What Is Vertigo? What Causes Vertigo?

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Main Category: Ear, Nose and Throat
Also Included In: Neurology / Neuroscience
Article Date: 18 Aug 2009 - 0:00 PDT

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Vertigo is a sensation that everything around you is spinning or moving, which is usually caused by a problem in the inner ear, but can also be caused by vision problems. People with vertigo commonly feel things are moving when they are standing completely still and everything around them is still.

Vertigo is medically different from dizziness, lightheadedness, and unsteadiness. Lay people commonly use the terms dizziness and vertigo indistinctly. If this happens, it is important for a doctor to determine exactly what the patient is trying to describe.

Doctors say that vertigo is more severe than dizziness, which commonly happens when a person stands up and feels light-headed. People with vertigo may find it harder to move around because the spinning sensation tends to affect balance.

"Vertigo" is often used, incorrectly, to describe the fear of heights, but the correct term for this is acrophobia. The medical term vertigo can occur at any time and may last for days, weeks, months, and even years, while acrophobia symptoms only occur only when the person is high up and looking down. However, vertigo is so commonly used 'incorrectly' by lay people that it would be naive today to say it only has one meaning.

What are the symptoms of vertigo?

The patient may feel that his/her surroundings seem to be moving either vertically or horizontally. There may also be a sensation of spinning. Sometimes the feeling may be so slight that it is hardly noticeable. However, for some people the severity of symptoms makes it hard to keep balance and carry out everyday tasks.

A bout of vertigo can last from a few minutes to several days, and sometimes much longer. The following symptoms are possible:

• A sensation that everything around you is moving or spinning
• Loss of balance
• Nausea
• Vomiting
• Light-headedness
• Problems walking properly
• Problems standing still properly
• Blurred vision
• Earache

What are the causes of vertigo?

The vertigo can be caused by a problem with the balance mechanisms of the inner ear, a problem with the brain, or a problem with the nerves that connect the brain to the middle ear.

Labyrinthitis

Inflammation of the labyrinth, a system of canals and cavities within the inner ear which gives us our sense of balance. The sudden onset of a feeling of vertigo caused by labirynthitis is triggered by head or body movement, and is usually accompanied by a feeling of nausea and malaise.

Labyrinthitis may be caused by a viral or bacterial infection. Viral infections, such as a common cold or flu can spread to the labyrinth - labyrinthitis. Bacterial infections are less common.

The patient may also have a painful ear and fever.

Vestibular neuritis

The vestibule is in the inner ear. It is like an internal carpenter's level. The vestibule and the semicircular canals work with the brain to control balance. Vestibular neuritis is inflammation of the vestibular nerve - the nerve running to the vestibule. Vestibular neuritis often follows an upper respiratory infection. Patients will experience vertigo, but will not usually have ringing in the ear (tinnitus) or hearing problems.

Benign paroxysmal positional vertigo (BPPV)

The vestibular labyrinth, inside the ear, includes semicircular canals (loop-shaped structures) that contain fluid and tiny hair-like sensors that monitor the rotation of the head. The otolith organs, also in the ear, monitor movements of the head and its position. There are crystals in the otolith organs that make us sensitive to movement. Sometimes, when the patient is lying down, these crystals can become dislodged and move into one of the semicircular canals, making it sensitive to head position changes - something it would not normally do. This unusual response to head movements by the semicircular canal can give patients vertigo symptoms.

BBPV most commonly occurs in elderly patients. A blow to the head can cause BBPV; even a minor blow. BBPV can also be caused by disorders that damage the inner ear, infection, ear surgery damage, or if the patient has been lying on his/her back for too long.

Most BBPV attacks clear up within a few days. The condition generally goes away within a few weeks or months, but can sometimes recur.

Meniere's disease

Dysfunction of the semi-circular canals (endolymphatic sac) in the inner ear. Patients experience recurrent vertigo, as well as tinnitus and loss of hearing in the affected ear, abnormal eye movements, nausea, and vomiting. People with Meniere's disease usually find that the tinnitus gets worse over time. Hearing loss may start off as intermittent, but gradually progresses until it becomes permanent.

