Vertigo is the perception of spinning and loss of balance. It is a symptom and not a disease. Vertigo related dizziness can be triggered by different things such as sudden head movement or looking down from a great height. Vertigo attacks are sudden and unpredictable
The common symptoms associated with vertigo include:
• Feeling sick
• Loss of balance
Vertigo is a common symptom, and about 20% to 30% of people experience it atleast once in their lives.
Alert: Vertigo typically resolves itself; however, it can continue for days or months. You must not overlook Vertigo if it exists for than a few hours as the underlying disorder may get worse with time if left untreated, thereby leading to further complications.
There are two different types of Vertigo:
• Peripheral Vertigo- associated with problems in the inner ear
• Central Vertigo- associated with problems in the brain
Due to Vertigo, you may experience four different types of dizziness
• Type 1 dizziness: a sensation of rotation
• Type 2 dizziness: feeling like about to faint
• Type 3 dizziness: loss of balance and unsteadiness
• Type 4 dizziness: lightheadedness
When you are experiencing Vertigo, you may feel the following signs and symptoms:
• Spinning sensation – you may feel that your surroundings are spinning
• Loss balance
• Feeling the lack of equilibrium and stumbling
While Vertigo is itself a symptom of other disorders, it is usually accompanied by the following symptoms:
• High temperature
• Tinnitus – ringing sound in the ears
• Hearing loss
Typically Vertigo and the associated loss of balance is caused either by:
• Problems in the inner ear which causes peripheral Vertigo. This may lead to loss of balance and unsteadiness
• Problems in the brain which causes central Vertigo. The affected brain parts typically are:
Different kinds of disorders may lead to peripheral Vertigo or central Vertigo
|Peripheral Vertigo||Central Vertigo|
|• Benign Paroxysmal Positional Vertigo (BPPV):|
• Trauma or injury in the head:
• Meniere’s disease
• Vestibular Neuronitis
• Side effects of certain medicines
• Multiple Sclerosis
• Brain Tumor
• Migraines- neurological condition causing severe headaches of varying intensity
• Benign Paroxysmal Positional Vertigo (BPPV): most common cause of Vertigo. It causes a sudden spinning sensation inside the head. It is primarily caused by chunks of calcium carbonate breaking off from the linings in your inner ear. In BPPV, besides Vertigo, you may also experience:
– Rare vomiting
– Nystagmus- uncontrollable eye movement
• Vestibular Neuronitis- an inflammation causes this disorder in the vestibular nerve. It causes sudden vertigo attacks that are usually very intense
• Labyrinthitis- in this disorder, there is an inflammation:
– In the inner ear or
– In the nerves that connect the inner ear to the brain
An infection like the flu typically causes it.
• Meniere’s disease- this is area rare disorder that affects the inner ear and causes sudden episodes of dizziness that may last for hours or days. Besides Vertigo, it can also cause:
– Loss of hearing
– A feeling of fullness in the ear
• Multiple sclerosis: The immune system works against the protective covering of the nerves,thereby damaging it.
Note: Vestibular system is the sensory system that is a part of the inner ear. It provides information to the brain about the movement and orientation.
In case you are noticing the signs of Vertigo, you would need to see one of the following doctors to identify the underlying cause:
• Primary care physicians
• Physical therapists
For the diagnosis of Vertigo, your doctor performs a physical examination and ask you specific question associated with your symptoms.
These questions can be about:
• Your age
• The type of dizziness
• The frequency of attacks
• The relation between your movements and the vertigo attacks, for example: whether you feel more at risk of experiencing dizziness when you are standing up or sitting down, etc
Based on the preliminary results, your healthcare provider may recommend the following tests:
• Hearing tests: These are mainly recommended if you are also experiencing problems like tinnitus. Some hearing tests that your doctor may recommend include:
– Tuning fork test- The doctor will place a tuning on your head or in the center of the forehead. Upon tapping the doctor will ask you if the sound is equal in both the years as it should be normally
– Audiometry test- An audiometer is used to produce sounds of varying pitch and intensity. The doctor will then ask you if you can hear the sounds.
• Caloric testing: This test is done to check the responsiveness of your vestibular system and to see the symmetry of responses. It is a non-painful test in which warm or cold water is run into your ear for 30 minutes.
• Videonystagmography: this is used to test your inner ear and the central motor functions
• Scans: your doctor may recommend MRI scans or CT scans to find out if any non-cancerous brain tumours are causing the Vertigo
• The Romberg maneuver: This test is done to find if there are any problems associated with neurological functions that are causing the loss of balance.
• The head impulse test- In this test, your doctor will gently rotate your head in different directions to investigate problems associated with your peripheral vestibular system- The peripheral vestibular system includes:
– Hair cells and
– Cranial nerves that transmit signals from hair cells to the central nervous system
• The Fukuda-Unterberger Test
• The Dix-Hallpike maneuver- this test is conducted to diagnose benign positional paroxysmal Vertigo.
• Posturography- This test is used to determine how much control you have on your posture in different stances while moving or while staying still.
The management and treatment of Vertigo is dependent on the underlying disorder that is causing the Vertigo. In some cases, the symptoms of Vertigo may resolve on its own without any treatment.
If Vertigo is associated with a problem in the inner ear, your doctor may recommend certain medications for the management of acute episodes. To control the symptoms during these extreme attacks, your doctor may recommend:
• Antihistamines – meclizine is the most commonly prescribed antihistamine. It is considered safe during pregnancy, as well.
Alert: Typically, Antihistamines, Benzodiazepines, and Antiemetics have sedating effects. Hence, if these medicines are given to an elderly you should consult the doctor regarding the potential risks.
• Physical therapy
• Avoiding known triggers like high-salt diet, caffeine, and alcohol
Based on the underlying disorder that is causing your Vertigo, the following may be the recommendations of your doctor
|Vestibular dysfunction||Physical therapy, vestibular rehabilitation|
|Meniere disease||Vestibular rehabilitation|
Lifestyle adjustments like avoiding high-salt diet, caffeine and alcohol
Vestibular suppressants like meclizine
|Benign paroxysmal positional Vertigo Non-pharmacological agents||Epleymaneuver or head rotation maneuvers that put calcium deposits back in the vestibule|
Whether your Vertigo will go away or not depends on the underlying cause. For example most cases of BPPV go away on their own. For other causes, treatments can be effective. Please consult with your doctor to get a better idea about how long it will take for the disorder causing your Vertigo to resolve.
MBBS (ENT- Honours) (KGMC-Lucknow),
M.S. (KGMC- Lucknow), FAOI (AIIMS), FAOI (U.K.)
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