Understanding Vertigo : Symptoms, Causes, and Treatment Options

WHAT IS VERTIGO ?

  • Vertigo is a false sense of motion, spinning or feeling of imbalance. Sufferers often call it dizziness, imbalance, light-headedness. Often the imbalance is associated with nausea, vomiting or unsteadiness on walking. It may worsen when you move your head. 
  • It is a fact that 20-40% people are affected by dizziness at some point in time in their life; 15% people have dizziness, and 2-3% of emergency visits in the developed world is for vertigo.
  • But it must be noted that vertigo is not a disease. It is only a symptom of a disorder. Therefore, suppressing the symptom is not the solution. Proper diagnosis of what is causing vertigo/dizziness is possible only when the doctor makes a systematic evaluation. 
  • A neuro- otological workup alone will help to find out if a vertigo patient is suffering from disorders like BPPV, Meniere’s Disease, Vestibular Neuritis, Labyrinthitis, Acoustic Neuroma, Otolith Dysfunction, Vestibular Migraine, Central Vestibulopathy or psychogenic disorders.

TYPES OF VERTIGO

  • Vertigo caused by problems in the brain or central nervous system are called as central vertigo. When the causes are due to problems in the inner ear it is called as peripheral vertigo. Vertigo may also be a symptom of other conditions.

CAUSES OF VERTIGO

  1. Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo & is identified by the brief sensation of motion lasting 15 seconds to a few minutes. It may be caused by sudden head movements or moving the head in a particular direction, such as rolling over in bed. This type of vertigo is rarely dangerous & can be easily treated.
  2. Vestibular Neuronitis is when the vestibular nerve that connects the inner ear and the brain stem is inflamed, leading to severe dizzy spells that can last up to 2 weeks. A viral infection can cause this condition.
  3. Meniere’s Disease is a condition caused by the build-up of fluid in the ear. This can trigger vertigo and is often accompanied by tinnitus, fluctuating hearing loss and ear pressure. This is a relatively rare condition, but a more serious inner ear issue that needs to be treated through medication and lifestyle changes.
  4. Acoustic neuroma is a type of tumor of the nerve tissue of the ear that can cause vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss.
  5. Labyrinthitis is the infection of the labyrinth( Inner ear) leading to vertigo, hearing loss and tinnitus. 
  6. Perilymph Fistula

 A small tear in the fluid-filled inner ear causes fluid to leak into the middle ear. This leakage disturbs the equilibrium and leads to vertigo spells, especially when the patient does straining activities or coughs vigorously. This condition may also lead to tinnitus and hearing loss. 

Vestibular Paroxysmia 

 Microvascular compression is the most common reason for vestibular paroxysmia. The patient may have frequent short spells of vertigo episodes recurring throughout the day. VNG/ ENG and MRI scanning are recommended to diagnose Vestibular paroxysmia.

  1. Vertigo can be caused by decreased blood flow to the base of the brain. Bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo, headache, difficulty in walking. 
  2.  Vertigo is often the presenting symptom in multiple sclerosis. 
  3. Head trauma and neck injury may also result in vertigo, which usually goes away on its own. Cervical vertigo can be caused by neck problems such as impingement of blood vessels or nerves from neck injuries.
  4. Migraine associated vertigo

 Migraine, a severe form of headache, may also cause vertigo. The vertigo is usually followed by a headache. There is often a prior history of similar episodes but no lasting problems.

  1. Complications from diabetes can cause arteriosclerosis (hardening of the arteries) which can lead to lowered blood flow to the brain, causing vertigo symptoms.

Symptoms you might experience when you have vertigo include:

  • Nausea and vomiting
  • Dizziness
  • Balance issues
  • Hearing loss in one or both ears
  • Tinnitus (ringing in your ears)
  • Headaches
  • Motion sickness
  • A feeling of fullness in your ear
  • Nystagmus (a condition that causes your eyes to move from side to side rapidly and uncontrollably).

HOW TO DIAGNOSE CAUSES OF VERTIGO ?

Healthcare providers may perform some tests to diagnose vertigo. These tests can include:
  1. Fukuda – Unterberger test: Your healthcare provider will ask you to march in place for 30 seconds with your eyes closed. If you rotate or lean to one side, it could mean that you have an issue with your inner ear labyrinth. This could cause vertigo.
  2. Romberg’s test: During this assessment, your healthcare provider will ask you to close your eyes while standing with your feet together and your arms to your side. If you feel unbalanced or unsteady, it could mean that you have an issue with your central nervous system (your brain or spinal cord).
  3. Head impulse test: For this test, your healthcare provider will gently move your head to each side while you focus your eyes on a stationary target (for example a spot on the wall or your provider’s nose). As they move your head, they’ll pay close attention to your eye movements. This can tell them if there’s an issue with the balance system in your inner ear.
  4. Imaging tests: These may include CT (computed tomography) scans or MRI (magnetic resonance imaging).
  5. Video Nystagmography (VNG) 

HOW DOES VNG WORK?

VNG is a complete diagnostic system for recording, analyzing and reporting involuntary eye movements, called nystagmus, using video imaging technology. The main advantage of this procedure is that, it helps us to differentiate between the central and peripheral causes of vertigo. 

HOW TO TREAT VERTIGO ?

Depending on the cause and type of vertigo the ENT Doctor will decide on the mode of treatment. This may include a combination of 

  • Simple lifestyle changes 
  • Medications
  • Physical therapy

Simple lifestyle changes

  • Simple exercises to correct symptoms.
  • Getting up slowly from a seated position
  • Sitting up slowly from lying down position, waiting for a minute before standing up.
  • Avoid bending forwards even to pick up objects.
  • Sleep with the head raised.
  • Doing actions that trigger vertigo to slowly condition the brain.
  • Move your head and neck slowly while doing daily activities.
  • Vitamin D supplementation may be advantageous for patients diagnosed with benign paroxysmal positional vertigo.
  • Herbal remedies such as ginger root, ginkgo biloba, & coriander may help to decrease vertigo symptoms in few people. Consult a doctor before using any natural treatments.
  • Avoid elements that can influence circulation, including caffeine, tobacco, or alcohol.
  • Drink plenty of liquids.

VERTIGO MEDICATIONS 

Medication may help in some cases of acute (sudden onset, short duration) vertigo. Healthcare providers may recommend motion sickness medications (like meclizine or dimenhydrinate) or antihistamines (like cyclizine) to ease vertigo symptoms

PHYSICAL THERAPY

  • A modified Epley maneuver is a type of physical therapy often prescribed that involves head & body movements done while sitting on a bed. Traditionally, it is conducted in a doctor or physical therapist’s office, but it may also be prescribed to be done at home. Once a patient has obtained proper instruction, this exercise can relieve vertigo symptoms in a week.
  • Particle repositioning exercise is a treatment based on the idea that the disease is caused by the displacement of tiny stones in the balance center (vestibular system) of the inner ear. The head is repositioned to relocate the stones to their normal position. This exercise is repeated until the abnormal eye movements are no longer visible 

SURGERY

Surgery is advised for rare cases of vestibular disorders such as Acoustic neuroma, Perilymph fistula, Meniere’s disease (Failed Medical Management) etc.,

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