Vertigo

Symptoms Of Vertigo 

Vertigo is not a disease but a symptom of an underlying condition. Symptoms can range from mild to severe, and vary from person to person depending on the cause of vertigo. Vertigo can also lead to or occur alongside other symptoms:

• When a person feels he/she is spinning or the world around him/her is spinning

• A feeling of abnormal balance or a loss of balance

• A sensation of dizziness or swaying

• Giddiness or feeling faint

• Increased sweating

• A sensation of nausea that may or may not be accompanied by vomiting

• Headaches

• A feeling of fullness in the ear

• Ringing in the ears or pain in the ears, or loss of hearing

• Abnormal or jerky eye movements called nystagmus

Causes Of Vertigo

The ear is the organ responsible for maintaining vestibular equilibrium in the body. The innermost part of the ear, called the inner ear, has 3 loop-shaped structures called ‘semicircular canals’ which are responsible for the orientation of the body with respect to movements of the head. Any issue that causes a disturbance in these semicircular canals can lead to vertigo. This type of vertigo which is associated with the inner ear or the vestibular nerve, which connects the inner ear and the brain is called peripheral vertigo.This is the most common type of vertigo.

Neurological problems such as brain tumors, stroke, cervical spondylosis, multiple sclerosis, etc., cause central vertigo. 

The various causes of vertigo are discussed as follows:

1. Benign paroxysmal positional vertigo (BPPV)

• Benign: not dangerous to health

• Paroxysmal: presents as a sudden, brief episode

• Positional: set off by particular head or bodily movements

• Vertigo: an internal sense of irregular or spinning movement either of oneself or of the surroundings

BPPV is the most common cause of vertigo. It is a harmless condition that presents as mild to intense dizziness lasting for a few seconds or minutes. It is often associated with a sudden change in the position of the head or body, like bending over, turning in bed, or sitting up. BPPV usually resolves on its own and is not serious.

The inner ear is a system of canals filled with fluid that lets the brain know about movements of the head. In BPPV, small calcium crystals in the inner ear move out of place. Hence, the system is not able to send the correct signals to the brain.

BPPV can happen because of a head injury or aging as well. The natural breakdown of cells that happens with age or during injury is thought to be responsible for this.

2. Meniere’s disease

This is a rare condition that causes severe vertigo, nausea, ringing in the ears, muffled or distorted hearing, hearing loss, and feeling of a plugged ear. This condition is characterized by excess fluid buildup in the inner ear. Meniere’s attacks usually happen suddenly and can last from 20 minutes to 24 hours. Patients also feel worn out after the attack passes.

3. Ear infections

Viral and less commonly bacterial infections can cause inflammation of the nerves in the ears. The vestibulocochlear nerve, a nerve in the inner ear, has two branches:

• The vestibular nerve sends signals to the brain about balance. Its inflammation leads to vestibular neuritis.

• The cochlear nerve sends signals about hearing. Its inflammation causes labyrinthitis.

This inflammation hinders the messages the nerves of the ear take to the brain. Hence, the symptoms of vertigo are experienced.

Rarely, another viral infection caused by the varicella-zoster virus can lead to Herpes zoster oticus, a type of shingles. It is an infection of the inner, middle, and external ear caused by the spread of the virus to the facial nerves. This leads to various symptoms of vertigo. In case it paralyzes the muscles of the face, it is known as Ramsay Hunt syndrome.

4. Acoustic neuroma (vestibular schwannoma): 

It is a benign tumor that develops on the vestibular or cochlear nerves leading from the inner ear to the brain. The pressure on the nerve from the tumor may cause vertigo.

5. Vestibular migraine

Migraines are often characterized by painful headaches, however vestibular migraine may or may not involve headaches along with vestibular symptoms such as vertigo and imbalance. People with vestibular migraine do report common migraine symptoms, such as sensitivity to light, sensitivity to sound etc.

