on the brainstem.

• #2 Vertigo pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Vertigo_pathophysiology

  It is thought that vertigo is the result of a disruption in the vestibular system. It is identified as peripheral vertigo if the lesion is in the labyrinth or vestibular nerve or central vertigo if the area of disruption originates from the brainstem or cerebellum. […] Disruption in the vestibular system results in vertigo. The region of disruption could be peripheral (labyrinth, vestibular nerve) or central (brainstem, cerebellum). […] Disruption of the vestibular system can lead to vertigo and associated signs and symptoms. […] The neurochemistry of vertigo includes 6 primary neurotransmitters that have been identified between the 3-neuron arc that drives the vestibulo-ocular reflex (VOR). Many others play more minor roles. […] Acetylcholine appears to function as an excitatory neurotransmitter.

• #2 Vertigo pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Vertigo_pathophysiology

  GABA is thought to be inhibitory. […] Dopamine may accelerate vestibular compensation. […] Norepinephrine regulates the strength of central responses to vestibular stimulation and mediates compensation. […] Histamine is only present centrally and its role is unclear. Centrally acting antihistamines are noted to regulate the symptoms of motion sickness and acute vertigo.

• #2 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2010.6.2.51

  Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by changes in head position. BPPV is the most common etiology of recurrent vertigo and is caused by abnormal stimulation of the cupula by free-floating otoliths (canalolithiasis) or otoliths that have adhered to the cupula (cupulolithiasis) within any of the three semicircular canals. […] Schucknecht was the first to provide a pathophysiological concept of BPPV. In 1969 he proposed the theory of „cupulolithiasis” on the basis of pathological studies that demonstrated otolithic debris attached to the cupula. […] In 1979, Hall proposed the concept of „canalolithiasis”, which states that otolithic debris from the utricular macule migrates into the semicircular canal via the nonampullary portion, causing vertigo and nystagmus by moving freely inside the semicircular canal and inducing endolymph flow during positional changes.

• #2 Relation between vitamin D deficiency and benign paroxysmal positional vertigo | Scientific Reports

  https://www.nature.com/articles/s41598-021-96445-x

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. Vitamin D deficiency may be one of the causes of its development. […] There is a relation between BPPV recurrence and low serum Vitamin D. […] Dislodgement of calcium carbonate crystals (otoconia) from the utricle into the semicircular canals (most commonly the posterior canal) is one of the accepted theories of pathogenesis of BPPV. Vitamin D plays a major role in Calcium metabolism which may affect the calcium carbonate crystals (otoconia) density and matrix. […] In osteoporosis, there is a disturbance in the metabolism of both vitamin D and calcium and this is probably the key element of the pathogenesis of BPPV. Vitamin D level and deposition of calcium crystals affect the otoconia matrix and density similar to its effect on bone structures.

• #2 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2010.6.2.51

  The detached otolith debris could be either attached to the cupula (cupulolithiasis) or may be free-floating in the semicircular canals (canalolithiasis). Pathological studies have shown that both of these conditions exist. The otolithic debris deflects the cupula and gives rise to a spinning sensation via a direct gravitational effect on the cupula or by inducing endolymph flow during head motion in the direction of gravity. According to the cupulolithiasis theory, a cupular deposit (heavy cupula) would induce a gravitational effect on the crista. However, the action of free-floating debris is the currently accepted pathophysiologic mechanism of typical BPPV. According to the canalolithiasis theory, the free-floating particles move under the influence of gravity when changing the position of the canal in the earth-vertical plane. The hydrodynamic drag of the particles induces endolymphatic flow, resulting in cupular displacement and leading to the observed typical responses.

• #2 Hypothetical Mechanism for Vertigo in Meniere’s Disease | Ento Key

  https://entokey.com/hypothetical-mechanism-for-vertigo-in-menieres-disease/

  The endolymphatic sac secretes various substances, including aquaporins, glycoproteins, and even endolymph. […] The rate of longitudinal flow is restricted by the isthmus of the ED rather like sand draining through an hour glass. It is hypothesized that if the endolymph cannot drain quickly enough, the endolymphatic sinus may act as a reservoir, temporarily holding the excess fluid.

• #2 Geriatric benign paroxysmal positional vertigo: a single-center study | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-geriatric-benign-paroxysmal-positional-vertigo-S1808869423000459

  Previous studies have shown that the Canalith Repositioning Procedure (CRP) is less effective in elderly patients with BPPV than in younger patients. […] The incidence of residual symptoms after a CRP, such as prolonged episodes of dizziness and unsteadiness, increases significantly with advancing age. […] The horizontal canal BPPV (particularly horizontal canal BPPV-cupulolithiasis) and multicanal BPPV subtypes were more common and the anterior canal BPPV subtype was less common in elderly patients. […] The effectiveness of canalith repositioning may decrease with age. […] Vascular risk factors may affect the microcirculation in the inner ear and the metabolic balance of calcium in the otoliths in the utricle, leading to an increased risk of episodes of BPPV. […] The internal auditory artery is a terminal vessel and does not have collateral anastomotic connections that would allow continuation of a blood supply to the end organs if an ischemic event occurred, which would render the labyrinth especially vulnerable to ischemic phenomena.

