Vertigo – causes, diagnosis and treatment

Suffering from sudden bouts of dizziness? You could be having vertigo. Here are its causes, diagnosis and treatment.

Suffering from sudden bouts of dizziness, when everything around you seems to be spinning? Or spells of instability? It might be time you visited a doctor. Many people who suffer from these symptoms frequently or after doing something in particular like bending, are known to suffer from a condition called vertigo. Sounds like a complicated condition? Well, don't despair.

Here are some simple answers, with inputs from renowned ENT surgeon and otolaryngologistDr Rajeev Nerurkar, to common questions about the condition.

What is vertigo and is it related to fear of heights at all?

Vertigo is actually a sense of spinning or rotation that is felt while you are standing still. You could call it an illusion of movement. People having vertigo not only feel that they are spinning but also feel that their surroundings are moving around them.

Vertigo cannot be defined as fear of heights. However, there is a specific type of vertigo which is triggered by heights. The sensation of spinning worsens when the neck is moved suddenly or when any other movements involving the head is executed. People with vertigo may actually find it difficult to balance themselves while walking or when they stand up suddenly after resting for a long time. They also may find it difficult to focus their eyes on an object or experience ringing in their ears. These symptoms may last for a few minutes or may persist for longer. (Read: Feeling faint often? 10 reasons not to neglect it!)

What causes vertigo?

When we are standing or doing some work, our brain sends constant signals to our sensory organs (like our eye and skin) about the position we are in, which in turn helps us maintain our balance. It is the inner ear which performs the task of handling this balance mechanism and makes us aware of our position in the surroundings. In the case of vertigo, these signals are not received correctly leading to instability, loss of balance and the feeling of spinning.

There are two types of vertigo, one that is triggered by a problem in the inner ear called positional vertigo (can last upto 20 seconds). And the other one is where the condition is triggered by a problem in the brain and is called central vertigo (which lasts upto 5 seconds). (Read: Hearing loss or deafness: 7 facts you ought to know)

Could recurring episodes of vertigo be dangerous?

Yes, it most definitely can be. Recurring episodes may lead to severe consequences like falling over or even lead to symptoms like vomiting and nausea. But, what you need to understand is that vertigo is also a symptom that could indicate a deeper problem in the inner ear or in the brain. Here are some conditions that cause vertigo as a symptom: (Read: Why you should take headaches more seriously)

• Benign paroxysmal positional vertigo (BPPV) is a common cause of positional vertigo that is found in 20 percent of all patients with vertigo. It is believed that when calcium particles in the inner ear get displaced, it affects the ear function and causes BPPV. People with BPPV experience sudden vertigo when they move their heads. This feeling lasts for a few seconds, usually less than a minute. Movements such as rolling over while sleeping, getting out of the bed and lifting the head triggers the condition. Episodes of BPPV may occur for a few weeks and then may disappear suddenly.
• A viral infection in the labyrinth, a part in the inner ear that controls balance, may cause inflammation in the ear triggering vertigo. The imbalance caused by cold infection usually will not persist after the cold subsides.
• Drug induced toxicity that affects the nerve responsible for balance (Vestibular nerve).
• Head trauma or an injury to the head can cause vertigo in a few cases.
• Migraine can also cause vertigo along with headache, nausea and vomiting.

Other rare causes of vertigo:

• M ni re's disease is a rare condition in which vertigo is associated with dizziness, hearing loss and ringing in the ears (tinnitus).
• Brain tumor or tumor in the inner ear, also called acoustic neuroma, affects the nerve which is linked to the inner year, thereby leading to a feeling of loss in balance.
• Stroke or seizures that affect the brain may also cause central vertigo.
• Multiple sclerosis is a condition in which the nervous system is affected. This leads to faulty or incomplete nervous impulses being sent to the brain, leading to a feeling of instability.

Although vertigo is not life-threatening, it can be disabling. So you should seek medical help if your vertigo is associated with:

• Difficulty in understanding speech
• Difficulty in talking or walking
• Fatigue
• Blurred or binary vision

How is vertigo diagnosed?

Diagnosis of the cause of vertigo depends a lot on how you describe your symptoms. Usually, patients with vertigo use the word 'dizziness' to describe what they feel. This creates confusion and makes diagnosis difficult.

