著者

道祖尾 弦 隈上 秀高 髙橋 晴雄

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.73, no.6, pp.528-532, 2014-12-31 (Released:2015-02-01)

参考文献数

18

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We hereby report on our experience regarding a case of rotatory vertigo exhibiting vestibular disorder-like findings accompanying normal pressure hydrocephalus (NPH). The case pertains to a 60-year-old man. Gait disturbance, dysuria, and so on, appeared from around 2007, and he was diagnosed as having NPH by the Department of Neurology of our hospital?. Rotatory vertigo suddenly appeared in October 2011, and he was admitted to the Department of Neurology and subsequently referred to our department on the 2nd sick day. Third degree of horizontal rotatory nystagmus to the left was observed, with no difference between the left and right observed upon a hearing test, and although he was observed with an increased threshold in the high sound area appropriate to his age, no other neurologic symptoms were observed. An equilibrium test was carried out at a later date under the suspicion of right vestibular neuronitis, however, no decline in semicircular canal function was observed upon caloric testing, with no difference between the left and right observed as well upon vestibule-ocular reflex (VOR), and so a follow-up was carried out with a diagnosis of vertebrobasilar insufficiency. The symptoms subsequently rapidly improved, however, nystagmus to the left at III° appeared again one week later, with the same nystagmus appearing again two months later. Lightheadedness was prolonged when rotatory vertigo attacks were not observed and so the patient consulted the Department of Neurology and underwent a tap test taking into consideration his dizziness caused by NPH, as a result of which his dizziness rapidly disappeared compared to the day prior, along with the other symptoms including improved gait disturbance and dysuria, which all continued to improve further. Subsequently, all dizziness disappeared after undergoing an endoscopic third ventriculostomy.

著者

重野 浩一郎

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.76, no.6, pp.661-673, 2017-12-31 (Released:2018-02-03)

参考文献数

51

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Benign Paroxysmal Positional Vertigo (BPPV) is the most common and representative vestibular disease of peripheral origin. The three original monographs of BPPV are introduced and commented upon. In addition, a series of essential up-to-date papers are described, focusing particularly on the pathophysiology of BPPV: cupulolithiasis and canalolithiasis, the treatment of posterior canal BPPV, the characteristics of lateral canal BPPV and anterior canal BPPV.

著者

池園 哲郎

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.76, no.4, pp.302-309, 2017-08-31 (Released:2017-10-01)

参考文献数

19

被引用文献数

5 6

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In this symposium, we have discussed the diagnostic criteria of Ménière's disease including the newly published one from the Japan Society for Equilibrium Research (JSER) in 2016. The diagnosis of Ménière's disease is primarily based on the clinical symptoms of vertigo attacks and hearing loss, which usually fluctuates. Historically, several different diagnostic criteria have been published by: 1) The Japanese Ménière's disease study group in 1974 and 2008; 2) The JSER in 1987 and 2016; and 3) The American Academy of Otolaryngology-Head and Neck Surgery in 1995. 4) The Bárány Society also proposed diagnostic criteria for Ménière's disease in 2015. In order to address the future direction for the diagnosis, treatment and research of Ménière's disease, it is crucial to comprehensively understand how these criteria describe the symptoms and background etiology of Ménière's disease. For example, the exact definitions of the term “vertigo” differ among these criteria. In the Japanese criteria, “vertigo” is not restricted to a rotating sensation of the body, whereas the American criteria define “vertigo” as a spinning sensation. In the Japanese criteria, hearing loss temporally coincides with the vertigo attacks, whereas the American and Bárány Society's criteria do not have such restrictions. Along with the current advances in diagnostic tests for otologic diseases, the Bárány Society's criteria include an updated list of the differential diagnosis for Ménière's disease. Most importantly, the Japanese criteria and the American criteria strongly support the hypothesis that the etiology of Ménière's disease is endolymphatic hydrops, and the Japan Society's 2016 criteria include MRI identification of hydrops. In the Bárány Society's criteria, the pathogenesis includes not only endolymphatic hydrops but other conditions as well. It is important to understand the concordance and differences of these criteria for the diagnosis of Ménière's disease.

