I. Conceptual issues Vertigo (vertigo) refers to the sense of rotation or oscillation of oneself or the environment, a kind of motion hallucination, often the result of vestibular system lesions; dizziness (dizziness) refers to the sense of instability of oneself, which can be the result of either the recovery or posterior period of vestibular lesions, or the result of deep sensory or visual system lesions. Dizziness (woozy, light-headedness) refers to the sense of mental unclearness, usually as a result of cortical dysfunction. The pathogenesis of vertigo and dizziness varies, and sometimes they are two manifestations of the same disease at different times. II. EpidemiologyThe exact incidence of vertigo lacks a more consistent epidemiological conclusion. In Germany, the prevalence of dizziness was 7.8% in a random survey of 5,000 inhabitants, and the incidence was as high as 4.9%; in Valencia, Spain, the prevalence was 1.78% in a random survey of 10,000 inhabitants; in Lombardy, Italy, dizziness accounted for 3.5% of emergency patients; in Jiangsu Province, China, the prevalence of dizziness was 4.1% in a random survey of 6,000 people. Although there is no accurate epidemiological data on dizziness in the United States, dizziness has been shown to account for 2.5%-3.3% of all emergency room visits in the United States, or nearly 8,000,000 patients per year. Recently, the prevalence of dizziness has been reported to be as high as 35.4%, which somehow reflects the fact that the prevalence of dizziness may be higher than previously understood. Women are more likely to suffer from vertigo than men; the prevalence of vertigo tends to increase with age. The etiological classification of vertigo, whether vertigo or dizziness, is just a symptom with many causes. Depending on the location of the disease, vertigo or dizziness is often classified as otogenic (peripheral vestibular lesions), central (various lesions located in the brainstem, cerebellum and craniocervical junction area), psychological disease (mainly square terror, anxiety, depression) related, systemic disease related and unknown causes. The comprehensive literature is categorized as follows: otogenic vertigo accounts for about 30-50% of cases, with benign positional vertigo (BPPV) topping the list in terms of incidence of single diseases, followed by Meniere’s disease and vestibular neuritis; central vertigo accounts for about 2-30% of cases; dizziness associated with psychological disorders accounts for 15-50% of cases; dizziness associated with systemic disorders is about 5-30% of cases; with the current level of medical technology, at least 15- Yin et al. conducted a retrospective analysis of 2,000 patients with vertigo over 20 years at the Department of Otolaryngology, Akita University, Japan, and the results were 33.8% for peripheral vertigo, 17.2% for central vertigo, 22.2% for unexplained vertigo, and 26.8% for other vertigo. There are some differences between vertigo in children and adults, and although the results reported by various authors are not consistent, the general trend is that the proportion of central vertigo (mainly post-traumatic vertigo and migraine-associated vertigo) is significantly higher than that of adults, accounting for about 19-49%; the higher incidence of single diseases are: benign paroxysmal vertigo (BPVoC), post-traumatic vertigo, and otitis media-associated vertigo. IV. The main auxiliary examination techniques for vertigo nystagmography (ENG) is the most important auxiliary examination for the diagnosis of vestibular lesions, and the application of nystagmographic view (VEG) makes the observation of nystagmus clearer and easier. The examination includes steps such as sweeping, smooth tracking, gaze, position test and hot and cold test to determine vestibular and other functions through quantitative analysis; among them, the hot and cold test is the main means to check the function of the semicircular canal. The stimulation level in the hot and cold test is roughly comparable to 0.002-0.004 Hz in the rotation test. The swivel chair test is an important complement to the nystagmographic technique and corroborates the correctness of the ENG results. It is more effective in those with bilateral vestibular hypofunction. Vestibular autorotation test (VAT) Unlike the ENG and the chair test, the VAT is based on the principle of high-frequency rotational (1-5 Hz) stimulation to detect vestibulo-ocular reflex function. Its disadvantage is that it requires patients to actively shake their heads, and some patients have difficulty in cooperating, so sometimes the results are more variable. At present, only a few units in China have this equipment. Hearing examinations Commonly used are pure tone hearing threshold test, acoustic impedance test, cochlear electrogram and auditory brainstem response. Thin-layer CT or MRI of the internal auditory canal and inner ear water imaging provide an anatomical understanding of the morphological structure of the vestibule and cochlea. Vestibular evoked myogenic potentials (VEMPs) Primarily used to examine lesions of the inferior vestibular nerve, lateral vestibular nucleus, vestibular thalamic tract and ipsilateral sternocleidomastoid motor neuron pathway, currently of value in evaluating the inferior vestibular nerve (as opposed to ENG which is primarily used to evaluate the superior vestibular nerve). It requires close patient cooperation and is currently used mainly in individual research units. Neurological and inner ear imaging, routine, biochemical and immunological tests of blood and cerebrospinal fluid are of great value in diagnosing the etiology of vertigo. V. Treatment of vertigo etiology is of utmost importance, but unfortunately nearly 1/3 of vertigo, or even more, is currently difficult to specify the cause. The aim of symptomatic treatment is to reduce the vertigo feeling, stop vomiting and control palpitations in patients with vertigo attacks. The main components of vestibular depressants commonly used in clinical practice are antihistamines (iproniazid, diphenhydramine, mincozine, etc.), anticholinergics (scopolamine) and benzodiazepines, and the above-mentioned drugs can both control vertigo symptoms and stop emetics. Antiemetics such as benzamide derivatives (gastrofacial), phenothiazines (chlorpromazine), and bupropion are sometimes used in combination with vestibular depressants to control some severe vertigo symptoms. Vestibular inhibitors work mainly by inhibiting neurotransmitters, but if applied for too long, they can inhibit the establishment of central compensatory mechanisms, so they should be discontinued when the patient’s acute phase symptoms are controlled; they cannot be used in patients with permanent impairment of vestibular function, and vestibular inhibitors are generally not used for non-vestibular dizziness. For patients with persistent severe vertigo that is difficult to control with medication, inner ear surgery needs to be considered. Vestibular rehabilitation training is aimed at patients with balance disorders due to low vestibular function or loss of vestibular function, which often persist for a long time and for which conventional medication is ineffective. Common training includes adaptation, substitution, habituation, Cawthorne-Cooksey training, etc. The aim is to rebuild the integration of visual, proprioceptive and vestibular afferent information functions, improve patients’ balance function and reduce vibration hallucinations through training. VI. Problems to be further solved Limited to the current medical level, there are still many causes of vertigo that cannot be clarified, especially in some young adult patients whose clinical presentation is only simple episodic vertigo. If detailed medical history, detailed physical examination, comprehensive imaging and comprehensive vestibular function examination cannot clarify the cause of vertigo or even meet the criteria for a suspected diagnosis, only a symptomatic diagnosis can be made tentatively. At present, most hospitals in China have high-end imaging equipment, but there is a serious lack of equipment and items for vestibular function examination, which undoubtedly increases the difficulty in diagnosing the cause of vertigo.
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