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The sensation of moving, tilting, or spinning surroundings or the feeling that you are in motion or falling despite being still is known as vertigo.
Vertigo often has a sudden onset and its duration can vary anywhere between a few seconds and several minutes. However, severe vertigo may last for much longer and impede your ability to perform daily activities.
True vertigo is accompanied by a feeling of spinning and differs from lightheadedness or nonspecific dizziness.
What Goes Wrong?
The vestibular system, composed of the semicircular canals in the inner ear, vestibular nerve, brainstem, and cerebellum, plays a crucial role in maintaining the posture and balance of the body. Therefore, any problem in these parts can cause imbalance.
Dizziness or the feeling of movement can also result from the generation of contradictory signals from the ears, skin, muscles, and eyes or a misinterpretation of these signals by the brain.
How Common Is Vertigo?
The following statistics and data point to the prevalence of vertigo:
- A 2016 study showed that dizziness (including vertigo) affects about 15% to over 20% of adults every year. (1) BPPV accounts for nearly 30% of all the vertigo cases in adults, making it the most common form of this disorder.
- In the estimates released by Brandt and Daroff (1980) and Toupet (1982), almost 60% of all patients with vertigo are female, which means women are more susceptible to this condition than their male counterparts.
- Vertigo is mostly observed in older populations that are nearing the retirement age, but a few people under the age of 20 years have also been diagnosed with this condition.
Types of Vertigo
Vertigo is classified into the following two types:
1. Peripheral vertigo
It results from problems in the inner ear or vestibular nerve, with benign paroxysmal positional vertigo (BPPV) being the most common form. BPPV occurs due to problems in the heavy calcium particles (otoliths) present in the vestibular labyrinth.
2. Central vertigo
This form of vertigo generally occurs after head trauma, brain injury, or disease. It usually happens due to a compromised or restricted blood supply (ischemia) to these structures, especially in older adults with vascular problems.
The incidence of different forms of vertigo depends on the affected individual’s age, health problems, and medications taken. Many central pathologies only cause ataxia (clumsiness) or disequilibrium rather than true vertigo. (2)
Causes of Vertigo
The causes of central and peripheral vertigo vary since they affect different areas of the balance system.
Peripheral vertigo may be due to the following reasons.
- Labyrinthitis: An infection in the inner ear may involve the semicircular canals.
- Vestibular neuritis: The vestibular nerve may be inflamed due to a viral infection, leading to severe vertigo, nausea, vomiting, and instability in walking (gait instability).
- Ear injury: An injury to the eardrum or small bones in the middle ear may cause a hole or fistula between the middle ear and inner ear.
- Medications: Certain medicines, including cisplatin, salicylates, diuretics, and aminoglycoside antibiotics, may be harmful to the inner ear.
- Anxiety and stress: Stress and/or anxiety may not induce vertigo, but they can aggravate the problem. Depression and vertigo may also be connected.
- Meniere’s disease: This rare condition of the inner ear can lead to vertigo, tinnitus, hearing loss, and aural fullness (pressure in the ear).
- Abnormal growth: A tumor such as a vestibular schwannoma (acoustic neuroma) or an abnormal blood vessel can put pressure on the vestibular nerve.
- Trauma: Head or neck trauma, skull fractures, or damage to the peripheral vestibular system often leads to vestibular complaints. (2)
The following factors may contribute to central vertigo.
- Stroke: Hemorrhagic or ischemic infarcts in the brain (stroke), especially those affecting the vertebrobasilar system or the cerebellum, may lead to vertigo.
- Multiple sclerosis (MS): This leads to the formation of demyelinating plaques in the vestibular pathways, which impede efficient signal transmission by the nerve cells.
- Disorders: Atrial fibrillation, narrowing/obstruction of the carotid artery, diabetes, sleep apnea, and many other medical problems that affect the blood vessels or blood flow to the brain increase the risk of central vertigo.
- Migraine: One of the common causes of central vertigo is a vestibular migraine that results in one-sided headaches, vomiting, phonophobia, nausea, and photophobia.
- Medications: The use of aspirin, nonsteroidal anti-inflammatory medications, anticonvulsants, intravenous aminoglycoside antibiotics, certain chemotherapy medications, and many others can cause damage to hearing and balance.
