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.
Although from the name of the procedure one would expect that the entire vestibular nerve would be cut, in reality this is not always possible. According to Eisenmen (2001) there is evidence for retained vestibular function in about half of patients following nerve section or labyrinthectomy. Some of the fibers of the vestibular nerve run very close to the cochlear (hearing nerve), and because of this they may be spared. Saccule derived nerve fibers may be purposefully spared because they tend to run close to the cochlear nerve (Silverstein et al, 1994). Sometimes there is an attempt to cut these fibers at another site with a singular neurectomy. Singular neurectomies, however, are somewhat difficult and unreliable even in very experienced hands.
Four trials, involving a total of 149 participants, compared the effectiveness of oral corticosteroids against placebo . All the trials were small and of low methodological quality. Although there was an overall significant effect of corticosteroids compared with placebo medication on complete caloric recovery at one month ( risk ratio ( RR ) of ; 95% confidence interval ( CI ) to , P = ), no significant effect was seen on complete caloric recovery at 12 months ( RR ; 95% CI to , P = ), or on the extent of caloric recovery at either one month ( mean difference ( MD ) %; 95% CI - to , P = ) or at 12 months ( MD %; 95% CI - to , P = ). In addition, there was no significant difference between corticosteroids and placebo medication in the symptomatic recovery of vestibular function following idiopathic acute vestibular dysfunction with respect to vertigo at 24 hours ( RR ; 95% CI to , P = ) and use of the Dizziness Handicap Inventory score at one, three, six and 12 months.