著者

石崎 久義 野末 道彦 Ilmari Pyykko

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.50, no.3, pp.255-262, 1991 (Released:2009-10-13)

参考文献数

19

被引用文献数

1 1

---

The postural control system is considered to be comprised of vestibular, visual and proprioceptive endo-organs. When a person stands on a moving platform, changes of the center of gravity are measured and analyzed as displacements of vertical force on the platform constructed on the strain gauge principle. The vestibular endo-organ perceives the change of head movement and responds to velocity and acceleration of head movement. Also the visual system detects a moving target and responds to velocity. The proprioceptive system responds to changes of displacement of the center of gravity and the distention of the muscle spindles of the calf muscles. Postural control was studied in 48 healthy volunteers and 18 very old subjects with posturography and 20, 40, 60, 80, 100 Hz vibration to the calf muscles, which send misleading signals to the central nervous system. The purpose of this investigation was to determine the kind of postural testing to be used in healthy volunteers and very old persons. The postural control system was analzsed with cumulative recordings of position, velocity and acceleration. Postural control was amazingly stable in healthy subjects. However, variance of velocity and acceleration were greater in very old persons with and without vibration. Postural instability in the elderly was interpreted as a deterioration of many sensory organs : visual, vestibular and proprioceptive endo-organs.Vestibular endo-organs are well known to be a major part of the control system at times of sudden perturbation, and reciprocal sensory systems are well constituted to keep postural control. It is impossible to explore further which one of these parameters is primarily responsible for postural control and to what degree because of good correlation between velocity and acceleration values. At least in the vestibular system, the acceleration parameter has a major function in posture control.

著者

野村 泰之

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.68, no.3, pp.149-153, 2009 (Released:2009-08-01)

参考文献数

28

被引用文献数

1

著者

杉内 友理子

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.80, no.4, pp.303-310, 2021-08-31 (Released:2021-10-02)

参考文献数

31

被引用文献数

1

---

Descending information from the labyrinth to the spinal motoneurons is mainly conveyed through the vestibulospinal system, which consists of the lateral and medial vestibulospinal tracts. The lateral vestibulospinal tract (LVST) arises mainly from the lateral vestibular nucleus and descends ipsilaterally in the ventrolateral funiculus. It mainly receives input from the otolith organs, extends throughout the length of the spinal cord, and exerts excitation on the extensor muscles of the lower leg. Single LVST axons have multiple axon collaterals at different segments along the entire length of the spinal cord, thus playing an important role in maintaining the posture. In contrast, the medial vestibulospinal tract (MVST) originates in the descending, medial and lateral vestibular nuclei, and descends bilaterally in the ventromedial funiculus of the cervical cord. It conveys mainly semicircular canal inputs to the neck motoneurons, and single MVST axons have multiple axon collaterals terminating on neck motoneurons in different segments of the cervical spinal cord, thus playing an important role in the vestibulocollic reflex.

著者

真鍋 恭弘 伏木 宏彰

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.79, no.3, pp.141-147, 2020-06-30 (Released:2020-08-05)

参考文献数

9

---

Benign paroxysmal positional vertigo (BPPV) is the most common form of peripheral vertigo. It can be caused by debris in the semicircular canal of the ear. In regard to the location of the debris in the affected semicircular canal, sequential movement of the patient's head in the canalith repositioning procedure can cause the debris to move from the semicircular canal to the utricle. There is evidence that the canalith repositioning procedure is a safe, effective treatment for BPPV, but busy doctors are not always capable of performing of this procedure for all applicable cases. Therefore, we examined whether performance of the canalith repositioning procedure by well-trained nurses under the supervision of a doctor might be effective. We chose the Epley manoeuver as the canalith repositioning procedure. The results revealed that the period until resolution of dizziness was significantly shortened and the cure rate improved significantly. Therefore, we concluded that the outcomes of nurses' assistance in the Epley manoeuver are favorable. Transferring some of the duties of doctors to nurses would reduce the burden on doctors and allow them to focus on diagnosis and treatment that only doctors can handle. Consequently, task shifting of doctor's work to nurses under the supervision of a doctor can be considered in many aspects of health care.