- Alcohol: Excessive consumption of alcohol may also contribute to vertigo.
- Tumor: Both malignant and benign brain tumors can cause central vertigo.
- Blood pressure: A very high or very low blood pressure may lead to vertigo.
- Psychological disorders: Anxiety, stress, somatization, and mood can also lead to vertigo.
- Head injury: The most common reason for central vertigo is an injury to the brain.
Symptoms of Vertigo
Vertigo is, in itself, a symptom of many medical problems and medications. Vertigo is chiefly recognized by the misapprehension of movement and body imbalance. It may also be accompanied by the following symptoms:
- Nausea and vomiting
- Tinnitus, or ringing sound in the ear
- Slurred speech
- Nystagmus, or involuntary movement of the eye
- Disturbed or blurred vision
- Difficulty walking
- Dizziness, lightheadedness, and fatigue
- Fullness in the ear
- Temporary hearing loss
- Weakness, feeling faint, and numbness
- Sweating or diaphoresis
- A feeling of being pulled toward one side
- A sensation of internal or external spinning
Clinical Treatment for Vertigo
Vertigo treatment chiefly focuses on making an accurate diagnosis and alleviating the symptoms.
The following methods may be used for treatment:
1. Balance therapy
The exercises included under this method aid recovery from inner ear or CNS problems by helping the brain recover normal balance functions.
2. Vestibular rehabilitation therapy (VRT)
This treatment is a special form of balance therapy that involves head movements and other exercises that stimulate the brain and aid in gait (body movement) and visual stabilization.
3. Canalith repositioning
This procedure is helpful for the treatment of BPPV. It is done to relocate the otoliths from the semicircular canal to the vestibule in the inner ear, where they remain until they spontaneously dissolve.
Multiple over-the-counter medicines are available for alleviating mild vertigo or associated nausea and vomiting. However, these medications should be taken for limited periods as long-term use may delay the readjustment and adaptation in the central balance pathways after an episode of vertigo.
Some cases may require surgical procedures, such as microvascular decompression, semicircular canal procedures, singular neurectomy, endolymphatic shunt, repair of inner ear fistula, and permanent destruction of the semicircular canals.
The symptoms and a detailed medical history will help the doctor with the diagnosis. He/she may inquire about personal or family history of migraines and also assess the possibility of cerebrovascular, cardiac, and neurologic diseases.
For confirmation, you may need to undergo tests such as:
- MRI and CT scan
- Blood tests
- Video nystagmography (VNG) to evaluate the brain control of eye position and movement
- Balance tests/posturography
- Vision tests
- Electroencephalogram (EEG)
- Audiological (ear function) tests
- Rotary chair tests
- Head maneuvers such as Dix-Hallpike maneuver
- Brainstem auditory evoked potential studies to evaluate nerve conduction
- Otoacoustic emission tests
Risk Factors for Vertigo
The chances of developing vertigo increase with the following factors:
- Head injury
- Thyroid disease
- Irregular/slow heart rhythm
- Older age (above 50 years)
Complications Associated With Vertigo
The sudden onset of vertigo episodes may affect your lifestyle, especially your day-to-day activities such as school, work, and travel. The unexpected sensation of movement can throw you off balance, making you fall. Vertigo may also lead to injuries, fractures (of the hip), and accidents.
When to See a Doctor
If vertigo is severe, persists for more than a few days, interferes with your daily activities, or is associated with other worrisome symptoms, it is recommended to seek medical help.
You are more likely to get quick relief if you consult an otolaryngologist or neurologist, who are medical specialists in problems of balance.
Get urgent medical care if you experience any of the following symptoms:
- Severe headache
- Shivering and chills
- Sickness and vomiting
- Difficulty walking
- Imbalance and loss of coordination
- High body temperature
- Blurry vision
- Slurred speech
- Recent history of head trauma, especially if there has been bleeding from the ear
Many cases of true vertigo resolve with no treatment. However, if vertigo is severe, lasts for more than a few days, disrupts your activities, or is associated with other worrisome symptoms, it is recommended to seek medical help.