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.
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.
Dizziness is a very vague term that can be used to describe a wide variety of conditions such as
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.
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.
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.
The common disorders that may affect the inner ear thereby causing the person to experience dizziness or vertigo include:
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.
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 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.
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.
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.
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.
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:
The symptoms of central vertigo may include the following listed below and immediate medical attention is needed to rule out stroke or cardiac problems.
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.
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.
[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.
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.
When your dizziness results from anxiety disorders the usual vertigo treatment recommended are medications and psychotherapy, alone or in combination.
These medications helps relieve the inflammation in the inner ear, relaxes the muscles and prevent other symptoms associated with vertigo like nausea and vomiting.
Recurrent vertigo attacks resulting from Meniere’s disease can be treated by injecting medications like Gentamicin or Dexamethasone to the middle ear.
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.
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:
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:
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:
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.
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.
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.
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.
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.
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.