著者

塚田 景大 宇佐美 真一

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.77, no.3, pp.180-187, 2018-06-30 (Released:2018-08-01)

参考文献数

32

---

We summarize the similarities and differences between the cochlea and vestibular endorgans in relation to mutations of genes causing hereditary hearing loss. In regard to the gene expressions associated with hereditary hearing loss in the inner ear, most of the genes expressed in the cochlea are also expressed in the vestibular end-organs. This implies that the genes associated with hereditary hearing loss also function in the vestibular endorgans, and mutations in these genes leading to hearing loss phenotypes may be associated with vestibular dysfunction phenotypes and/or symptoms. We searched the literature for the frequency of vestibular symptoms in patients with mutations in the causative genes for hearing loss. Although 67.3% of the patients with SLC26A4 mutations complained of vestibular symptoms, few patients with other mutations of genes known to cause hereditary hearing loss complained of vestibular symptoms. SLC26A4 and COCH mutations have been reported to be the most frequently associated with vestibular dysfunction and/or symptoms. Characteristically, in patients with SLC26A4 mutations, vertigo episodes are associated with acute hearing deterioration, and in patients with COCH mutations, progressive vestibular dysfunction is associated with progressive hearing loss. Although 4% of patients with GJB2 mutations complained of vestibular symptoms, saccular dysfunction was more frequent. It is difficult to explain the absence of vestibular symptoms in most patients with mutations of the causative genes for hearing loss?. Possible explanations for this inconsistency are the presence and functioning of other molecules to compensate for the functional loss of sensory activity in the vestibular end-organs; congenital or slowly progressive vestibular dysfunction could be compensated by visual and somatosensory input. Furthermore, the vestibular sensory system may have a lower sensitivity than the auditory system. Further studies are required to elucidate the effects of mutations linked to deafness on the vestibular functions.

著者

北島 明美

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.70, no.2, pp.85-87, 2011 (Released:2011-06-01)

参考文献数

10

被引用文献数

1 1

著者

近藤 貴仁 小川 恭生 大塚 康司 北島 尚治 稲垣 太郎 清水 重敬 小林 賀子 鈴木 衞

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.69, no.4, pp.213-217, 2010 (Released:2010-10-01)

参考文献数

14

被引用文献数

5

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When examining patients with vertigo, it is essential to differentiate between central and peripheral lesions. It has been reported that some infarctions associated with the posterior inferior cerebellar artery (PICA) can mimic peripheral vertigo, such as benign paroxysmal positional vertigo (BPPV). We report on a case that had been treated as BPPV at another institution and eventually turned out to be cerebellar infarction in the PICA legion. Two infarction lesions were observed in the cerebellum. Obstruction of the left vertebral artery was found on MRA. Six months from the first consultation, the BPPV decreased. We should be aware of cases of cerebellar infarction in which nystagmus mimics BPPV.