Dr Nerurkar says 'Dizziness is the term that is used to denote a sensation of movement of the person in relation to the environment whereas vertigo is the other way around.' 'But the differentiation between dizziness and vertigo is controversial', he adds further.Dizziness can refer to a lot of things. It may indicate lightheadedness which can be caused by vascular problems or can be related to weakness and fatigue. Therefore, explanation of your symptoms plays an important role in the proper diagnosis of the underlying causes.

Based on your explanation, if a problem in the inner ear is suspected, the doctor performs a physical examination by moving your head deliberately, changing its position to check for the triggers of vertigo. You may have also have to undergo some ear function or a hearing test as well. You may also be advised an MRI to check for a neurological disorder that might be causing your vertigo. (Read: Revealed how the noise around you is making you deaf!)

In some cases, vertigo may also get resolved on its own. But if you do require treatment for it, you will be treated with either physical therapy, medication or surgery; depending on the severity of your symptoms.

How is vertigo treated?

1. Physical therapy:

Physical therapy helps the brain to regain the loss of ear function. The aim of the therapies is to improve the brain's balancing system. The most common types of therapy are:

a. Vestibular rehabilitation

Is a new type of physical therapy which involves simple exercises such as movement of the eyes from side to side, changing the position of the head while walking or climbing downstairs.

b. Re-positioning maneuver/Epley maneuver

This maneuver treatment is used in BPPV, where vertigo is caused by dislocation of calcium carbonate crystals in the inner ear. It involves a series of body turns to move the crystals to a part where they can stay still and be less dangerous.

2. Medication

Medication does not treat the causes of vertigo, they are just used to reduce the intensity or suppress the symptoms of acute attack of vertigo to some extent. Depending on the symptoms you show, your doctor will prescribe appropriate medication. Dimenhydrinate, promethazine and anticholinergic drugs are generally prescribed to reduce the intensity of the spinning sensation and the activity of the inner ear. Sometimes, when vertigo is associated with vomiting and nausea, antiemetics (medication to stop vomiting and nausea) may be given. If you experience severe spinning as one of the symptoms of vertigo, your doctor may prescribe vestibular suppressants such as antihistamines, scopolamines and sedatives to help resolve the condition.

3. Surgery

Surgical procedures for vertigo can either be corrective or destructive. A corrective surgery is performed to stabilize the inner ear whereas a destructive surgery is performed to stop transmission of information from the inner ear to the brain.

a. Endolymphatic subarachnoid shunt surgery: In case where the cause of the vertigo is Meniere's disease, this corrective procedure is performed. In this surgery, a tube is introduced into the labyrinth of the inner ear to drain out excess fluid that disturbs the balance mechanism in the inner ear.

b. Canal Plugging: It is a corrective procedure performed in patients with BPPV. In this procedure, the inner ear canal is plugged with small chips to stop the movement of particles that send false signals to the brain.

c. Labyrinthectomy: It is a destructive procedure in which the part of inner ear that controls the balance mechanism is removed so that signal transmission to the brain is stopped completely.

d. Vestibular Neurectomy: It is a destructive procedure in which the nerve that sends signals to the brain from the inner ear is removed.

e. Tumor Resection: Inpatients withacoustic neuroma, vertigo can be treated with surgical removal of the tumor in the inner ear.

Apart from all the medical help you take for this condition, there are some things you can do on your own to help reduce the intensity of the spinning sensation inside your head.Dr Nerurkar suggests the following changes to avoid vertigo attack:

• Avoid stressful physical activity and excessive neck movements that can trigger vertigo.
• Avoid exposure to loud sound or bright light.
• While sleeping, use a pillow to keep your head slightly raised.
• When you are about to get out of bed, make sure you get up slowly. Sit at the edge of the bed for a minute before you stand up.
• Walk slowly while climbing up or down stairs. Be careful while taking an escalator to avoid falls.
• Do not bend down to pick up fallen things as this could worsen the symptoms.
• Move your head very carefully while performing daily activities. Essentially, avoid extending your neck suddenly to look at things.
• A good way to reduce the symptoms of vertigo is to keep your blood pressure in check.

References:

David Solomon. Benign Paroxysmal Positional Vertigo

Bademci G, Bata F et al. Selective microsurgical vestibular neurectomy: an option in the treatment of intractable vertigo and related microsurgical landmarks.

Teufert KB, Doherty J. Endolymphatic sac shunt, labyrinthectomy, and vestibular nerve section in Meniere's disease.

Patient.co.uk (www.patient.co.uk)

MedlinePlus (http://www.nlm.nih.gov/medlineplus)

American Hearing Research Foundation (http://american-hearing.org)

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