Vertigo

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Dr. Poonam Kathe
ENT specialist

verified

Vertigo is 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 the fear of heights. However, there is a specific type of vertigo that is triggered by heights. The spinning sensation worsens when the neck is moved suddenly or when any other movements involving the head are executed. People with vertigo may find it difficult to balance themselves when they walk or stand up suddenly after resting for a long time. They may also experience ringing in their ears or find it difficult to focus their eyes on an object. These symptoms may last for a few minutes or may persist longer.

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Types

There are two types of vertigo as follows:

● Positional Vertigo- It is triggered by a problem in the inner ear. It can last up to 20 seconds.

● Central Vertigo- It is triggered by a problem in the brain. It lasts up to five seconds.

Symptoms

The signs and symptoms of vertigo include:

● A false feeling that you or your surrounding is whirling, spinning, or moving horizontally/vertically

● Hearing loss

● Visual disturbance

● Abnormal, involuntary eye movements

● Blurred vision

● Dizziness

● Nausea

● Vomiting

● Slurred speech or difficulty in speaking

● Ringing in the ears

● Sweating

● Weakness

● Numbness

Causes And Risk Factors

Causes

When you are standing or doing some work, your brain sends constant signals to your sensory organs (like your eyes and skin) about your position, which in turn helps you maintain your balance. The inner ear performs the task of handling this balancing mechanism and makes you aware of your position in the surroundings.

 

Recurring episodes may lead to nausea, vomiting or severe consequences like falling over. Vertigo is also a symptom that could indicate a deeper problem in the inner ear or the brain. Here are some conditions that cause vertigo as a symptom:

● Benign paroxysmal positional vertigo (BPPV) is a common cause of positional vertigo found in 20 per cent 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 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 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 that you should be aware of are as follows:

● Meniere’s disease is a rare condition in which vertigo is associated with dizziness, hearing loss, and ringing in the ears (tinnitus).

● Brain tumour or tumour in the inner ear, also called acoustic neuroma, affects the nerve linked to the inner year, thereby leading to a feeling of loss of 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 (tiredness)

● Blurred or binary vision

In the case of vertigo, these signals are not received correctly leading to instability, loss of balance and the feeling of spinning.

Diagnosis

Diagnosing 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. Unfortunately, this creates confusion and makes the diagnosis difficult.

Dizziness can refer to a lot of things. It may indicate light-headedness caused by vascular problems or can be related to weakness and fatigue. Therefore, explanation of your symptoms plays an essential 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 and changing its position to check for the factors that trigger vertigo. In addition, you may also have to undergo some ear function test or a hearing test. You may be advised an MRI (Magnetic Resonance Imaging) scan to check for a neurological disorder that might be causing your vertigo.

Treatment

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

· Physical Therapy

Physical therapy helps the brain to regain the loss of ear function. The treatment aims is to improve the brain’s balancing system. The most common types of therapy are:

- Vestibular rehabilitation: It is a new type of physical therapy that involves simple exercises such as movement of the eyes from side to side, changing the position of the head while walking or going down the stairs.

- Re-positioning manoeuvre/Epley manoeuvre: This manoeuvre treatment is used in BPPV. It involves a series of body turns to move the displaced calcium crystals in the inner ear to a part where they can stay still and be less dangerous.

· Medication

Medications do not treat the causes of vertigo; they are just used to reduce the intensity or suppress the symptoms of an acute attack of vertigo to some extent. Your doctor will prescribe appropriate medication as per your symptoms. 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 (medicines 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, scopolamine and sedatives to help resolve the condition.

· Surgery

Surgical procedures for vertigo can either be corrective or destructive. Corrective surgery is performed to stabilise the inner ear, whereas destructive surgery is performed to stop the transmission of information from the inner ear to the brain. The various types of surgery are as follows:

- Endolymphatic subarachnoid shunt surgery: This corrective procedure is performed in cases where the cause of vertigo is Meniere’s disease. 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.

- 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.

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

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

- Tumour Resection: In patients with acoustic neuroma, vertigo can be treated with surgical removal of the tumour in the inner ear.

Lifestyle/management

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. For example, during an episode of vertigo, you should lie down in a quiet, dark room or sit down immediately.

The following tips may help you to reduce the number of vertigo episodes:

● Avoid stretching your neck

● Avoid fast head movements during day-to-day activities

● Squat instead of bending over from the waist to pick up things

● If you have a risk of falling, use a walking stick

● Keep two or more pillows under your head while sleeping

● If you get up in the middle of the night, switch the lights on

● Sit for a few minutes before getting up from the bed

● Keep your anxiety in check

Prognosis

While most people do not require treatment, others may require medicines and other therapies to treat vertigo. Personal measures can help you to keep the number of vertigo episodes to a minimal.

References


  1. Vertigo treatments. University of California San Francisco. Available at: https://www.ucsfhealth.org/conditions/vertigo/treatment.

  2. Vertigo. NHS. Available at: https://www.nhs.uk/conditions/vertigo/.

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