Vertigo is one of the common clinical symptoms, and the prevalence of vertigo is 5%, and the incidence is 1.4%. Because of the huge population base in China, the number of vertigo patients in China is about 70 million by this calculation, and the number of new cases is about 20 million every year, and it increases significantly with age, with the prevalence rate of 33.3% in the age group of 70 years old, and increases to 50% after 85 years old.
Vertigo caused by ear disease accounts for 71% of vertigo patients and is the main cause, while others include central vertigo in neurology, cervical vertigo in orthopedics, and psychosomatic vertigo. Vertigo is a growing concern because of its high incidence, complex etiology, multiple disciplines involved, difficulty in diagnosis, and its impact on patients’ work and quality of life.
I. How can we generally determine if vertigo is caused by ear disease?
Vertigo caused by ear disease is mainly seen in otoliths, Meniere’s disease (Meniere), vestibular neuritis, vagal concussion, sudden deafness with vertigo, etc. It includes the following characteristics.
1. mostly visual rotation vertigo.
2. short duration of vertigo attacks (minutes to days).
3. vestibular coordination phenomena: phenomena of vegetative dysfunction consistent with the degree of vertigo, such as nausea, vomiting, cold sweats, panic, diarrhea, etc.; vertigo consistent with the degree of balance disorder or vertigo heavy balance disorder light.
4. transient, fine and rapid nystagmus, mostly horizontal rotational.
5. It is often accompanied by deafness and tinnitus. Common peripheral vertigo include Meniere’s disease, BPPV, vestibular neuronitis, sudden deafness, vertigo caused by drug intoxication, vagal fistula, vaginitis, etc.
Second, how to treat otogenic vertigo?
The treatment methods of vertigo are roughly divided into three categories: medical treatment, surgical treatment and rehabilitation treatment. Different treatment methods are chosen for different patients with vertigo and different pathological stages of vertigo. Currently, medication and rehabilitation are the mainstay of vertigo treatment, but the importance of surgical treatment needs to be reiterated. Surgical treatment of vertigo is mainly applied to persistent vertigo that is not well controlled by drugs, such as Meniere’s disease (Meniere), or to stop further hearing loss. Surgical treatment of vertigo diseases is very widely carried out abroad, but relatively little is carried out in China.
What are the vertigo surgeries?
1.Endolymphatic sac surgery includes endolymphatic sac decompression and shunt surgery, which is considered as the preferred surgical treatment for Meniere’s disease because it is simple, does not affect hearing, and has a vertigo control rate of up to 75%.
2. Vestibular neurectomy can theoretically treat all unilateral vestibular peripheral vertigo, but the procedure requires good contralateral vestibular function and is mostly performed on patients under 60 years of age. The advantages are high control rate of vertigo and preservation of hearing; the disadvantage is that it requires craniotomy, which is a risky procedure.
3.Vagotomy
The main point of the surgery is to remove or destroy all vestibular sensory epithelium. It is suitable for patients with near loss of hearing or no residual hearing, especially for Meniere’s disease where other surgeries are ineffective.
4.Semicircular canal surgery
This includes hemi-canal filling to treat recalcitrant otoliths, Ménière’s disease, and superior hemi-canal fissure.
Studies have shown that about 20% of patients with Ménière’s disease need surgical treatment to control vertigo symptoms while avoiding further hearing loss, and decompression is the procedure of choice for surgical treatment of Ménière’s disease, and the procedure can be repeated for recurrent Ménière’s disease or bilateral Ménière’s disease. Although the percentage of vertigo patients who need surgical treatment is not high, considering the high prevalence of vertigo, vertigo patients who need surgical treatment are a large group.
IV. Why is the current status of vertigo surgery poorly developed?
Studies show that about 20% of patients with Ménière’s disease need surgical treatment to control vertigo symptoms while avoiding further hearing loss, and decompression is the procedure of choice for surgical treatment of Ménière’s disease, and the procedure can be repeated for recurrent Ménière’s disease or bilateral Ménière’s disease. Although the percentage of vertigo patients who need surgical treatment is not high, considering the high prevalence of vertigo, the number of vertigo patients who need surgical treatment is a large group.
At present, surgical treatment of vertigo is widely carried out in foreign countries, but relatively little in China, where an otolaryngologist may report thousands of cases, while the total number of patients in China in recent years is only a few hundred. The reasons for this may include
1. Physician factors.
(1) Inability to meet clinical skills
In large medical centers, technology is not a problem.
(2) Insufficient knowledge of comprehensive treatment of vertigo disease
This is a problem. Vertigo treatment is a multidisciplinary team treatment, and multidisciplinary cooperation as well as a deep understanding of vertigo is very important.
(3) Reluctance to perform such surgeries, which are laborious and unpleasant
Many otologists are reluctant to get involved because some vertigo surgery is to relieve the condition and not to guarantee a cure, and patients with recurrent attacks are mostly accompanied by psychological disorders, such as anxiety and depression, which can easily lead to medical disputes. However, these problems can be solved if we communicate well with patients and give them proper treatment expectations through multidisciplinary collaboration.
2. Patient factors.
(1) Economic factor, it costs more money to do surgery
In fact, the cost of treatment for repeated vertigo attacks is much more than the cost of surgery.
(2) Fear, fear of not being cured for nothing and other complications
In large medical centers, general anesthesia surgery is very safe, so it is better to receive surgical treatment than to let vertigo recur and prevent you from living and working normally.
(3) Insufficient knowledge that vertigo will be cured after surgery
The treatment of vertigo, including drugs and rehabilitation means, is basically to relieve the condition. Surgical treatment includes those that relieve the condition and those that cure it, which should be chosen according to the condition. For persistent vertigo, if drug treatment is ineffective, the efficacy of surgery is certain.
3.Social factors.
(1) Tension in doctor-patient relationship and mutual distrust between doctors and patients.
(2) Insufficient awareness of clinical medical treatment at the social level, and the belief that if you get sick and enter the hospital, you must be cured.
V. What should surgeons do in the face of vertigo?
Although there are such and such problems, an ear surgeon should bravely pick up the scalpel and open the knife to the persistent disease of vertigo, so that the patient can get rid of the trouble of vertigo and return to normal life and society.