Correspondence (letters to the editor): Additional Remarks

In routine clinical practice, multifactorial age-related vestibular vertigo is the most common diagnosis, caused by a progressive impairment of vestibular substitution systems, muscle weakness, and vision defects. Cardiovascular disorders, diabetes mellitus and presbycusis are aggravating factors. Bilateral vestibulopathies are rare. Gentamicin induced vestibulotoxicity is a rare event nowadays. Oscillopsia is not among the symptoms of unilateral vestibular loss as the contralateral vestibulo-ocular reflex is intact.

In benign positional paroxysmal vertigo, a one-off release maneuver does not make patients symptom-free—most patients additional require individual exercises for a few days.

The Bárány Society’s new criteria unfortunately include hearing impairment symptoms that are untypical for Menière’s disease. Labyrinthectomy is obsolete in Menière’s disease. High doses of betahistine up to 144 mg/d are mostly not tolerated because of adverse gastrointestinal effects. Much lower dosages are often sufficient for the purposes of prophylaxis.

Treating basilar migraine in the same way as other forms of migraine is not unproblematic with regard to triptan therapy.

I do not follow the claim that vertigo syndromes are simple to diagnose, even for non-specialist physicians—the crux lies in the numerous unnecessary radiological investigations using large apparatus.

With the exception of cerebellopontine ischemia, the vertigo syndromes discussed in the article are benign. This is not the case for vertigo in otogenic diseases affecting the labyrinth, cerebral nerves, and cerebrum (cholesteatoma, mastoiditis, labyrinthitis, Ramsay-Hunt syndrome, glomus tumor/paraganglioma, schwannoma)—which was not mentioned, and whose adequate diagnosis is sometimes relevant for survival.