How to distinguish between "otolithiasis" and "cervical vertigo"? You need to know at least these 4 points!

There are many similarities in the clinical symptoms of "otolithiasis" and "cervical vertigo", which makes it difficult for patients to distinguish them clearly, and non-specialist doctors are prone to misdiagnosis and mistreatment. This article will briefly explain the clinical manifestations, pathogenesis, diagnostic criteria, and treatment.

Different clinical manifestations

"Otolithiasis" is a typical disease caused by peripheral vestibular dysfunction belonging to the Department of Otolaryngology. The full name of the disease is: Benign Positional Paroxysmal Vertigo (BPPV)

The main characteristics of the clinical symptoms of BPPV are: sudden dizziness caused by changes in the head position relative to the direction of gravity. The dizziness is rotational and most of the time lasts from a few seconds to about 1 minute. In terms of the clinical symptoms of this type of disease, it has the characteristics of regional local reactions, that is, not all patients may experience adverse reactions.

Specific adverse reactions include nausea, vomiting, and unstable heart rate. In addition, patients may experience a strong sense of floating, decreased sense of balance, and hallucinations. Judging from the onset of clinical symptoms, the symptoms mainly occur in the morning, when lying down, and when turning over. There are no precursors before the onset of the disease, and repeated induction of postural vertigo can cause repeated occurrences. Characteristic positional nystagmus is an important sign.[1]

"Cervical vertigo" is a typical disease that belongs to the orthopedics department and the vertigo clinic. The main reason for vertigo in patients is dizziness caused by compression of the vertebral artery. The full name of this disease is cervical spondylosis of vertebra artery (CSA). It is a disease caused by cervical vertebrae, which leads to vertebral artery blood supply disorder, causing blood circulation disorder in the cerebellum and inner ear, and secondary vertigo or dizziness. Cervical facet joint disorder may be the direct cause of vertigo or dizziness.

The main symptoms of dizziness are: feeling lightheaded, floating, walking as if walking on cotton, and fear of falling or losing consciousness. It is often triggered by twisting the head and neck, lowering or raising the head. It is often accompanied by clinical manifestations such as tinnitus, nausea, blurred vision, and imbalance. Abnormal head posture and neck and shoulder pain are the main signs.[2]

Different pathogenesis

Regarding the onset of otolithiasis, there are usually two different mechanisms: First, otolithiasis is caused by canalithiasis. When the disease occurs, the otolith particles located on the macula of the utricular sac of the patient fall off and enter the lumen of the semicircular canal. In this case, if the position of the human head changes with the direction of gravity, the particles will move under the action of gravity and rub against the wall of the canal. During this process, the endolymph is also in a flowing state. Subsequently, the ridge cap structure of the ampullary ridge will also shift at the same time. This series of shifts and changes will bring about the above-mentioned signs and clinical symptoms in the human body. Second, because the otolith particles adhere to the ridge cap of the ampullary ridge, their density in the lymphatic system changes, and accordingly, their sensitivity to gravity will also change. This will also lead to the above-mentioned symptoms [3]. Vertebral artery type cervical spondylosis is caused by long-term improper posture, strain, trauma and other factors, which lead to pathological changes in the cervical intervertebral disc, cervical bone hyperplasia, inflammation and other tissues, which in turn cause changes in the physiological structure of the cervical spine, destroy the internal and external balance of the vertebral structure, and further lead to obstruction of blood circulation inside. The nerves and spinal cord are compressed, and then corresponding symptoms and signs appear.

Different diagnostic criteria

Diagnostic criteria for vertebral artery type cervical spondylosis:

① Cervical vertigo occurs, accompanied by cataplexy;

② Often accompanied by tinnitus, hearing impairment, blurred vision, etc.;

③Neck rotation test is positive;

④X-rays show bone hyperplasia or segmental instability in the uncovertebral joint;

⑤Exclude cardiac, cerebral, ear and eye vertigo.

Diagnostic criteria for BPPV:

(1) After the head position is changed relative to the direction of gravity, the patient will experience repeated attacks, and the dizziness during the attack will not last too long, generally not exceeding 60 seconds.

(2) During the position test, the patient experienced vertigo, accompanied by obvious positional and characteristic nystagmus.

(3) Exclude other types of diseases with similar symptoms, such as migraine and paroxysmal diseases caused by vestibular dysfunction, vertigo caused by central nervous system abnormalities, Meniere's disease, and vertigo caused by psychological and psychiatric reasons.

Different treatments

Otolith repositioning treatment: The operation process of this treatment method is relatively simple, and you can freely choose whether to use the instrument to complete the inspection operation. However, it should be noted that different repositioning methods are required according to the type of otolithiasis. Patients with severe cervical spondylosis or severe heart disease should be carefully treated with manual repositioning methods.

(1) BPPV (posterior semicircular canal vascular disease) can be treated with the Epley method, which can be modified for further application if necessary.

(2) Horizontal semicircular canal BPPV: Lempert or Barbecue method and Gufoni method can be used.

(3) Yacovino's method can also be appropriately selected and applied. The combination of manual reduction and drug treatment can significantly shorten the course of the disease, usually with immediate effect, significant efficacy, simple and safe, and good recovery effect. From the perspective of traditional Chinese medicine, the treatment of vertebral artery type cervical spondylosis is based on order, exercise, and adjustment of the curve as the main principles and methods. In terms of treatment methods, a comprehensive application of manual treatment, acupuncture treatment, internal and external medication, and cervical functional exercise methods help the disease recover.

There is no specific treatment method to restore the normal physiological position of the cervical spine and improve the blood circulation of the brain. The course of treatment is generally long. According to the clinical symptoms, both can be given drugs that improve microcirculation, such as: citicoline, betadine, sibelium, ginkgo leaf preparations, and Minshilang.

References:

[1] Editorial Committee of the Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Chinese Society of Otorhinolaryngology. Diagnostic basis and therapeutic evaluation of benign paroxysmal positional vertigo (2006, Guiyang) [J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2007.

[2] Chen Guanfu, Lai Zhigang. Acupuncture knife treatment of cervicogenic vertigo [M]. Chengdu: Sichuan Science and Technology Press, 2006: 227-233. [3] Hall SF, Ruby RR, Mcclure JA. The mechanics of benign paroxysmal vertigo [J]. J Otolaryngol, 1979, 8(2): 151-158.

Source: ANDS