What is vertigo? Vertigo or balance disorder is a disturbance that causes an individual to feel unsteady, giddy, woozy, or have a sensation of movement, spinning, or floating, and loss of balance. Causes of dizziness related to the ear are often characterized by vertigo (spinning) and nausea.

What you will find in this Vertigo Guide

  1. Psychology of Balance - how our balance system works
  2. What causes Vertigo
  3. Diagnostic Tests
  4. Medical Treatment

Vertigo Overview

Dizziness is a very vague term that can be used to describe a wide variety of conditions such as

  • feeling of lightheadedness,
  • motion sickness,
  • nausea,
  • fainting spells,
  • losing balance
  • feeling as if the environment is tilting or spinning.

All of these symptoms can be a result of a number of health conditions. But a specific kind of dizziness is known as vertigo.

Vertigo is a type of dizziness that is commonly experienced by a number of people and it presents a sensation as if the patient is spinning or the environment is swaying or tilting.

The sensation is described as if you just got off from a merry go round. The symptom is worsened by a sudden change in head position, noise, coughing and sneezing. Vertigo usually lasts for several minutes but it can also take days in some severe cases.

Vertigo can be considered a serious disease as it increases the risk factor for some of the serious disorders such as strokes and tumors. There are different types of vertigo such as peripheral vertigo , objective vertigo and central vertigo, hence, the treatment of the vertigo is a necessity as it may lead to severe imbalance problems. 

Physiology of Balance

What is Vertigo

The human balance system works with our visual and skeletal systems to maintain orientation or balance. Visual signals are sent to the human brain about the body's position in relation to its surroundings. These signals are processed by the brain, and compared to information from the vestibular, visual and the skeletal systems.

A complex group of sensorimotor systems controls our balance. A myriad of different functions are all happening in perfect synchrony in order for us to stand, walk, sit and lay down properly without falling off.

Our brain receives inputs from our eyes, muscles, joints and vestibular system in our ears, then it process these nerve impulses so that it can give the person a correct perception of the environment.

Our ears contain special parts like the saccule, utricle and three semicircular canals which are all part of the vestibular apparatus. The purpose of vestibular apparatus is to provide the brain the correct perception of equilibrium (balance), spatial orientation and motion. The parts that are responsible for vertical orientation are the saccule and utricle.

The rotational movement is detected by the semicircular canals that contain fluid known as endolymph. The endolymph moves and triggers the sensory receptors within the canal which sends nerve impulses to the brain regarding the movement. Impulses from both canals of the side of the head would normally send symmetrical impulses in order for the brain to interpret the impulses properly.

Two Possible Causes of Vertigo

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Diagnosing a person experiencing vertigo can still be difficult because this symptom can be caused by several disorders. This is why the doctor may need to get a full medical history of the patient so that proper diagnosis and treatment can be done.

There are two possible causes of vertigo: peripheral vertigo and central vertigo.

Peripheral Vertigo

Peripheral Vertigo refers to the disorders that involve disturbances in the inner ear. 

The common disorders that may affect the inner ear thereby causing the person to experience dizziness or vertigo include:

  • Vestibular Neuritis – Inflammation of the vestibular nerve which is responsible for taking the nerve impulses from the semicircular canals in the inner to the brain.
  • Labyrinthitis – Inflammation of the labyrinth which is also in the inner ear and most of the time may also involve the vestibular nerve.

Both of these disorders are usually caused by a viral infection that may have reached the inner ear. The symptoms may appear during or after you had a sore throat, cold, glandular fever or flu. Vestibular Neuritis and Labyrinthitis can also result from other causes such as a complication of a middle ear infection with a bacteria, ear injury, tumors, a side effect of medicine, allergies, and Meningitis.

Symptoms include:

  • Ear Pain – The pressure inside the ear increases due to inflammation.
  • Fever – Suggesting of an infection
  • Nystagmus – Involuntary eye movements. The doctor will make you move your eyes in certain ways to see if it produces any other movements that you can’t control. It may appear in one or both eyes. This symptom may also be present in other conditions of the brain.
  • Mild hearing loss in one or both ears

A patient experiencing vertigo and also have these other symptoms may most likely be suffering from Labyrinthitis and/or Vestibular Neuritis. Since both labyrinthitis and vestibular neuritis have the similar causes and symptoms, it can be very difficult to determine which one you have.

The only symptom that may differentiate between the two is the presence of hearing problems. This is because the inflammation of the labyrinth is most likely to present with a hearing disturbance because it is part of the cochlea.

