Periferik Vertigoda Tedavi Stratejileri
Özet
Periferik vertigo, yaşam kalitesini önemli ölçüde etkileyen ve klinik pratikte sık karşılaşılan vestibüler bozuklukların başlıca semptomlarından biridir. Etkin tedavi için öncelikle hayatı tehdit edebilecek santral nedenlerin dışlanması ve altta yatan periferik vestibüler patolojinin belirlenmesi gerekir. Tedavi; etiyolojiye yönelik yaklaşımlar, semptomatik farmakoterapi, vestibüler rehabilitasyon ve seçilmiş olgularda cerrahi girişimleri içermektedir. Benign paroksismal pozisyonel vertigoda (BPPV) primer tedavi kanalit repozisyon manevralarıdır. Vestibüler süpresanlar ve antiemetikler akut semptomların kontrolünde yararlı olmakla birlikte, santral kompansasyonu geciktirebileceklerinden uzun süreli kullanımlarından kaçınılmalıdır. Kortikosteroidlerin kullanımı hastalığa özgü olarak değerlendirilmelidir. Vestibüler rehabilitasyon, santral kompansasyonu destekleyerek özellikle persistan vestibüler disfonksiyonda tedavinin temel bileşenlerinden birini oluşturur. Psikiyatrik komorbiditeler, rezidüel dizziness ve persistan postüral-perseptüel dizziness kronik semptomların değerlendirilmesinde göz önünde bulundurulmalıdır. Konservatif tedaviye dirençli seçilmiş hastalarda cerrahi yöntemler uygulanabilir. Bilateral vestibüler yetmezlikte vestibüler implantlar, vestibüler fonksiyonun yeniden oluşturulmasını amaçlayan umut verici bir tedavi seçeneğidir.
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