(Dizziness)
Vertigo – Definition
Vertigo is a feeling of spinning or whirling when you are not moving. It can also be an exaggerated feeling of motion when your body is still. Vertigo is different from passing dizziness or light-headedness.
Vertigo – Causes
Inner ear nerves and structures sense the position of your head and body in space. Vertigo is often caused by problems with these nerves and structures.
Vertigo can be due to the following conditions:
Benign Paroxysmal Positional Vertigo (BPPV)
There are tiny particles that naturally exist in the inner ear. Sometimes these particles can be displaced when the head is tilted. The particles then push against hair-like sensors in the ear. This can cause vertigo. BPPV may result from:
- Head injury
- Infections
- Disorders of the inner ear
- Age-related breakdown of the vestibular system
- Idiopathic (no obvious cause)
Labyrinthitis
Labyrinthitis is swelling and irritation of the inner ear. This often follows an upper respiratory infection, like a cold.
Meniere’s Disease
Meniere’s disease is caused by a fluid buildup in a part of the inner ear. This vertigo usually occurs along with hearing loss and tinnitus (ringing in the ear).
Acoustic Neuroma
Acoustic neuroma (acoustic schwannoma) is a slow-growing, noncancerous tumor of a nerve to the ear. The tumor can press on the nerves responsible for hearing and balance. This can lead to hearing loss, tinnitus, and vertigo. This is a common type of tumor in people with a hereditary tumor condition called Neruofibromatosis type 2 (NF2).
Vertebrobasilar Insufficiency
Decreased bloodflow to certain area of the brain may also cause vertigo. Blood flow may be reduced by atherosclerosis (deposits of fat in the arteries) or other causes of narrowing of blood vessels.
It is usually accompanied by other nervous system-related symptoms.
Medications and Other Substances
Vertigo may also be brought on by:
- Medicines, such as aspirin, streptomycin, gentamicin, anticonvulsants, antihypertensives, tranquilizers
- Caffeine
- Alcohol
Vertigo – Risk Factors
Factors that may increase your chance of vertigo include:
- Age
- Family history
- Head injury
- Viral upper respiratory infection
- Cerebrovascular disease — deposits of fat in blood vessels leading to the brain
- Brain stem tumor
Vertigo – Symptoms
Many cases of vertigo occur with nystagmus. This is an abnormal, rhythmic, jerking eye movement. Other symptoms depend on the condition causing the vertigo.
BPPV
Symptoms may come and go for weeks or even years. You may have sudden, short (15-30 seconds), intense bursts of dizziness when you move your head a certain way, roll over in bed, or tip your head back to look up. You may have:
- Feeling like the room is spinning
- Light-headedness
- Imbalance
- Nausea and/or vomiting
- Lingering fatigue
Symptoms do not occur when the head is held still.
Viral Labyrinthitis (Vestibular Neuritis)
Sudden, intense vertigo that lasts for several days to one week. Often occurs with nausea and vomiting.
Meniere’s Disease
Sudden vertigo attacks last between minutes and hours. They typically occur with prominent hearing loss and tinnitus.
Vertebrobasilar Insufficiency
Common symptoms include:
- Vertigo
- Visual disturbances including double vision (diplopia)
- Difficulty speaking
- Disorientation
- Incoordination
- Weakness/numbness
- Dysphagia (difficulty swallowing)
Vertigo – Diagnosis
The doctor will ask about your symptoms, medicine intake, and medical history. A physical exam will be done. In addition, the following tests may be done:
- Vestibular maneuvers (Dix-Hallpike maneuver) — particular movement of the head to relieve or stimulate symptoms
- Auditory (hearing) tests
- Blood pressure test, both lying down and standing up
- Electronystagmogram (ENG) — to check for nystagmus
- Magnetic resonance imaging (MRI) — to look for problems in the brain, such as a stroke or brain tumor
- Rotatory chair test in certain situations (for difficult cases)
- Brainstem auditory evoked potential studies (BAEPS or BAERs) — to check for nerve conduction in the brain auditory nerve and brain stem (severe or persistent cases)
Vertigo – Treatment
Vertigo due to BPPV, labyrinthitis, or vestibular neuritis may go away on its own. They usually go away within six months of onset but some may take longer.
Treatments include:
Medications
Medication that may be used to treat vertigo and nausea include:
- Meclizine (Antivert, Bonine, Dramamine, Meclicot, Medivert)
- Dimenhydrinate (Calm X, Dinate, Dramamine, Dramanate, Hydrate, Triptone)
- Diphenhydramine (Benadryl)
- Promethazine (eg, Anergan, Antinaus, Pentazine)
- Scopolamine (Transderm-Scop)
- Atropine
- Diazepam (Diastat, Diazepam Intensol, Dizac, Valium)
Medication that may be used to treat Meniere’s disease include:
- Diuretics
- Antibiotics injected into the middle ear
Maneuvers
Maneuvers are specific movements to your head to try to realign ear structures. This type of treatment is most often used to treat BPPV. Specific maneuvers include:
- Semont maneuver — The patient is moved rapidly from lying on one side to the other (also called liberatory maneuver).
- Epley maneuver — This maneuver involves head exercises to move the loose particles to a place in the ear where they won’t cause dizziness.
If you continue to experience vertigo, the maneuvers can be repeated, or more difficult maneuvers, such as Brandt-Daroff exercises, can be done.
Physical therapy can also be helpful.
Surgery
Surgery may be considered if symptoms last for a year or more and cannot be controlled by the maneuvers. A surgical procedure called canal plugging may be recommended. Canal plugging completely stops the function of one part of the ear without affecting the functions of the rest of the inner ear. This procedure poses a small risk to hearing.
Other surgical procedures include:
Removing parts of the nerve or inner ear
Gentamycin injections — talk with your doctor to learn more about these injections
Treatment of the Underlying Cause
Vertigo can be a symptom of another medical condition, such as a heart problem or a neurological problem. Once that condition is treated, vertigo should stop, or, in this case, the underlying medical problem should be treated to help relieve the vertigo.
If your vertigo is due to Meniere’s disease your doctor may also recommend a low-salt diet.
Vertigo – Prevention
If you are prone to vertigo, the following precautions may help prevent an episode:
- Rest your head on two or more pillows while sleeping.
- Avoid sleeping on the bad side of your head.
- In the morning, get up slowly. Sit on the edge of the bed for a minute before standing.
- Avoid bending down to pick items up.
- Avoid extending your neck, such as to get something out of a cabinet.
- Be careful at the dentist’s office, hair salon, sports activities, or positions where your head is flat or extended.
