Look up the word vertigo in the dictionary and you will find confirmation of the widespread understanding that it is the slightly dizzy feeling we get at great heights - perhaps when looking down from the top of a tall building.
This feeling of giddiness is normal though, and does not constitute the medical definition of vertigo. In medical terms, vertigo is a sensation of spinning (a kind of dizziness) in the absence of associated movement, caused by underlying pathology in the ear, brain, or sensory nerve pathways.
In this article we will take you through the causes of vertigo, the symptoms that often accompany it and how vertigo is diagnosed. We will also discuss the available treatments for people suffering with the condition.
Contents of this article:
You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.
Fast facts on vertigo
Here are some key points about vertigo. More detail and supporting information is in the main article.
- Vertigo is a sensation of spinning - a specific kind of dizziness.1,2
- The dizziness that defines vertigo has one of two causes - disturbance in either the balance organs of the inner ear, or parts of the brain or sensory nerve pathways.
- Peripheral vertigo collectively refers to vertigo caused by inner ear problems.
- Central vertigo collectively refers to vertigo caused by dysfunction in the central nervous system.
- Vertigo is a symptom rather than a medical condition.
- Other symptoms that can accompany vertigo include: hearing loss, tinnitus, nausea, vomiting or a feeling of fullness in the ear.1
- Physical examination might include looking into the ear, using a maneuver test or undergoing an MRI or CT scan.
- Doctors will explore medication use, family history of migraines or Ménière's disease and recent ear infection or head injuries.
- Some types of vertigo can disappear without treatment.
- Other treatment options may include the Epley maneuver or symptomatic drug treatment.
What is vertigo?
In medical terms, vertigo is a specific kind of dizziness - a sense that you, or your environment, is moving or spinning, even though there is no movement.1,2
In the medical sense, vertigo does not mean a fear of heights. Instead, acrophobia is the diagnostic term used to refer to a fear of heights that is excessive and inappropriate to a situation. With acrophobia, a person overestimates danger, becomes distressed and avoids heights altogether.3
Vertigo, then, is a specific symptom unrelated to heights that has various medical causes.
Specialist doctors in dizziness clinics have narrowed down the definition of vertigo, differentiating it from other types of dizziness and classifying it by its causes and its particular type of moving sensation - that you or your environment is moving or spinning.4
Vertigo is thereby set apart from presyncope, which is a sense of almost fainting (typically a result of temporarily lowered blood pressure). Disequilibrium is also something separate, seen in older people - an unsteadiness due to poor balance and strength.4,5
Light-headedness, often associated with anxiety, is different too, sometimes called psychogenic vertigo.4,5
What causes vertigo?
The rotational dizziness that defines vertigo is brought on by one of two causes - disturbance in either:2,4
- The balance organs of the inner ear, or
- Parts of the brain or sensory nerve pathways.
Vertigo is a special kind of dizziness that feels like spinning.
Peripheral vertigo is a term that collects together the inner ear causes.
The labyrinth of the inner ear has tiny organs that enable messages to be sent to the brain in response to gravity. By telling our brains when there is movement from the vertical position, we are able to keep our balance, to maintain equilibrium.6
Disturbance to this system therefore produces vertigo and can be created by inflammation among other causes. Viral infection is behind the inflammation seen in the following two conditions:2
- Labyrinthitis - this is inflammation of the inner ear labyrinth and vestibular nerve (the nerve responsible for encoding the body's motion and position7)
- Vestibular neuronitis - this is thought to be due to inflammation of the vestibular nerve.
Ménière's disease can also be caused by inflammation, but this can be due to bacterial as well as viral infection.2,8
This form of vertigo is thought to be caused by high pressure of a fluid in a compartment of the inner ear (a swelling that is also known as endolymphatic hydrops).
As well as infection, Ménière's disease can result from metabolic and immune disorders.
Most vertigo is a disturbance of the inner ear's role in balance perception.
Benign paroxysmal positional vertigo (BPPV) is thought to be caused by a disturbance in the otolith particles.2
These are the crystals of calcium carbonate within inner ear fluid that pull on sensory hair cells during movement and so stimulate the vestibular nerve to send positional information to the brain.6
In people with BPPV, normal movement of the endolymph fluid continues after head movement has stopped.9
Benign paroxysmal positional vertigo is twice as common in women than men, usually affects older people and most often arises without a known cause (idiopathic). While most cases are spontaneous, BPPV vertigo can also follow:2,9
- A head injury
- Reduced blood flow in a certain area of the brain (vertebrobasilar ischemia)
- An episode of labyrinthitis
- Ear surgery
- Prolonged bed rest.
Beyond peripheral vertigo brought on by benign paroxysmal positional vertigo, labyrinthitis, vestibular neuronitis or Ménière's disease, inner ear disturbance can also be caused by drug toxicity and syphilis.2
Rare causes are:10 perilymphatic fistula (tear in one or both of the membranes separating the middle and inner ear11), cholesteatoma erosion (skin growth behind the eardrum12), Herpes zoster oticus (a viral infection of the ear, also known as Ramsay Hunt syndrome13), otosclerosis (a genetic ear bone problem that causes deafness14).
Central vertigo is a term that collects together the central nervous system causes - involving a disturbance to one of the following two areas:2
- The parts of the brain (brainstem and cerebellum) that deal with interaction between the senses of vision and balance, or
- Sensory messages to and from the thalamus (part of the brain).
Migraine headache is the most common cause of central vertigo. An estimated 40% of patients with migraine have some accompanying vertigo (involving disrupted balance and/or dizziness) at one time or another.28
Recent developments on vertigo causes from MNT news
Scientists in Korea found that people with osteoporosis, a disease that lowers bone density and increases risk of fracture, are also more likely to have vertigo, a dizziness disorder caused by problems in the inner ear.
A new study presented at the 2007 AAO-HNSF Annual Meeting & OTO EXPO reveals that contrary to previous hypotheses, no single entity is the root cause of dizziness in the elderly.
On the next page, we look at the symptoms of vertigo and how it is diagnosed. On the final page we discuss the available treatments for vertigo.