Vertigo, commonly known as dizziness, is a very common symptom that is often seen in ENT or neurology departments. For those who suffer from vertigo on a regular basis, they are anxious to know the causes of vertigo, the dangers of vertigo and how to treat it. However, episodes of vertigo can take a very diverse form, ranging from episodes that occur for a few seconds when the body position is changed, to sudden onset after colds and viral infections, to repeated episodes during exertion or mood swings, to trauma or after the use of ototoxic medications. Typical symptoms of vertigo are the sudden onset of heavenly rotation, the feeling that the surrounding objects are rotating, swaying or jumping, accompanied by nausea, vomiting, profuse sweating, the onset of an attack without aura, causing the patient to panic, lying down and closing their eyes and not daring to move. Vertigo can occur alone or in combination with other conditions such as deafness, facial paralysis and otitis media. These disorders cause great pain to patients and seriously affect their work, life and study. There are many diseases that can cause vertigo, and vertigo caused by ear diseases accounts for a large part of them. Because there are many causes of vertigo and many overlapping symptoms associated with vertigo, even clinicians may not be able to differentiate between these causes, let alone patients with vertigo. Therefore, there are many misunderstandings in the understanding of vertigo, resulting in vertigo can not be correctly treated. What is vertigo Misunderstanding: Almost all patients confuse vertigo, imbalance and dizziness, once occurred are attributed to “dizziness, dizziness”, a considerable portion of the people to emergency in the Department of Neurology, do not know that different symptoms are often caused by different etiology, the treatment is also very different. So what exactly is vertigo? Correction: Vertigo is a sudden, unexplained illusion of movement of oneself or an object in the surroundings caused by an external stimulus, which can be a sensation of rotation, ascent, descent, or swaying. Dysbalance refers to a feeling of unsteadiness when walking or a feeling of repeated leaning over. Dizziness and lightheadedness, on the other hand, refer to feelings of discomfort within the head that cannot be clearly expressed, such as a feeling of drowsiness and confusion. Many cases of vertigo are caused by diseases of the inner ear, in other words otogenic, and should be seen in an ENT department. Vertigo can be a single episode (just one) or recurrent. Some disorders are accompanied by tinnitus and hearing loss; common ones are Meniere’s disease, sudden deafness, traumatic vertigo, otosclerosis, chronic suppurative otitis media (cholesteatoma), acoustic neuroma, and Remsay Hunt syndrome (herpes zoster). Other disorders without tinnitus and hearing loss are common, such as benign paroxysmal positional vertigo (BPPV) and vestibular neuronitis. Ototoxic drugs mostly cause balance disorders, sometimes with tinnitus and hearing loss. In general, balance disorders and dizziness and lightheadedness are mostly caused by neurological disorders, vascular disorders, or systemic diseases, and commonly include brainstem disorders, intracranial tumors, intracranial infections, cardiovascular disorders, postural hypotension, hypoglycemia, and thyroid dysfunction. From the above definition, symptom characteristics and disease classification, it is not difficult to know that vertigo has a close relationship with the ear, and it is important not to seek medical advice in a hurry. On the other hand, there are many causes of vertigo, should go to the regular hospital, only the correct diagnosis can get the correct treatment. Ménière’s disease Myth: Once there is dizziness, dizziness, indiscriminately that is thought to have “Meniere’s syndrome”. Some patients come to the clinic, the first sentence said “I have Meniere’s syndrome”, which is a misunderstanding of this disease. What is Meniere’s syndrome? Correction: Meniere’s syndrome, now known as Meniere’s disease, is one of the most common causes of vertigo, and is characterized by hydrops of the membranous labyrinth. The etiology is unclear, and possible causes include impaired endolymphatic fluid circulation, impaired endolymphatic sac absorption due to autoimmune response, and vegetative nerve dysfunction. Meniere’s disease is typically characterized by recurrent episodes of vertigo with hearing loss, tinnitus, and a feeling of ear stuffiness. Vertigo is rotational or oscillatory in nature and lasts from tens of minutes to several hours, up to a maximum of twenty-four hours. Attacks are often accompanied by pallor, cold sweat, nausea, and vomiting. Intermittent vertigo disappears. Patients with Ménière’s disease experience fluctuating hearing loss, i.e., hearing loss during episodes and partial or complete recovery of hearing during intervals. As the disease progresses, the hearing loss no longer fluctuates and gradually worsens. Tinnitus occurs before the onset of vertigo and worsens when vertigo occurs, which can be recognized as an aura of vertigo in patients with longstanding disease; it disappears during the intermittent period when vertigo is relieved, but tinnitus can be persistent in patients with recurrent episodes. The diagnosis of Meniere’s disease should be made after a series of hearing and vestibular function tests, and exclude other diseases that cause vertigo, do not encounter vertigo patients diagnosed as Meniere’s disease. There is no specific treatment or prevention method for Meniere’s disease, and about 80% of patients are able to alleviate their symptoms