Head injury

Some patients can develop vertigo after a head injury. If you have had a head injury and subsequently experience vertigo or dizziness you should tell your doctor straight away.

Migraine

Usually characterized by periodic headaches and some vision problems, such as seeing stars (as if someone had quickly flashed a strong light in your eyes). Some migraine patients also experience dizziness and vertigo. In fact, for some migraine patients, vertigo can eventually become the only symptom. Some studies have shown that migraine patients who experience vertigo during their attacks tend to show a higher lifetime prevalence of migraine.

Chronic otitis media

Long-term infection of the inner ear, or infection of the inner ear that recurs over a long period. Some patients with chronic otitis media have episodes of vertigo.

Acoustic neuroma

A benign (non-cancerous) tumor that develops on the acoustic nerve of the inner ear; this nerve is involved in helping us balance. Patients who do experience vertigo usually have mild symptoms.

Dehydration

Dehydration may lead to feelings of lightheadedness, dizziness, and/or vertigo, especially when changing positions. This symptom is due to a drop in blood pressure.

Some medications

Salicylates, quinine, and aminoglycosides may sometimes cause vertigo.

Boat, airplane, car travel (motion sickness)

Some people experience vertigo during and/or after a plane, boat, or even a car trip. This may last from a few minutes, hours to a couple of days.

Earthquakes

Some people who have been in a strong earthquake can suddenly feel that the firm ground around them moves long after the earthquake is over. This sudden sensation can occur on-and-off over a number of days, and sometimes weeks.

I was in the devastating Mexico City earthquake of 1985 (Richter 8.2). For a couple of weeks I would occasionally feel that the firm ground was wobbling - the sensation would last a couple of seconds and slightly affected my balance. I know a number of people who had to sit down when this happened to them.

How is vertigo diagnosed?

Symptoms related to dizziness are commonly found in many conditions and illnesses. It is important for the doctor to eliminate them in order to be able to diagnose accurately. A diagnosis of vertigo will require careful interpretation of the answers to the following questions:

• A detailed description of symptoms
• How regularly symptoms occur
• The duration of symptoms each time they occur

Dix-Hallpike's maneuver

This maneuver triggers vertigo and nystagmus (rapid rhythmic repetitious involuntary eye movements) symptoms and is effective for diagnosing BPPV (benign paroxysmal position vertigo). The patient is asked to:


• Sit upright.
• Quickly move to a supine position (lie down facing upwards), the head must be below the horizontal line of the body - so it is usually hanging over the examining table.
• Head is turned to right or left. When the head is turned towards the affected ear vertigo is elicited.

Patients with BPPV will experience vertigo symptoms for several seconds.

Standing still with eyes closed

If the patient's balance is affected there is a strong likelihood that there is a middle ear problem.

If the patient also has tinnitus the GP (general practitioner, primary care physician) may refer him/her to an ENT (ear, nose and throat) specialist, also known as an otolaryngologist. The ENT specialist may order an ear X-ray, hearing tests, and further balance tests. Imaging scans, such as MRI or CT scans may also be ordered if the doctor needs to check for any kind of tumor.

Electronystagmography (ENG) or videonystagmography (VNG)

The aim here is to detect any abnormal eye movement. An ENG is done with electrodes, while a VNG uses small cameras. Both tests can check for eye movements, which determine whether the dizziness is due to inner ear disease. The patient's head is placed in different positions while the balance organs are stimulated with water or air.

What are the treatment options for vertigo?

Treatment options depend on several factors, including the cause of the vertigo, severity, and the patient's age and general state of health.

Treatment for Labyrinthitis

In most cases, labyrinthitis resolves itself without any treatment. If it is caused by a bacterial infection the doctor may prescribe antibiotics.

