Treatments

By Marcello Cherchi, MD PhD

This outline is broadly categorized into “pharmacologic,” “non-pharmacologic” and “mixed.”

1. Pharmacologic

   1. Comments on drug side effects

   2. Classes of pharmaceutical agents

      1. ✅ Aminopyridines (4-AP, 3,4-DAP)
      2. ✅ Anti-nauseant and anti-emetic medications
      3. ✅ Anti-oxidants
      4. ✅ Benzodiazepines
      5. ✅ Beta blockers
      6. ✅ Botulinum toxins
      7. ✅ Corticosteroids
      8. ✅ Diuretics
      9. ✅ cGRP inhibitors
      10. ✅ Serotonin-norepinephrine reuptake inhibitors (SNRIs)
      11. ✅ Serotonin-specific reuptake inhibitors (SSRIs)
      12. ✅ Tricyclics
      13. ✅ Vaccines and treatments for COVID-19

   3. Individual medications

      1. ✅ Acetazolamide
      2. ✅ Baclofen
      3. ✅ Betahistine
      4. ✅ Botulinum toxin
      5. ✅ Dimenhydrinate
      6. ✅ Fludrocortisone
      7. ✅ Fluticasone and azelastine
      8. ✅ Gabapentin
      9. ✅ Lamotrigine
      10. ✅ Meclizine
      11. ✅ Memantine
      12. ✅ Midodrine
      13. ✅ Oxcarbazepine
      14. ✅ Scopolamine
      15. ✅ Topiramate
      16. ✅ Trimetazidine
      17. ✅ Venlafaxine
      18. ✅ Verapamil

2. Non-pharmacologic

   1. Nutritional supplements

      1. ✅ Coenzyme Q10
      2. ✅ Magnesium
      3. ✅ Riboflavin
      4. ✅ Vitamin D
      5. ✅ Melatonin

   2. Herbal supplements

      1. ✅ Butterbur
      2. ✅ Feverfew

   3. Procedures, non-surgical

      1. ✅ Acupuncture
      2. ✅ Nerve blocks for headache
      3. ✅ Transcutaneous electrical nerve stimulation (TENS)
      4. ✅ Transcranial magnetic stimulation (TMS)
      5. ✅ Vagal nerve stimulation (VNS)
      6. ✅ Hyperbaric oxygen therapy (HBOT)

   4. Procedures, surgical

      1. ✅ Tympanostomy tube placement
      2. ✅ Transtympanic injections
      3. ✅ Tympanoplasty
      4. ✅ Silverstein MicroWick
      5. ✅ Positive pressure therapies for Meniere’s disease
      6. ✅ Labyrinthectomy and vestibular neurectomy
      7. ✅ Surgery for superior semicircular canal dehiscence
      8. ✅ Surgery for BPPV

   5. Physical therapy

      1. Vestibular physical therapy
         1. ✅ Physical therapy for benign paroxysmal positional vertigo
            1. ✅ Posterior canal, right side
               1. ✅ Epley maneuver, right posterior canal
               2. ✅ Semont maneuver, right posterior canal
               3. ✅ Semont plus maneuver, right posterior canal
               4. ✅ Foster maneuver, right posterior canal
               5. ✅ Gans maneuver, right posterior canal
               6. ✅ Modified Epley maneuver, right posterior canal
            2. ✅ Posterior canal, left side
               1. ✅ Epley maneuver, left posterior canal
               2. ✅ Semont maneuver, left posterior canal
               3. ✅ Semont plus maneuver, left posterior canal
               4. ✅ Foster maneuver, left posterior canal
               5. ✅ Gans maneuver, left posterior canal
               6. ✅ Modified Epley maneuver, left posterior canal
            3. ✅ Posterior canal, bilateral or unknown
               1. ✅ Brandt-Daroff maneuver, bilateral posterior canal
            4. ✅ Lateral (horizontal) canal, right side
               1. ✅ Lempert roll, right lateral canal
               2. ✅ Vannucchi-Asprella maneuver, right side
            5. ✅ Lateral (horizontal) canal, geotropic, right side
               1. ✅ Gufoni/Appiani maneuver, lateral canal, geotropic, right side
               2. ✅ Modified Zuma maneuver, lateral canal, geotropic, right side
            6. ✅ Lateral (horizontal) canal, apogeotropic, right side
               1. ✅ Gufoni/Appiani maneuver, right lateral canal, apogeotropic variant
               2. ✅ Zuma maneuver, right lateral canal, apogeotropic variant
            7. ✅ Lateral (horizontal) canal, left side
               1. ✅ Lempert roll, left lateral canal
               2. ✅ Vannucchi-Asprella maneuver, left side
            8. ✅ Lateral (horizontal) canal, left side, geotropic variant
               1. ✅ Gufoni/Appiani maneuver, lateral canal, geotropic, left side
               2. ✅ Modified Zuma maneuver, lateral canal, geotropic, left side
            9. ✅ Lateral (horizontal) canal, left side, apogeotropic variant
               1. ✅ Gufoni/Appiani maneuver, lateral canal, apogeotropic, left side
               2. ✅ Zuma maneuver, lateral canal, apogeotropic, left side
            10. ✅ Lateral (horizontal) canal, bilateral or unknown
                1. ✅ Kurtzer hybrid maneuver
            11. ✅ Anterior (superior) canal, right side
                1. ✅ Kim maneuver, right side
                2. ✅ Modified (reversed) Semont maneuver, right side
                3. ✅ Reverse Epley maneuver, right side
                4. ✅ Rahko maneuver, right side
            12. ✅ Anterior (superior) canal, left side
                1. ✅ Kim maneuver, left side
                2. ✅ Modified (reversed) Semont maneuver, left side
                3. ✅ Reverse Epley maneuver, left side
                4. ✅ Rahko maneuver, left side
            13. ✅ Anterior (superior) canal, bilateral or unknown
                1. ✅ Yacovino maneuver
                2. ✅ Casani maneuver
                3. ✅ Crevits prolonged forced position procedure
         2. ✅ Mechanical chair treatment for benign paroxysmal positional vertigo
         3. ✅ Physical rehabilitation therapy for vestibular weakness
      2. ✅ Physical therapy for the neck

   6. ✅ Chiropractic manipulation

   7. ✅ Motion desensitization (Puma method)

   8. ✅ Mingjia Dai’s treatment for MdDs

   9. Auditory treatments

      1. ✅ Hearing amplification
      2. ✅ Hearing amplification, balance and falls
      3. ✅ Treatment of idiopathic tinnitus

   10. ✅ Strategies for managing ear symptoms during flight

3. Mixed (pharmacologic and non-pharmacologic)

   1. ✅ Vestibular compensation