• #2 Dizziness and Vertigo

  https://practicalneurology.com/articles/2019-mar-apr/dizziness-and-vertigo

  Recovery from vestibular neuritis may be suboptimal because of combined abnormal visual dependency and anxiety, despite objective vestibular function tests showing recovery of function. […] The inner ear is particularly susceptible to ischemic injury because it is supplied by an end artery, the internal auditory artery (IAA). […] The most common mechanism of IAA territory infarction is thrombotic stenosis of the parent vessel, usually the AICA, or the origin of the AICA in the basilar artery. […] Spells of vertigo associated with auditory symptoms (eg, tinnitus or unilateral hearing loss) that last for minutes can represent AICA TIAs that precede stroke. […] Fluctuating sensorineural hearing loss in the low-to-medium frequency (30 dB, 2000 Hz) range with tinnitus and aural fullness occur in association with spontaneous episodic vertigo in patients with Mnires disease.

• #2 Dizziness and Vertigo

  https://practicalneurology.com/diseases-diagnoses/headache-pain/dizziness-and-vertigo/30119/

  When its not clear whether a patient with acute prolonged or episodic symptoms has a vestibular or nonvestibular etiology, the presence of vegetative symptoms suggest a vestibular disorder. […] The inner ear is particularly susceptible to ischemic injury because it is supplied by an end artery, the internal auditory artery (IAA). […] The most common mechanism of IAA territory infarction is thrombotic stenosis of the parent vessel, usually the AICA, or the origin of the AICA in the basilar artery. […] Spells of vertigo associated with auditory symptoms (eg, tinnitus or unilateral hearing loss) that last for minutes can represent AICA TIAs that precede stroke. […] Episodes of VM typically last 5 minutes to 72 hours and are accompanied by a variety of sensations including dizziness, vertigo, and/or unsteadiness that are often aggravated by head movements and visual stimulation. […] Although stroke is the most common cause of central AVS, multiple sclerosis and Wernickes encephalopathy also should be considered.

• #2 The Interaction of Hypertension for Vertigo in Audiovestibular Medicine Clinic

  https://www.e-rvs.org/journal/view.php?doi=10.21790/rvs.2022.21.2.29

  This effect of uncontrolled hypertension leads to damage to both the cerebral vasculature and to the inner ear vasculature, leading to both central and peripheral causes of vertigo. […] The systematic review by Shekhar et al. showed that chronic uncontrolled hypertension can result in dysfunction of the cerebral autoregulation leading to a leakage of the blood brain barrier. […] When this affects the areas of the brain that are involved in vestibular network, it can result in neuronal death and synaptic dysfunction in the propagation of vestibular signals, leading to vertigo. […] The presence of a raised blood pressure, or a history of hypertension, should raise an index of suspicion in clinicians for this pathological association between hypertension and vertigo.

• #2 The Role of Calcium in the Pathophysiology of Vertigo and its Tre

  https://www.itmedicalteam.pl/articles/the-role-of-calcium-in-the-pathophysiology-of-vertigo-and-its-treatment-with-flunarizine-107691.html

  Vertigo is a complicated symptom caused mainly by a dysfunctional vestibular system, either central or peripheral. […] The mechanisms of BPPV, VM and PCI remain unclear, they are all related to a dysfunctional vestibular system, where calcium homeostasis is disrupted. […] Calcium metabolism is an essential etiological factor in BPPV development. […] Vitamin D plays an important role in keeping calcium ions at a normal level by regulating the expression of some calcium binding proteins; and its deficiency can change the structure of otoconia and disrupt calcium metabolism, resulting in BPPV attacks due to calcium deficiency-related degradation and fragmentation of otoconia. […] An interesting study using native thiol/disulfide (SH/SS) homeostasis as a novel marker of oxidative stress for the first time showed oxidative stress played a significant role in the disorder of calcium metabolism and the development of BPPV.

• #2 Relation between vitamin D deficiency and benign paroxysmal positional vertigo | Scientific Reports

  https://www.nature.com/articles/s41598-021-96445-x

  In another meta-analysis that investigated the difference between the recurrence and non recurrence of BPPV, there was a significant difference in the Vitamin D levels between the two groups, which indicated that Vitamin D plays a role in the recurrent nature of BPPV. […] Our data suggest that most patients with BPPV in Egypt have low serum Vitamin D and Vitamin D supplement may have a role in decreasing recurrent attacks of BPPV.

