Vestibular paroxysmia is believed to be caused by the neurovascular compression of the cochleovestibular nerve, as it occurs with other neurovascular compression syndromes (. trigeminal neuralgia). The irregular and unpredictable spells are the most disabling aspect of this condition, making some daily activities, like driving, extremely dangerous. In theory, given its pathophysiology, surgical treatment could be considered. Still, due to the substantial surgical risks involved, this approach is reserved for particular cases where pharmacological treatment is not effective or tolerated. Treatment with carbamazepine (Tegretol®) or oxcarbamazepine (Trileptal®), both anticonvulsants primarily used in the treatment of epilepsy, is usually not only effective in small dosages, but is also diagnostic. Vestibular depressants are not effective.
In extremely severe cases, treatments that deaden the inner ear such as gentamicin injections or surgery may be considered. This is a last resort for persons who have severe attacks which are disabling. At present, we favor gentamicin for most instances where destructive treatments are being considered. Injections of gentamicin are given through the ear drum, through a small hole or through a small tube. This procedure allows the doctor to treat one side alone, without affecting the other. Typically, about four injections are given over a period of one month. Some authors have reported improvements in 60 to 90 percent of patients with gentamicin (Driscoll et al., 2009; Bodmer, 2007; Boleas-Aguirre, 2007; Chung, 2007), and Chung reported equally effective results with a single injection compared to multiple injections (Chung, 2007). Dizziness may reoccur one year later, requiring another series. Gentamicin injection can also result in hearing loss (Silvertein 2009; Colletti, 2007).