Meniere's Disease

Meniere's disease is a disorder of the inner ear, although still not fully understood, it is thought to be resulting from irregular composition or volume of endolymph, the fluid that fills the semicircular canals, in the inner ear. There are several possible causes of Meniere's disease this include an anatomical abnormality in the inner ear that causes the blockage of fluid, allergies, trauma to the head, viral infection, migraines or abnormal immune response.

Symptoms include:

  • Tinnitus – roaring sound in the ear
  • Hearing loss – usually this come and go even without treatment, mostly affects only one ear
  • Ear pain or pressure

The symptom of Meniere’s usually begins with an increase in the pressure in the ear, this is followed by tinnitus that increases gradually then hearing slowly decrease and the person begins to feel dizzy. Once vertigo sets in, the person may then feel nauseated and even vomit.

The attack may last briefly for 20 minutes but may persist for several hours. After which the signs and symptoms will just resolve and the person may be symptom free for some time.

The intensity and frequency of each episode may differ from one person to another. Some may only experience mild symptoms but can have tinnitus that can affect one’s sleep or daily activities.

BPPV

Benign Paroxysmal Positional Vertigo or BPPV – This result from the movement of the otolith, which is a very small particle made of calcium inside the ear. The otolith organs detect the movement of your head and its relation to gravity. For some reason the otolith can be dislodged and move into the semicircular canals and affect the movement of the fluid inside thereby causing it to send irregular nerve impulses to the brain making the person get dizzy.

Symptoms include:

  • Lightheadedness
  • Dizziness
  • Unsteadiness
  • Blurring of vision
  • Nausea and vomiting

BPPV is usually triggered by a sudden change in the position of the head like when lying down, tipping the head up and down or turning over. Vertigo associated with BPPV usually lasts for just a couple of minutes then gradually subsides by keeping the head steady.

A therapy known as the Epley Maneuver can be performed by your doctor and it can relieve dizziness associated with BPPV most of the time.

Central Vertigo

Central Vertigo refers to the dizziness or vertigo that result from a problem in the brain. 

The area of the brain that is usually affected is the brainstem or cerebellum. Dizziness can be a symptom of a more serious illness if not properly diagnosed.

Disorders that can cause central vertigo may include:

  • Alcohol Intoxication
  • Brain Tumor
  • Aneurysm – Blood vessel disorder, can be life threating
  • Certain medications such as anticonvulsants and aspirin
  • Migraine
  • Multiple sclerosis
  • Seizures
  • Stroke

The symptoms of central vertigo may include the following listed below and immediate medical attention is needed to rule out stroke or cardiac problems.

  • Numbness or tingling of one side of the body
  • Severe crushing headache
  • High grade fever - 101 F (38 C) and above
  • Loss of vision
  • Slurring of speech
  • Leg or arm weakness
  • Loss of consciousness
  • Chest pain, or rapid or slow heart rate

 

Vertigo Diagnostic Tests - What to Expect

The first step in diagnosing vertigo is to determine if the patient is really suffering from vertigo or dizziness. This is why your doctor will immediately ask you whether you feel like you or the room is spinning, or if you feel lightheaded.

If you answer that you just feel lightheaded, then it can be suggestive of abnormality in blood pressure, blood sugar levels, hyperventilation, irregular heart rhythm, bleeding, anxiety, stress or fatigue.

However, if you answer that you feel like the room is spinning, then you are experiencing vertigo. Your doctor may perform several more tests to determine the cause of your vertigo.

  • Blood tests - To check for presence of infection.
  • Romberg test – The doctor will have you stand with your eyes open and feet together, then maintain your balance while your eyes are closed.
  • Vestibular testing – To check for any involuntary movements of the eye (nystagmus).
  • Fukuda-Unterberger test – In this test, the patient will have to close the eyes and march in place while trying not to lean to the side.
  • Head-Thrust test – To check for eye movement, you will have to look at your doctor’s nose and then he or she will make a quick head movement and see if there are any movement of your eyes.

In some instances, the doctor will require you to undergo diagnostic imaging tests like CT-Scan or MRI to rule out vertigo associated disorders. Presence of neurological signs like slurring of speech, poor muscle coordination, loss of consciousness, vomiting, numbness of extremities or weakness of one side of the body can be warning signs of stroke and are considered as a medical emergency.

