Disorders of Vestibular Function

The vestibular organ (organ of equilibrium) is used to perceive acceleration and to determine the direction of the earth’s gravitational force. It is a component of the inner ear. The vestibular organ consists of three semicircular canals and the two structures called macula organs (saccule and utriculus). The arcades, filled with the endolymph, form the rotational sense organ. The macula organs sense the translational acceleration of the body in space. The sensory information thus obtained is transmitted via the VIII. Cranial nerves (Nervus vestibulocochlearis) to corresponding nerve nuclei in the brainstem (vestibular nuclei). Disorders of vestibular function are described below. According to ICD-10, disorders of vestibular function can be divided into the following forms:

  • Ménière’s disease (ICD-10 H81.0) – disorder of the inner ear associated with rotational vertigo and hypacusis (hearing loss); incidence: 10.1%.
  • Vestibular migraine / basilarism migraine (IDC 10: G43.1) – dizziness is thereby partial symptom of migraine; 11.4%), Meniere’s disease (10.1%) Spontaneous, repeated attacks of vertigo.
  • Benign (benign) paroxysmal (seizure-like) vertigo (H81.1) or Benign paroxysmal positional vertigo (BPLS; synonyms: cupulolithiasis; canalolithiasis and (abbreviated) benign positional vertigo (not to be confused with positional vertigo); benign paroxysmal positional vertigo (BPPV); benign peripheral paroxysmal positional vertigo (BPPV)) – is a harmless, albeit extremely unpleasant, very common form of vertigo; incidence: 17.1%.
  • Neuritis vestibularis (synonym: neuropathia vestibularis) (H81.2) – an acute or chronic dysfunction of the balance organ in the inner ear; incidence: 8.3%.
  • Bilateral vestibulopathy (BV) – vestibular disorder characterized by complete failure or incomplete deficit of both labyrinths and/or vestibular nerves; incidence: 7.1 %
  • Vestibular paroxysmia – neurovascular compression syndrome of the eighth cranial nerve; vertigo attacks usually last only seconds to a few minutes; both rotational and fluctuating vertigo may occur; frequency: 3.7%.
  • Other peripheral vertigo (H81.3) – disturbance of the so-called labyrinth (the organ of balance localized in the inner ear); this is perceived as an unpleasant sensation of movement (illusion of movement)
  • Vertigo of central origin/central vertigo (H81.4) – vertigo caused by disorders of the central nervous system:
  • Other disorders of vestibular function (H81.8).
  • Disorders of vestibular function, unspecified (H81.9)

The following types of vertigo can be distinguished:

  • Systematic vertigo (directed vertigo).
    • Continuous vertigo
    • Spinning dizziness
    • Altitude vertigo
    • Positional vertigo
    • Positional vertigo
    • Elevator vertigo
    • Staggering vertigo (e.g. phobic staggering vertigo, frequency: 15%).
  • Unsystematic vertigo (undirected vertigo, diffuse vertigo).

Vertigo attacks are the second most common leading symptom after headache, not only in neurology. Gender ratio Benign paroxysmal positional vertigo: men to women 1: 2. Meniere’s disease: men are more often affected than women. However, study evidence is conflicting in many cases. Frequency peak: vertigo in general occurs more frequently with increasing age, especially in the group over 80 years. Benign peripheral paroxysmal positional vertigo (BPPV) can occur from childhood to senility. Neuritis vestibularis: The disease occurs predominantly between the ages of 30 and 60. Meniere’s disease: the disease occurs predominantly between the ages of 40 and 60. Non-cardiac vertigo: The disease occurs predominantly in those over 65 years of age. The prevalence (disease incidence) for vertigo in general is approximately one quarter of the population (in Germany). The prevalence can increase up to 40% with age.The lifetime prevalence for moderate and severe vertigo is up to 30%. Those over 65 suffer from vertigo at least once a month in about 30% of cases.The prevalence for benign paroxysmal positional vertigo is 10% (in those over 80).The lifetime prevalence of spinning and swaying vertigo is about 30%. The lifetime prevalence of Meniere’s disease is 0.5%.The lifetime prevalence of vestibular migraine is estimated at 1%, and the one-year prevalence is 0.9%.The prevalence for non-cardiac vertigo is 20% (in those over 65 years of age). The incidence (frequency of new cases) for benign paroxysmal positional vertigo (BPLS) is approximately 64 cases per 100,000 population per year (in the United States). The incidence for neuritis vestibularis (vestibular vertigo) is approximately 3.5 disorders per 100,000 population per year (in Germany). The incidence for Meniere’s disease is approximately 1 disease per 1,000 inhabitants per year (in industrialized countries). Course and prognosis: attacks of vertigo are usually unexpected and may be accompanied by nausea (nausea) and vomiting (vomiting). Affected individuals usually feel helpless. The prognosis depends on the type and severity of the underlying condition. However, it usually takes time to diagnose the underlying disease. For example, persistent vertigo usually indicates psychological triggers.