Dtsch Med Wochenschr 2019; 144(12): 799-806
DOI: 10.1055/a-0747-0349
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© Georg Thieme Verlag KG Stuttgart · New York

HNO-ärztliche Therapie des Schwindels bei älteren Patienten

Dizziness, vertigo and unsteadiness with emphasis on problems in elderly patients
Martin Westhofen
Further Information

Publication History

Publication Date:
18 June 2019 (online)

Abstract

Gait disturbance and risk for falls of the elderly are a major problem for neurotologic diagnosis and treatment. Diagnostic differentiation especially in the case of acute vestibular syndrome and in cases of chronic or recurrent paroxysmal vestibular deficits is mandatory for treatment indications. Criteria for medical, surgical conservative and surgical destructive therapy as well as for vestibular rehabilitation are outlined.

Schwindel stellt bei Älteren aufgrund von z. B. Gangstörungen und Sturzrisiken ein großes Problem dar. Diagnose und Behandlung sind eine Herausforderung. Vor der Therapie ist eine diagnostische Differenzierung v. a. bei akutem vestibulärem Syndrom und chronischen oder rezidivierenden paroxysmalen vestibulären Defiziten zwingend erforderlich. Im Folgenden wird auf Kriterien und Therapieformen aus Sicht des HNO-Arztes eingegangen.

 
  • Literatur

  • 1 Zu Eulenburg P, Ruehl RM, Runge P. et al. Ageing-related changes in the cortical processing of otolith information in humans. Eur J Neurosci 2017; 46: 2817-2825
  • 2 Walther LE, Westhofen M. Presbyvertigo-aging of otoconia and vestibular sensory cells. J Vestib Res 2007; 17: 89-92
  • 3 Damulin IV. Changes in walking in the elderly. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118: 100-104
  • 4 Tinetti ME, Williams CS, Gill TM. Health, functional, and psychological outcomes among older persons with chronic dizziness. J Am Geriatr Soc 2000; 48: 417-421
  • 5 Fernandez L, Breinbauer HA, Delano PH. Vertigo and Dizziness in the Elderly. Front Neurol 2015; 6: 144
  • 6 Murdin L, Schilder AG. Epidemiology of balance symptoms and disorders in the community: a systematic review. Otol Neurotol 2015; 36: 387-392
  • 7 Neuhauser HK. Epidemiology of vertigo. Curr Opin Neurol 2007; 20: 40-46
  • 8 von Brevern M, Radtke A, Lezius F. et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78: 710-715
  • 9 Albernaz PL, Cabral FS. Vertigo and dizziness in elderly patients with neurological disorders. Einstein 2011; 9: 466-469
  • 10 Volz-Sidiropoulou E, Takahama J, Gauggel S. et al. The “dizziness handicap inventory”: initial psychometric evaluation of the German version. Laryngorhinootologie 2010; 89: 418-423
  • 11 Eckhardt-Henn A, Breuer P, Thomalske C. et al. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord 2003; 17: 369-388
  • 12 Adrion C, Fischer CS, Wagner J. et al. Efficacy and safety of betahistine treatment in patients with Meniere's disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial). BMJ 2016; 352: h6816
  • 13 Ernst A, Schlattmann P, Waldfahrer F. et al. Die Behandlung des M. Meniere mit Betahistin: Kritische Anmerkungen zur BEMED-Studie. Laryngorhinootologie 2017; 96: 519-521
  • 14 Djelilovic-Vranic J, Alajbegovic A, Tiric-Campara M. et al. Betahistine or Cinnarizine for treatment of Meniere’s disease. Med Arch 2012; 66: 396-398
  • 15 Shcherbakov DA, Raemgulov RA, Bukharova KP. et al. The effectiveness of the intra-tympanic administration of methylprednisolone and gentamycin for the treatment of Meniere’s disease. Vestn Otorinolaringol 2018; 83: 17-20
  • 16 Hong KS. Dual antiplatelet therapy after noncardioembolic ischemic stroke or transient ischemic attack: pros and cons. J Clin Neurol 2014; 10: 189-196
  • 17 Park JJ, Chen YS, Westhofen M. Meniere’s disease and middle ear pressure: vestibular function after transtympanic tube placement. Acta Otolaryngol 2009; 129: 1408-1413
  • 18 Westhofen M. Indications for operative therapy of vestibular vertigo and the associated success rates. HNO 2013; 61: 752-761
  • 19 Martins E Silva DC, Bastos VH, de Oliveira Sanchez M. et al. Effects of vestibular rehabilitation in the elderly: a systematic review. Aging Clin Exp Res 2016; 28: 599-606