Literature review and two study cases of vestibular paroxysmia from an otorhinolaryngology centre

Abstract

IntroductionVestibular paroxysmia is a rare disorder of the balance system manifested by recurrent attacks of vertigo, the etiology of which is associated with compression of a blood vessel on the vestibulocochlear nerve. The exact mechanism for triggering the symptoms is not fully understood. The condition occurs in all age groups and without gender predilection. The purpose of the study was to review the literature on vestibular paroxysmia, discuss criteria for the diagnosis of the disease, diagnostic management, proposed therapy, and present clinical cases from the authors’ own practice.Material and methodsA review of the scientific literature was conducted via the PubMed database using the keywords “vestibular paroxysmia,” “neurovascular conflict cochlear nerve,” and “neurovascular conflict vestibular nerve”. PRISMA guidelines for systematic reviews were applied.ResultsThere were 146 publications found; after analysis of titles and abstracts, 56 were included in the review; another 10 manuscripts were identified during reference review. Among them, 11 studies were devoted to diagnostic imaging, 19 described the clinical course of the condition based on retrospective studies, 15 were case reports, and 11 other reports and reviews. Following evaluation of this literature, two clinical cases of vestibular paroxysm from the authors’ own practice are described. These cases are presented along with their diagnosis and therapy.ConclusionsImaging studies are of significant value in diagnosing many vascular–neural conflicts, but for vestibular paroxysmia the diagnosis is made on the basis of clinical symptoms and according to the division proposed by the Bárány Society in 2016. Pharmacological therapy is recommended, and response to therapy is one of the criteria for diagnosing the condition. Surgical treatment is reserved for the most severe cases.