VERTIGO
Meaning of vertigo (Dizziness), causes, symptoms, types of vertigo and treatment options availableWhat is Vertigo (Dizziness) ?
It is a false sense of motion, spinning or feeling of imbalance
Often the imbalance is associated with nausea, vomiting or unsteadiness on walking. It may worsen
when you move your head. Vertigo should not be mixed up with acrophobia, which is an extreme fear of
heights.
Vertigo and dizziness are common complaints presented by patients to doctors of all specialties, and
they affect all age groups. It is a fact that 20-40% people are affected by dizziness at some point in time
in their life; 15% people have dizziness; 5% have vertigo in any given year; 2.5% of all primary care
visitors report dizziness, and 2-3% of emergency visits in the developed world is for vertigo.
But it must be noted that vertigo is not a disease. It is only a symptom of a disorder. Therefore,
suppressing the symptom is not the solution. Proper diagnosis of what is causing vertigo/dizziness is
possible only when the doctor makes a systematic evaluation. A neuro-otological workup alone will help
to find out if a vertigo patient is suffering from disorders like BPPV, Meniere’s Disease, Vestibular
Neuritis, Labyrinthitis, Acoustic Neuroma, Otolith Dysfunction, Vestibular Migraine, Central
Vestibulopathy or psychogenic disorders.
Different disorders causing vertigo have different presentations and require diverse treatment protocols.
A correct diagnosis will enable the doctor to offer the right treatment, which is the only way to give the
patient lasting benefit.
Meaning of Vertigo
The word vertigo is derived from the Latin phrase verto, which means, “to revolve”. Vertigo is a false sense of motion, spinning or feeling of imbalance. Sufferers often call it dizziness, imbalance, light-headedness or “chakkar aana (vertigo meaning in hindi)”
Symptoms of Vertigo / Dizziness
Patients suffering from persistent or intermittent dizzy spells usually describe their symptoms as below:
- Spinning
- Swaying
- Tilting
- Feeling unsteady or imbalanced
- Falling
- Dizziness
Causes of Vertigo / Dizziness
It is a disorder of the inner ear, which is characterised by episodes of hearing loss and fullness in one
ear, tinnitus and vertigo. Meniere’s disease is caused by increased pressure of the inner ear fluid. If not
treated timely, Meniere’s disease can lead to a progressive hearing loss. Meniere’s disease usually
affects one ear, but it may be bilateral in 15% of cases.
Vestibular Neuritis is caused by a viral infection leading to inflammation of the vestibular nerve. The
inflammation disturbs the balance function and causes dizziness.The dizziness symptom is accompanied
by blurred vision, nausea, vomiting and difficulty in focusing during head movement. Vestibular
Rehabilitation should be started at the earliest to help attain rapid recovery.
Damage to otolith organs (utricle and saccule) cause disequilibrium of the body and affects visual
stability. Until recently, there was no precise method to check the impairment of otolith organs. But now
Otolith disorders can be diagnosed with the Subjective Visual Vertical test and VEMP. Otolith stimulation
through vestibular rehabilitation therapy works well in treating the disorder.
10% of the population is affected by a migraine, most of them are women. The most common
presentation of a migraine is headaches. But in a vestibular migraine, the patient has dizziness which
may be associated with headaches. A severe headache coupled with dizziness indicates a vestibular
migraine. Along with the spinning sensation associated with headaches, motion sickness and
hypersensitivity to light and sound prominently show up in the patient. A vestibular migraine is
controlled with diet and lifestyle modifications. In cases of frequent dizzy spells, migraine prophylaxis is
prescribed.
The unusual movements of carbonate crystals from their chamber into fluid-filled semicircular canals
disturbs the way the balance nerve senses gravity and adjusts its movement. The result is vertigo or the
sensation of spinning. BPPV is a common cause of vertigo. It is seen more frequently in old aged
population after an ear infection, head injury, surgery or after prolonged rest. The canalith repositioning
exercises are the best method to cure dizziness caused by BPPV in which the offending particles are
repositioned according to the type of BPPV by maneuvers like Epley Maneuver, Semont Maneuver etc.
The infection causes labyrinthitis in the labyrinth of the inner ear leading to vertigo, hearing loss and
tinnitus. The difference between labyrinthitis and vestibular neuritis is; in labyrinthitis both vestibular and
cochlear nerves are affected and cause dizziness, ringing in the ear and hearing loss. While in
Vestibular neuritis only vestibular nerve is affected leading to vertigo but the hearing ability is not
affected. Labyrinthitis causes severe dizziness bouts that may last for days! Vestibular suppressants
may be prescribed by the doctors to treat dizziness and its associated symptoms, for a very short
duration of 3 to 5 days. Vestibular rehabilitation should be started at the earliest to ensure rapid recovery
Dizziness, fullness in the ear, vertigo spells are the symptoms of a perilymph fistula. A small tear in the
fluid-filled inner ear causes fluid to leak into the middle ear. This leakage disturbs the equilibrium and
leads to vertigo spells especially when the patient does straining activities or coughs vigorously. This
condition may also lead to tinnitus and hearing loss. Videonystagmography (VNG) and vestibular
examination help diagnose the presence of the perilymph fistula.
The compression of the vestibular nerve due to an inflamed blood vessel, radiation, surgery, or vestibular
neuritis may cause vestibular paroxysmia. Microvascular compression is the most common reason for
vestibular paroxysmia. The patient may have frequent short spells of vertigo episodes recurring
throughout the day. VNG/ ENG and MRI scanning are recommended to diagnose Vestibular
paroxysmia .
A rare condition of SSCD may occur as a result of thinning, or damage to the bony part of the labyrinth. It
affects the patient’s hearing ability too. A natural coughing or sneezing can trigger dizziness in this
condition. These patients have an extreme sensitivity to loud sound. VNG guided Valsalva manoeuvre,
VEMP and CT scan of the temporal bone confirm SSCD. The treatment for SSCD is to avoid actions
which aggravate dizziness. Surgical repair of the bony dehiscence is advocated for lasting results.
The patient experiences a continuous rocking or sense of motion as a result of long travel, either by ship
or aeroplane. Some individuals may develop MdDs even without exposure to long travel.A thorough
vestibular evaluation and studying the history of the patient can diagnose MdDS. Antidepressant
medication is prescribed to treat the swaying sensation. Vestibular rehabilitation treatment is the best
technique to treat MdDS. Virtual reality training is also advised for these patients.
Acoustic neuroma is a noncancerous growth on the balance nerve which causes unsteadiness,
dizziness, facial numbness or tingling sensation, change in taste etc. A tumour grows slowly, and hence
the patient often does not notice the symptoms. However, it may prove life-threatening if a tumour grows
big enough to press on the brain stem. Surgery and radiation are widely used methods to treat acoustic
neuroma.
Multiple sclerosis is an autoimmune disorder which attacks the protective shield of the nerve cells and
hampers the signal transmission to the brain. Loss of focus, visual problem, vertigo spells are some of
the symptoms of multiple sclerosis. Under this condition, the CNS is affected Spinal tap, VNG and MRI
brain are advised in the evaluation to confirm multiple sclerosis