著者

三輪 徹 蓑田 涼生

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.78, no.2, pp.93-101, 2019

被引用文献数

3

---

<p> Past major earthquakes have been associated with an increase in the prevalence of vertigo or dizziness; the 2016 Kumamoto earthquakes on April 14 and 16 (JST, moment magnitude=7.0, Shindo 7 [Japanese seismic scale]) and the large numbers of aftershocks were no exception. Several months after the initial earthquake, significant outbreaks of vertigo or dizziness occurred over a large area surrounding the epicenter of the earthquake. However, it is unclear why major earthquakes cause these symptoms. After the major earthquake in Kumamoto, we conducted a questionnaire and medical records survey to investigate post-earthquake dizziness (PED). This survey covered a total of 575 subjects who complained of exacerbation of vertigo or dizziness after the earthquake and visited the hospital for follow-up before the scheduled dates. Our results showed that the number of patients with vertigo or dizziness who visited the hospital increased after the earthquake, and peaked between 2 and 4 weeks after the earthquake. The timing of onset of vestibular disorders varied according to the underlying disease. This study also suggested that earthquake-related psychological stress or stress resulting from earthquake evacuation could cause the onset of some vestibular disorders. We speculated that PED could be caused by stimulation of the vestibular and visual systems and bathyesthesia, psychological stress, potential effects of autonomic stress on the equilibrium function, and/or sensory mismatch. Our study could contribute to establishing PED as a new concept in the area of vestibular disorders.</p>

著者

青柳 優

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.69, no.3, pp.113-126, 2010 (Released:2010-08-01)

参考文献数

16

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This article describes the basic elements of auditory evoked potentials, including stimulus tone and recording condition, and clinical applications of auditory evoked potentials, such as ECochG, ABR and ASSR. The clinical applications of auditory evoked potentials are roughly classified into (1) objective audiometry and (2) neurological examination. ECochG is applied to the diagnosis of endolymphatic hydrops and inner ear hearing loss. ABR is still an important examination in the diagnosis of acoustic neurinoma, though the prevalence of MRI has reduced its importance. The elongation of the I-V inter-peak latency (I-V IPL) of ABR in lower brainstem lesion is mainly due to I-III IPL elongation, whereas I-V IPL elongation is mainly due to III-V IPL elongation in upper brainstem lesions. Recruitment and conductive hearing loss can be estimated by the finding of the latency-intensity curve of wave V. Although ABR is the most popular device in objective audiometry, the prediction of hearing levels in the lower frequency range using ABR evoked by clicks is less accurate. The most important benefit of ASSR is to provide an accurate assessment of hearing at different frequencies in a frequency specific manner, if stimulation consists of a sinusoidally amplitude-modulated tone. However, ASSR is not appropriate to use as a diagnostic tool in neurological examinations, because the waveforms of ASSR consist of the interference of different wave components. Power spectrum analysis and phase coherence using fast Fourier transformation are useful for the automatic detection of ASSR, because of its sinusoidal waveform configuration. Because the detectability of ASSR changes under different arousal states, 40-Hz ASSR is suitable for waking adults and 80-Hz ASSR for sleeping children in the assessment of hearing. Its advantage is that the thresholds at 4 different frequencies in both ears can be predicted more rapidly than ABR using the multiple simultaneous stimulation technique.

著者

木村 洋 加藤 功 青柳 優 小池 吉郎

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.38, no.2, pp.233-237, 1979 (Released:2010-02-05)

参考文献数

17

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A 44-year-old woman noted sudden onset of hearing loss and tinnitus in the left ear after sneezing. This was followed several hours later by acute vertigo. Neurotological examination revealed left sided complete loss of hearing and positional nystagmus with clockwise rotatory components, when in the left lateral position. A left tympanotomy was performed after 11 days. At surgery, perilymph was found to derive from the round window in which there was a large fistula. The fistulous area was grafted with fatty tissue.After two months, the hearing in the left ear was essentially unchanged. ENG revealed no positional and spontaneous nystagmus and the vertigo gradually disappeared.In labyrinthine membrane rupture, surgical treatment is considered to be effective in alleviating vertigo, though hearing impairment remains unchanged.

著者

青木 光広

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.67, no.3, pp.234-241, 2008 (Released:2008-08-01)

参考文献数

11

被引用文献数

6 4

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Patients with orthostatic dysregulation (OD)-associated disease may show autonomic disorders more frequently as compared with patients with other types of dizziness. However, the pathological mechanisms of OD remain unclear. We examined the cardiovascular autonomic function in dizzy patients with postural orthostatic tachycardia syndrome (POTS) or chronic orthostatic intolerance (OI) in order to evaluate the contribution of the autonomic disorders to the occurrence of dizziness. Heart rate variability analysis during the Schellong test showed that patients with POTS have hypo-parasympathetic function and relative hyper-sympathetic function, and that some patients with OI also have hypo-parasympathetic function. In our clinic, single therapy with a β1-blocker (Atenolol) for patients with POTS or single therapy with an a- agonist for patients with OI relieved orthostatic symptoms in 60% of the patients with POTS and OI. Further clinical studies on OD-associated disease to evaluate methods for accurate diagnosis and appropriate combined physical and pharmacotherapy may improve the outcomes in patients with OD-associated disease.