Other Possible Tests:

Routine laboratory tests may include:

  • CBC (complete blood count)
  • Thyroid function tests ECG (electrocardiogram) with rhythm strip
  • MPPI (Minnesota Multiphasic Personality Inventory)
  • VEMP (vestibular evoked myogenic potentials) testing
  • An audiogram to assess the extent of hearing loss

It may also include specialized tests such as:

  • Magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) scan
  • EEG (electroencephalogram)
  • Battery of psychological tests
  • Tilttable (a monitor to determine if a person can keep a stable blood pressure when tilted from a horizontal to vertical position)
  • Holster monitor to evaluate the cardiac rhythm

To rule out possible diseases such as multiple sclerosis, and tumor, your doctor may order:

  • Posturography
  • CT (computerized tomography) scan
  • Auditory Brainstem Response Audiometry

To help your doctor assess ongoing balance problems he may request:

  • Electronystagmography (ENG)
  • Posturography
  • Rotary-chair testing
  • VEMP (vestibular evoked myogenic potentials)

Medical Treatment

Treatment of vertigo depends on the causative factor. Peripheral vertigo can be treated by bed rest, avoiding sudden position changes and use of Vestibular Blocking Agents or VBAs. These medications helps relieve the inflammation in the inner ear, relaxes the muscles and prevent other symptoms associated with vertigo like nausea and vomiting.

  • Meclizine (Antivert) or Diazepam (Valium) – Motion sickness drugs that can lessen the spinning sensation by relaxing the muscles.
  • Betahistine, Promethazine - Anti-nausea medications that are used to prevent nausea and vomiting.
  • Prochlorperazine, Metoclopramide – Antiemetics, drugs used to control vomiting.

Recurrent vertigo attacks resulting from Meniere’s disease can be treated by injecting medications like Gentamicin or Dexamethasone to the middle ear.

  • Gentamicin is an antibiotic that will hamper the balancing function of the affected ear so that the ear can function normally thereby lessening the frequency and severity of vertigo episodes. This treatment can cause permanent hearing loss to the affected ear.
  • Dexamethasone on the other hand is a steroid that can be also applied by your doctor to the affected ear. This is less toxic to your ear, but then its results are not as effective as gentamicin.

Surgery can also be another treatment options especially for persons with Meniere’s disease who are suffering from intense and frequent vertigo attacks.

Endolymphatic sac procedures – This involves the decompression of the endolymphatic sacs by removing a tiny part of the bone to allow better fluid absorption or decrease fluid production. A shunt may also be put in place to facilitate fluid drainage from the inner ear.

Labyrinthectomy – The removal of both the hearing and balance organs of the ear. This is only done when the patient’s affected ear already has total hearing loss.

Vestibular nerve section – This procedure is done by cutting the vestibular nerve which is the movement and balance sensors in the inner ear. This can help relieve vertigo attacks and at the same time prevent hearing loss.

Prognosis

Most of the symptoms associated with peripheral types of vertigo usually resolve on its own within a short period of time. Use this vertigo guide to find what causes vertigo and for prevention of recurrent attacks depends on the cause and knowing what can trigger your vertigo.

Since there’s still no available cure for Meniere’s disease, the treatment plan is mostly focused only on relieving the symptoms and preserve hearing.

When should you seek immediate help?

Seek immediate help if you have

  • Ringing in your ears
  • Have a severe headache that doesn't go away
  • Fall and hurt yourself
  • Feel confused, weak, and have changes in your vision
  • Have more than one-minute BPPV symptoms

There are many treatment options available for vertigo sufferers. Talk to your doctor about the best treatment for your condition.

"In-Depth" Perspective on Vertigo

In patients with vertigo, inflammation of the fluid or irritation of the crystals on the nerve membrane that lines the walls of the semicircular canals may cause the spinning sensation even without much head movement.

Often, only one canal is involved and the person may be symptom-free if they don't move.

Normally, when the head moves, fluid in the semicircular canals shifts and that information is relayed to the brain. When the head stops moving, the fluid stops as well. There may be a slight delay and is the basis for vertigo experienced after people participate in many children's games and carnival rides.

When a person goes on a merry-go-round or spins quickly around in circles, the fluid in the canals develops momentum and even though the head stops spinning, the fluid may continue to move. This causes vertigo or a spinning sensation and may cause the person to fall or stumble in a crooked line. It also may be associated with vomiting.The inner ear has two parts, the semicircular canals, and the vestibule, that helps the body know where it is in relationship to gravity.

There are three semicircular canals that are aligned at right angles to each other and act as the gyroscope for the body.

The canals are filled with fluid and are lined with a nerve-filled crystal encrusted membrane that transmits information to the cerebellum, the part of the brain that deals with balance and coordination.

The cerebellum adds information from sight and from nerve endings in muscles that deal with proprioception, the perception of movement, to help the brain know where it is in relationship to gravity and the world.

 

Post by:

Pavel Kotlykov

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