If symptoms are severe and the patient has suffered hearing loss from one ear the doctor may perform a labyrinthectomy - surgical removal of the vestibular labyrinth. After the operation the other ear will take over the patient's hearing and balance. A labyrinthectomy results in total hearing loss of the affected ear; therefore it is only performed if that ear has already suffered serious hearing loss.

Treatment for Benign paroxysmal positional vertigo (BPPV)

Canalith repositioning procedure - the doctor, audiologist or physical therapist may treat the patient with a series of movements. These consist of several simple and slow maneuvers for positioning the patient's head. The aim is to move particles from the fluid in the semicircular canals of the inner ear into a vestibule (small bag like open area) where the otolith organs are - if the particles can be moved there they won't cause any problems and are more easily absorbed.

Each head position is held for about 30 seconds after vertigo symptoms or abnormal eye movements stop. The patient must avoid lying flat or placing the affected ear below shoulder level for a specified period after treatment - usually about a week, but this may vary. This will mean propping the head up with some pillows while sleeping so that it is higher than the rest of the body.

Some patients will be taught how to do the procedure themselves so that they can do them at home.

If the canalith repositioning procedure does not work there is the option of surgery. A bone plug is used to block the portion of the inner ear that causes the dizziness.

Treatment for Meniere's disease

There is no cure for Meniere's Disease; however there is treatment for the symptoms.

Motion sickness medications, such as meclizine (Antivert) or diazepam (Valium) may reduce the spinning sensation of vertigo and help control nausea and vomiting.

Anti-nausea medications, such as prochlorperazine, may ease nausea and vomiting during an episode of vertigo.

Diuretic medication, such as the drug combination triamterene and hydrochlorothiazide (Dyazide, Maxzide) may reduce fluid retention which lowers pressure in the inner ear, resulting in fewer episodes and less severe symptoms of Meniere's disease. Patients on long-term diuretics should supplement their diets with extra potassium-rich foods, such as oranges, bananas, spinach, cantaloupes, and sweet potatoes.

Dietary changes can help reduce fluid retention. Eating regularly throughout the day helps regulate body fluids; several small meals are better than a few large ones. Limiting salt consumption helps reduce fluid retention, as well as avoiding foods with MSG (monosodium glutamate).

As a last resort, surgery can help reduce the severity of vertigo attacks caused by Meniere's disease. Some of the bones surrounding the inner ear are removed, which reduces swelling in the labyrinth - this procedure is called endolymphatic sac decompression.

How to prevent attacks of vertigo

Betahistine

Betahistine hydrochloride is the generic name for the anti vertigo drug SERC. It helps raise blood flow around the inner ear. It is said to reduce the number and severity of vertigo attacks if the patient takes it long-term.

Physical therapy (physiotherapy)

With a well trained physical therapist (physiotherapist) a patient can learn useful techniques, such as using alternative signals from the eyes, ankles, legs and neck to maintain balance. There are also various exercise techniques which help improve balance.

The following measures may help prevent bouts of vertigo, as well as reducing their severity:

• Sleep with your head slightly higher than the rest of your body. Slightly prop up your head and shoulders with a couple of extra pillows.


• If you have to pick something up from the floor or a surface far below your head, try to avoid bending down - the aim being to prevent your head from being lower or much lower than your shoulders. If you have good legs, try bending your legs to lower yourself rather than bending over.


• When reaching up for something, try not to extend your neck.


• If your neck is extended, or when you are lying down flat, more your head slowly.


• If you feel an episode of vertigo coming on sit down immediately. Avoid triggers that can make symptoms worse, such as bright lights, reading, sudden movements or watching TV.


• After an attack is over do not rush to return to normal activities; take your time.


• Stop smoking - people who suffer from episodes of vertigo usually experience fewer episodes and less severe symptoms if they give up smoking.


• If your vertigo is due to motion sickness, such as a rocking boat, and you feel symptoms coming on, fix your eyes on an unmoving object in the distance.


• A walking stick will not prevent symptoms, but can help with balance and prevent falls and injuries.

Written by Christian Nordqvist


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