著者

片山 直美

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.75, no.4, pp.163-170, 2016

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<p> The cause of vertigo/dizziness varies. We may reduce vertigo/dizziness with a nutritional approach involving the circadian rhythm and chrononutrition. We can avoid hypoglycemia-mediated vertigo/dizziness by modulating the glucose intake. We can prevent anemia-mediated vertigo/dizziness through dietary supplementation with iron, copper, and vitamin C. Supplementary calcium and zinc are effective for the prevention of psychogenic vertigo/dizziness. In addition, it is effective to enforce a low salt diet at breakfast and lunch. The effective intake-time of calcium is about 1.5 hours before sleep. It is necessary to regulate one's lifestyle, and to prevent diabetes, high blood pressure, dyslipidemia and obesity. We can reduce vertigo/dizziness by preventing edema. A genetic investigation in conjunction with obesity is also necessary. A nutritional approach based on the results of a genetic analysis can be effective for prevention of obesity. Controlled eating habits through nutrition/dietetics can help in the prevention of vertigo/dizziness.</p>

著者

永井 克也

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.71, no.3, pp.207-213, 2012 (Released:2012-08-01)

参考文献数

24

著者

郭 伸 Struzik Zbigniew R 相馬 りか 大橋 恭子 潘 衛東 山本 義春

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.67, no.1, pp.58-64, 2008 (Released:2008-05-02)

参考文献数

19

被引用文献数

2

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By means of noisy galvanic vestibular stimulation (GVS), it might be possible to ameliorate the blunted responsiveness of degenerated neuronal circuits in patients with degenerative neurological diseases. We evaluated the effects of 24-hour noisy GVS on the long-term heart rate dynamics in patients with multiple system atrophy and on the daytime trunk activity dynamics in patients with either levodopa-responsive Parkinson's disease or levodopa-unresponsive parkinsonism patients. Patients were also examined for cognitive performance by means of a continuous performance test. Short-range or high-frequency fluctuations of the heart rate were significantly increased by the noisy GVS as compared with that by sham stimulation, suggestive of improved autonomic, especially parasympathetic, responsiveness. The long-range anti-persistency of trunk activity patterns probed by an autocorrelation measure was significantly increased by the noisy GVS, suggestive of quickening of bradykinesic rest-to-active transitions. The mean reaction time in the continuous performance test was also significantly decreased by the noisy GVS, without significant changes in either the omission or commission error ratios, which is suggestive of improved motor execution during the cognitive task. Thus, noisy GVS improved the motor and autonomic responsiveness and is effective for ameliorating the symptoms in patients with multiple system atrophy or Parkinson's disease.

著者

渡邊 千尋 大和田 聡子 伊藤 吏 村上 信五 欠畑 誠治

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.78, no.3, pp.178-184, 2019-06-30 (Released:2019-08-02)

