Understanding this "spinning" experience

What is vertigo?

Below you'll find the complete overview that answers questions like, "what is vertigo", "what are two main causes of vertigo", "how to test for vertigo", "medical treatment", "preparing for doctor's appointment", and more.

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.

Vertigo describes an illusion of movement that you or your environment is spinning.

It differs from dizziness, which occurs without relation to motion or position, or motion sickness, which is a feeling of lack of equilibrium. This should not be confused with fainting either or lightheadedness symptoms.

First, we will start by clearing a misconception.

Vertigo in medical terms does not mean a fear of heights. Vertigo is actually a specific kind of dizziness.

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 is different from dizziness and makes your surroundings appear as they are moving, or that you’re moving when you’re actually standing still. Dizziness, however, typically causes you to feel woozy or lightheaded.

Physiology of Balance

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

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 includes 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

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.

Below is a quick overview of the most common causes of vertigo and their treatment procedures.

  • BPPV (Benign Positional Paroxysmal Vertigo)

[To learn more about BPPV read our guide here]

For BPPV there is a simple procedure which involves maneuvering the position of your head. This is called “canalith repositioning”, or Epley Maneuver

This is effective after one or two treatments. You will learn them from a physical therapist and continue them at home.

The doctor may also prescribe you with “meclizine” and “diazepam”, or over-the-counter “dimenhydrinate” in order to provide relief from nausea and dizziness.

  • Meniere’s disease

[To learn more you can read an article by vestibular.org]

In its treatment, the aim is to reduce the body’s retention of fluids. This is done through Diuretic use and diet changes like low-salt (salt leads to water retention). Sometimes injections through the ear drum or surgery may also be recommended.

  • Vestibular Migraine

[To learn more you can read our detailed post here]

To deal with Vertigo that arises due to Vestibular Migraine you doctor will first help you with identifying the triggers for it. Changes in diet, stress managing, sleep and exercise will be recommended to help deal with the triggers.

Also, medicines might be prescribed to help deal with nausea and vomiting. There are also exercises to help your body deal better with motion, known as vestibular rehabilitation.

  • Anxiety Disorders

When your dizziness results from anxiety disorders the usual vertigo treatment recommended are medications and psychotherapy, alone or in combination.

Medications overview

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.

When should you see a doctor?

Rarely dizziness hits people and passes off. But there are times where dizziness is a cause of concern and requires contacting your doctor. Contact your doctor if you are experiencing any recurrent, unexplained or severe case of dizziness.

You should seek emergency medical aid if you are experiencing severe dizziness or vertigo accompanied by any of the following:

  • A new, different or a severe headache
  • Your neck is very stiff
  • Experiencing trouble speaking
  • Sudden hearing loss
  • Have blurred vision
  • Feeling weakness if your leg or arm
  • Rapid slow heart rate or chest pain
  • Facing difficulty in walking or unable to stand properly
  • Loss of consciousness
  • A significant head injury

Preparing for your doctor’s appointment

There are excellent chances that your General Practitioner will be able to diagnose and treat the cause of your dizziness. However, in some cases, a visit to an ENT (Ear, Nose, and Throat) specialist or a neurologist might be required.

The doctor will probably ask you the following questions in order to proceed with identification and treatment:

  • Are spells of dizziness continuous or do they occur in episodes or spells?
  • If you are experiencing dizziness in episodes, how long do they last?
  • What is the frequency of your dizziness episodes occurring?
  • When do you experience dizziness, and what potentially triggers it?
  • When you are dizzy “does the room spin” or do you feel like “you are spinning”?
  • Does a loss of balance accompany dizziness?
  • Are you hearing a “ringing” in your ears or a feeling of “fullness” or trouble hearing?
  • Is vision blurred?
  • Does the dizziness increase if you move your head?
  • What if any, medication, vitamins or supplements you are taking?
  • Any existing health condition or symptoms, seemingly unrelated to dizziness. For example, you are feeling increasingly anxious or depressed
  • Any recent life changes or new stress factors.

Diagnostic Testing for Vertigo

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.

Usually, diagnosis is simple and straightforward. To identify what is the cause of your symptoms you doctor may ask you to tip your head back or lie down on a particular side in the exam room.

The additional tests, if required are:

  • Eye movement testing

Your doctor will observe the path of eyes when they are following a moving object. You may be also me made to take a “caloric test”. In this, the movement of the eye is tested when cold and warm water is placed in your ear canal at different times.

  • Posturography testing

This is a check of your balance system in order to identities which parts are working and which aren’t.

You will be asked to stand on your bare feet on a platform and asked to keep your balance under various conditions.

  • Rotary-Chair testing

This test is also designed to check your vestibular and brainstem system, components which contribute to maintaining balance.

In this test, you are placed in a computer-controlled chair that moves quite slowly in a full circular motion. At faster speed option, it moves back and forth in a very minimal arc.

  • MRI

This is required in very few cases. MRI is used to rule out the possibility of “acoustic neuroma”, a non-cancerous brain tumor or any other abnormality causing 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.

What really happens inside you (on biological level) during 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.

About
Sudden and extreme dizziness attack
8 Myths about Vertigo
Cervicogenic vertigo
Remedies
Best Natural Remedies
Essential Oils to treat Vertigo
Vertigo Diet
Minimize Vertigo Effect
Vertigo Medications
Exercises
Best Exercises for Vertigo
Epley Maneuver
Half-somersault Maneuver