Patient management with complaints of vertigo at the first visit
DOI: 10.32364/2587-6821-2023-7-10-8
A.V. Amelin1, S.V. Lilenko2,3, M.V. Zamergrad4,5, A.L. Guseva6, O.V. Zaitseva7, V.A. Voronov3, D.Yu. Demidenko3, M.I. Koreshkina8, D.A. Ovchinnikov9
1I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg, Russian Federation
2St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russian Federation
3I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation
4Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
5I.V. Davydovskiy City Clinical Hospital, Moscow, Russian Federation
6Pirogov Russian National Research Medical University, Moscow, Russian Federation
7National Medical Research Center of Otorhinolaryngology, Federal Research and Clinical Center of the Federal Medical Biological Agency, Moscow, Russian Federation
8Adelmed Medical Board LLC, St. Petersburg, Russian Federation
9V.A. Almazov National Medical Research Center, St. Petersburg, Russian Federation
Vertigo and balance disorders are one of the most common causes of patients seeking medical help. Vertigo and balance disorders study primarily consists of the following: complaint report, anamnestic data and neurovestibular study. Currently, an algorithm is used based on the identification of three vestibular syndromes: acute, recurrent and chronic, as well as on the analysis of vertigo triggers and concomitant symptoms. Primarily, it is important to determine which vestibular syndrome is acute, recurrent or chronic at the first patient visit with vertigo and balance disorders. Besides, using the otoneurological examination methods is essential for determining the presence or absence of signs concerning the central nervous system disorder or the labyrinth. At the same time, it should be understood that the nervous system disorders accompanied by vertigo can pose a particular danger to the patient and should be excluded first of all. For the treatment and rehabilitation of patients with vertigo, individual selection of therapy and vestibular rehabilitation programs is most effective, taking into account the origin of vestibular disorder, the progression severity, as well as the age, physical and emotional condition. Vestibular rehabilitation can significantly reduce the vertigo severity and improve resistance indicators in patients with vestibular disorders. To improve vestibular compensation, it is advisable to use drug therapy with betahistine dihydrochloride, 48 mg per day, in a modified-release dosage form for better adherence.
Keywords: dizziness, balance disorder, acute vestibular syndrome, chronic vestibular syndrome, recurrent vestibular syndrome, betahistine, neurovestibular study.
For citation: Amelin A.V., Lilenko S.V., Zamergrad M.V., Guseva A.L., Zaitseva O.V., Voronov V.A., Demidenko D.Yu., Koreshkina M.I., Ovchinnikov D.A. Patient management with complaints of vertigo at the first visit. Russian Medical Inquiry. 2023;7(10):658–665 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-8.
About the authors:
Alexander V. Amelin — Dr. Sc. (Med.), Professor of the Department of Neurology, neurologist, Head of the Department of General Neurology of the Research Institute of Neurology, Head of the Center for Diagnosis and Treatment of Cephalgia, I.P. Pavlov First St. Petersburg State Medical University; 6–8, Lev Tolstoy Str., St. Petersburg, 197022, Russian Federation; ORCID iD 0000-0001-6437-232.
Sergey V. Lilenko — Dr. Sc. (Med.), Head of the Vestibular Laboratory, St. Petersburg Research Institute of Ear, Throat, Nose and Speech; 9, Bronnitskaya Str., St. Petersburg, 190013, Russian Federation; Professor of the Department of Otorhinolaryngology, I.I. Mechnikov North-Western State Medical University; 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation; ORCID iD 0000-0001-9858-5219.
Maxim V. Zamergrad — Dr. Sc. (Med.), Professor of the Department of Neurology with the Faculty of Reflexology and Manual Therapy, Russian Medical Academy of Continuous Professional Education; 2/1, Barricadnaya Str., Moscow, 125993, Russian Federation; Head of the Vertigo Center, I.V. Davydovskiy City Clinical Hospital; 11, Yauzskaya Str., Moscow, 109240, Russian Federation; ORCID iD 0000-0002-0193-2243.
Alexandra L. Guseva — Dr. Sc. (Med.), Associate Professor of the Department of Otorhinolaryngology of the Medical Faculty, Pirogov Russian National Research Medical University; 1, Ostrovityanov Str., Moscow, 117997, Russian Federation, ORCID iD 0000-0002-7988-4229.
Olga V. Zaitseva — C. Sc. (Med.), Head of the Research and Clinical Department of Vestibulology and Otoneurology, National Medical Research Center of Otorhinolaryngology, Federal Research and Clinical Center of the Federal Medical Biological Agency; 30, bldn. 2, Volokolamskoe road, Moscow, 123182, Russian Federation; ORCID iD 0000-0002-4975-1310.
Viktor A. Voronov — C. Sc. (Med.), Associate Professor of the Department of Otorhinolaryngology, I.I. Mechnikov North-Western State Medical University; 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation; ORCID iD 0000-0002-3859-6298.
Diana Yu. Demidenko — C. Sc. (Med.), Associate Professor of the Department of Otorhinolaryngology, I.I. Mechnikov North-Western State Medical University; 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation; ORCID iD 0000-0003-4604-5039.
Marina I. Koreshkina — Dr. Sc. (Med.), Head of the Cephalgia Therapy Center, Adelmed Medical Board LLC; 1, Michurinskaya Str., St. Petersburg, 197046, Russian Federation; ORCID iD 0000-0002-4908-1193.
Dmitry A. Ovchinnikov — neurologist, Chief Medical Officer of the University Clinic, V.A. Almazov National Medical Research Center; 2, Akkuratov Str., St. Petersburg, 197341, Russian Federation; ORCID iD 0000-0001-9430-7561.
Contact information: Maxim V. Zamergrad, e-mail: zamergrad@gmail.com.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 01.08.2023.
Revised 22.08.2023
Accepted 12.09.2023.
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