参考文献数

15

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Herein, we present a patient with superior semicircular canal dehiscence syndrome (SCDS) manifesting as convergence spasms, which were alleviated by canal plugging surgery. SCDS is described in the literature by Minor as “a condition characterized by vertigo and oscillopsia induced by loud sounds or changes in the pressure of the external auditory canal or middle ear due to the dehiscence of the bone overlying the superior semicircular canal.” Convergence spasms are characterized by intermittent sustained convergence, accommodative spasms and miosis, and are likely to be caused by a functional disease, although in some cases, it is a manifestation of an organic disease. A 49-year-old male patient visited our department with a 2-year history of intermittent sudden vertigo and cloudy vision. The vertigo attacks had gradually increased in frequency and could last all day. Pure-tone audiometry showed bilateral conductive hearing impairment with air-bone gap at low frequencies from 125Hz to 500Hz. A head CT showed bone dehiscence above the bilateral superior semicircular canals and tegmen of the epitympani. Initial equilibrium testing did not reveal any abnormal findings. Initial sono-ocular testing of the right ear indicated upbeat nystagmus. However, after multiple outpatient visits, the upbeat nystagmus disappeared during the sono-ocular test and was replaced by paradoxical convergence. The eye tracking test also revealed paradoxical convergence, which became frequent and was accompanied by pupillary miosis. This paradoxical convergence was ultimately diagnosed as convergence spasms. No improvement of symptoms was achieved through non-surgical treatments over an extended period of time, therefore, canal plugging surgery was recommended. The surgery was performed through a middle fossa approach, and it completely eliminated the cochlear and vestibular symptoms associated with SCDS and the convergence spasms. Finally, we suspected that the convergence spasms were caused by ocular dysfunction as well as neurological factors related to the SCDS.

著者

高橋 正紘

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.80, no.3, pp.195-199, 2021-06-30 (Released:2021-08-04)

参考文献数

18

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To clarify the dynamic changes in the membranous lesions of Meniere's disease, the effects of aerobic exercise on different symptoms were analyzed. Out of a total of 351 patients with Meniere's disease who performed aerobic exercises for 6 months or longer who were enrolled, 338 showed improvement of one or more symptoms: disappearance of vertigo in 97.6% of cases; complete resolution of ear fullness in 60.1% of cases; improvement of hearing impairment in 38.5% of cases; complete resolution or marked decrease of tinnitus in 29.6% of cases. On the other hand, complete recovery of hearing was noted in 29.5% of the 78 patients with low-tone loss, 12.5% of the 96 patients with high-tone loss, and only 4.1% of the 170 patients with hearing loss across all frequencies. More than half of the patients with high-tone hearing loss and hearing loss across all frequencies failed to show any change in the degree of hearing loss. Considering the findings of temporal bone pathology, it seems probable that the Reissner's membrane, being ballooned and highly distended by endolymphatic hydrops, disturbs conduction of low-frequency waves by the perilymph, and the membrane, once it loses tension, is not resonant with either high-frequency waves or indeed waves of any frequency. Although aerobic exercise is effective to cure hydrops and improve membranous tension by activating homeostasis, its effect worsens with decreasing membranous tension.

著者

堀井 新

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.67, no.3, pp.251-255, 2008 (Released:2008-08-01)

参考文献数

10

被引用文献数

6 3

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Based on our recent papers (Horii A et al. Otol Neurotol 2004, Horii A et al., J Vestibular Res 2007), we discussed the psychiatric involvement in patients with vertigo and dizziness. Seventy percent of patients with chronic dizziness showed a high score in the Hospital Anxiety and Depression Scale (HADS), suggesting that many dizzy patients have comorbid psychiatric disorders. Fluvoxamine, one of the selective serotonin reuptake inhibitors (SSRIs), administered at a dose of 200mg per day was effective for subjective handicaps due to dizziness in patients with or without neuro-otologic illnesses, owing to its actions on both the comorbid anxiety and depressive disorder. More aggressive psychiatric treatment, such as administration of higher doses, may be the next step of treatment for non-responders without neuro-otologic diseases, because these patients have been shown to suffer from more severe psychiatric illnesses. In contrast, other types of drugs that are known to help recovery of the vestibular function are recommended for neuro-otologic diseases in patients without clinically significant anxiety or depression and non-responders to fluvoxamine. The main causes of dizziness in patients without physical neuro-otologic findings were psychiatric disorders. Bidirectional relationships between vertigo/dizziness and psychiatric disorders could be explained by the anatomical connections between the brainstem and limbic system, including the amygdala.