and control their condition through medication. However, there are a small number of patients with poor results after drug treatment, recurrent attacks of vertigo and gradual hearing loss, so the treatment should be selected according to the patient’s vertigo condition and hearing level. “Cervical spondylosis” Myth: A part of patients with vertigo suffer from cervical spondylosis after examination, such as cervical spondylosis, cervical vertebrae physiological curvature straightening, and from then on, the cause of vertigo is attributed to cervical spondylosis. “Cervical spondylosis is another common cause of vertigo besides Meniere’s disease, but cervical spondylosis and straightening of the physiological curvature of the cervical spine are not the real causes of vertigo. So what does vertigo related to cervical spondylosis look like? Correction: Because cervical spine pathology causes narrowing of the vertebral artery foramen in the cervical spine, resulting in vertebral artery blood flow obstruction caused by vertigo is called vertebral basilar artery transient ischemic vertigo. It is important to note that vertigo only occurs when vertebral artery stenosis is caused by osteophytes in the cervical spine. It is important not to assume the cause of vertigo to be cervical spondylosis when osteophytes are seen in any part of the cervical spine on an X-ray or CT scan. Transcranial Doppler can help in the diagnosis of this condition by providing information about the blood supply to the arteries. Transient ischemic vertigo of the vertebrobasilar artery is characterized by: (1) Vertigo lasting for several minutes, with episodes occurring several times a day or once every few days; the vertigo may be rotational, or dizziness, feeling of heaviness in the head, loss of balance, feeling of unsteadiness, feeling of tipping over, sudden collapse, and ataxia. (2) Weakness, paralysis, and inflexibility of movement of the limbs. (3) Numbness of the face and/or parts of the limbs, sensory loss or abnormalities. (4) Blurred or double vision. Blackouts. (5) Dysphagia, dysarthria. The diagnosis can be made after audiology, vestibular function, transcranial Doppler, and exclusion of other vertigo disorders, if there is the first item, and accompanied by any one or more of the items 2 to 5. Treatment of vertigo: Myth: Once vertigo occurs, patients mostly ask for infusion treatment, which is a misunderstanding on the treatment of vertigo. This is a misconception about the treatment of vertigo. How should vertigo be treated? Correction: Because there are many diseases that cause vertigo, the treatment is very complicated, and drug treatment only accounts for a small part of it. For example, benign paroxysmal positional vertigo only requires postural rehabilitation, while vertigo caused by cholesteatoma and acoustic neuroma should receive surgical treatment. Among the diseases that cause vertigo, Meniere’s disease is more common, so let’s take this as an example and introduce the treatment: In the initial stage of Meniere’s disease, medication can be used, i.e., vertigo control treatment during the attack period and maintenance treatment during the intermittent period. Vertigo control during the attack period can be used sedatives (Valium), anti-vertigo drugs (vertigo stop), diuretics (dihydroclonazepam), antiemetic (vitamin B6) and vasodilator (Min make Lang), the maintenance of the intermittent period of the treatment of physical exercise, appropriate work and rest, and a low-salt diet. Oral hormones are effective for less severe Meniere’s disease, if you are worried about the side effects caused by taking hormones, or if you have high blood pressure, diabetes mellitus, gastroduodenal ulcers can not be systemic hormones, you can make a tympanic membrane puncture intra-diaphragmatic use of hormones. Injections are given twice a week for three weeks. The purpose of intra-drum administration is to maximize the effect of the local medication on the inner ear without causing systemic side effects. If the above treatments do not control the vertigo caused by Meniere’s disease and there is concomitant hearing loss, intra-drum administration of gentamicin may be used, a method known as chemical labyrinthotomy. Injections are given once or twice a week for three to four weeks, but this method carries the risk of causing continued hearing loss. The current common method of administration is titration, which controls vertigo while preserving hearing. However, some patients still experience severe vertigo symptoms (persistent Meniere’s disease), such as frequent attacks of vertigo and significant hearing loss, which are ineffective with general medication and seriously affect the patient’s work and quality of life, and should be considered for surgical treatment. Surgical methods include endolymphatic sac surgery, vestibular neurotomy, and labyrinthectomy. Among them, endolymphatic sac surgery is relatively simple and can relieve the symptoms of vertigo in some patients, while selective vestibular neurotomy has the best efficacy and less damage among the various surgical treatments, which can effectively control vertigo, stop hearing loss, improve tinnitus, and the effect of hearing preservation is better than weekly injection of gentamicin in the tympanic cavity. Labyrinthectomy, for patients without practical hearing or who cannot tolerate intracranial surgery, has similar results to vestibular neurectomy. In fact, vertigo is not terrible, the key is to be able to recognize it correctly, to avoid all the misunderstandings mentioned above. May every one of you be free from the trouble of vertigo and enjoy a “smooth” and quiet life.