• #2 The Role of Calcium in the Pathophysiology of Vertigo and its Tre

  https://www.itmedicalteam.pl/articles/the-role-of-calcium-in-the-pathophysiology-of-vertigo-and-its-treatment-with-flunarizine-107691.html

  The CACNA1A gene analysis in BPPV patients showed increased risk of BPPV occurrence correlated with TT mutation of rs2074880 in the CACNA1A gene, indicating that CACNA1A was involved in the occurrence and pathogenesis of BPPV through calcium channel regulation, but the exact molecular mechanisms remain unknown and require further investigation. […] The current hypotheses of cortical spreading depression (CSD), trigeminovascular pathway and ion channel defect, especially calcium ion channel defect, maybe the underlying aetiology of VM. […] CSD may explain the onset of transient vertigo. […] The most frequent cause of PCI is atherosclerosis, which can occur in the proximal portion of the VA in the neck, intracranial vertebral arteries, basilar artery and posterior cerebral arteries. […] Brain ischemia rapidly leads to the loss of glucose and oxygen and thus energy depletion in the affected core tissue.

• #2 Vertigo – Wikipedia

  https://en.wikipedia.org/wiki/Vertigo

  Mnire’s disease is an inner ear disorder of unknown origin, but is thought to be caused by an increase in the amount of endolymphatic fluid present in the inner ear (endolymphatic hydrops). However, this idea has not been directly confirmed with histopathologic studies, but electrophysiologic studies have been suggestive of this mechanism. […] Vestibular neuritis presents with severe vertigo with associated nausea, vomiting, and generalized imbalance and is believed to be caused by a viral infection of the inner ear, although several theories have been put forward and the cause remains uncertain. […] Vestibular migraine is the association of vertigo and migraines and is one of the most common causes of recurrent, spontaneous episodes of vertigo. The cause of vestibular migraines is currently unclear; however, one hypothesized cause is that the stimulation of the trigeminal nerve leads to nystagmus in individuals with migraines.

• #2 Vertigo due to Eustachian Tube Dysfunction – SciTeMed Publishing Group

  https://scitemed.com/article/172/scitemed-aohns-2017-00017

  Simply stated, unilateral ETD can cause a loss of unilateral vestibular function, which in-turn causes unilateral peripheral vestibular loss vertigo with nausea, vomiting, and/or nystagmus. […] In conclusion, vertigo due to ETD is caused by a pressure imbalance between the middle ear cavities of the two ears. Middle ear pressure is frequently influenced by the function of the Eustachian tube.

• #2 New Research Pinpoints Mechanism Behind Sound-Induced Vertigo | The Hearing Review

  https://hearingreview.com/hearing-loss/vestibular-care/new-research-pinpoints-mechanism-behind-sound-induced-vertigo

  By monitoring the neurons and inner ear fluid motion in toadfish, which have similar inner ear balance organs as humans, it was discovered that this dizzying effect occurs when the sound generates pathological fluid mechanical waves in the semicircular canals of the ear. […] But when there is a pathological hole in the bone certain acoustic tones cause the inner ear fluid to pump, and as a result, the ear sends an incorrect signal to the brain that youre rotating your head when youre not. […] Fortunately, surgery to repair the dehiscence can help patients, Rabbitt says, but researchers now understand the connection of how a small hole in bone can create a lifetime of debilitating dizziness for many. […] What wasnt known was the Why? What exactly causes the symptoms patients have? he says. This finally connects the symptoms and the dehiscence in a precise biophysical way.

• #2 What is the mechanism of Betahistine Hydrochloride?

  https://synapse.patsnap.com/article/what-is-the-mechanism-of-betahistine-hydrochloride

  The elevated levels of histamine improve neuronal excitability and neurotransmission, which are crucial for maintaining balance and reducing vertigo symptoms. […] Betahistine’s capacity to enhance blood flow in this area helps in the normalization of endolymph production and absorption, thereby alleviating the pressure buildup that can lead to vertigo and hearing loss. […] Research suggests that Betahistine facilitates this compensatory mechanism by promoting neuronal plasticity and enhancing the synaptic activity of vestibular nuclei in the brainstem. […] In summary, the mechanism of Betahistine hydrochloride involves a multifaceted approach, including the modulation of histamine receptors, improvement of inner ear blood flow, and facilitation of central vestibular compensation. Through these combined actions, Betahistine effectively reduces the symptoms associated with Mnire’s disease and other vestibular disorders, providing relief to patients suffering from vertigo, tinnitus, and hearing loss.

• #3 Causes of vertigo – UpToDate

  https://www.uptodate.com/contents/causes-of-vertigo

  Vertigo is a symptom of illusory movement. […] It arises because of asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem or cerebellum. […] The pathophysiology, etiology, and differential diagnosis of vertigo will be reviewed here. […] Important to the pathogenesis of vertigo is the fact that there is a vestibular labyrinth on each side of the body. […] The spurious left-right differences that result from an acute unilateral peripheral vestibular disorder are also interpreted by the central nervous system as motion or vertigo.

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