6. Cholesteatoma

Repeated ear infections, skull or facial bone birth abnormalities or an injury to the eardrum can result in a noncancerous skin growth in the middle ear. This growth is called a cholesteatoma, and as it grows behind the eardrum, it can damage the bony structures of the middle ear. This can lead to the symptoms of vertigo.

7. Perilymphatic fistula

The middle ear is filled with air whereas the inner ear is filled with fluid called perilymph. Usually, thin membranes separate the inner and middle ear. A tear in these membranes is called a perilymph fistula (PLF) which causes perilymphatic fluid from the inner ear to flow into the middle ear thereby affecting balance and hearing.

8. Central nervous system (CNS) disorders

Neurological conditions such as brain tumors, stroke, transient ischemic attack, cervical spondylosis, seizures, ataxia, peripheral neuropathy, parkinson’s disease and multiple sclerosis etc., can also cause vertigo.

9.Trauma

Concussion and head trauma or any trauma during ear surgery can also cause vertigo.

10. Syphilis

Late neurosyphilis may affect the ear leading to hearing loss, fluctuating hearing, or vertigo.

Risk Factors For Vertigo

Vertigo can happen to anyone at any point of time in their life. It may occur as a one-time brief episode, or it may be long-lasting with intermittent periods of symptoms. Certain factors can increase the chances of developing vertigo, such as -

1. 1. Head and neck injuries 

   2. Old age

   3. Gender (Females are more prone than males) 

   4. A medical history of past episodes of dizziness

   5. Having a family member who has vertigo

   6. Certain medications, such as antidepressants, antipsychotics and antihypertensives

   7. Vitamin D deficiency

Diagnosis Of Vertigo

If you have symptoms of vertigo, you must visit your doctor who will perform a detailed physical examination, note down the history of symptoms, and may order certain diagnostic tests which are essential to determine the cause. 

History: Before confirming the patient is having vertigo, it is essential to rule out the conditions that may mimic the symptoms of vertigo or any brain disorders. A physician performs a detailed overview checkup, reviewing the patient’s history, and can ask the following questions:

• The characteristics of the dizziness the person is experiencing. Does dizziness leads to imbalance and light-headedness. 

• For how long the dizziness lasts.

• The frequency of vertigo attacks in a day. 

• The symptoms faced by a person right before a vertigo attack. 

Balance Tests

Vestibular system which is located in the inner ear along with the central nervous system is responsible for maintaining body balance. The following tests can be done to evaluate the functioning of these systems:

Fukuda-Unterberger’s test

The doctor asks the patient to march on a spot for 30 seconds with their eyes closed. If they rotate or lean to one side, it could indicate a problem in the inner ear, which could cause peripheral vertigo.

Romberg’s test

The doctor asks the patient to stand with their feet together, arms by their sides and then to shut their eyes. If the patient becomes unbalanced, it could point toward a problem with the central nervous system.

Rotary chair test

This test records eye movements while the patient is sitting on a rotational computerized chair. The test evaluates the vestibular system which regulates balance, posture and the body's orientation in space. 

Computerized dynamic posturography (CDP)

This test is also called test of balance (TOB). It evaluates the ability to remain standing in either stationary or moving conditions.

Vestibular evoked myogenic potentials (VEMP) test

This test assesses vestibular function by measuring the reaction of muscles to a repetitive sound stimulus.

Video head impulse test(vHIT)

The doctor will gently move the patient’s head to each side. Eye movements are recorded while the patient focuses on a stationary object like a spot on the wall. 

Vestibular test battery

A vestibular test battery includes several tests that will assess if vertigo is due to problems in the inner ear or due to some neurological cause. This helps in making an appropriate treatment plan.

Electronystagmography (ENG) and videonystagmography (VNG) tests
These tests record and measure the eye movements. In ENG, electrodes or small sensors are placed over the skin around the eyes. In VNG, special goggles are placed on the eyes. Patient is asked to look at and follow patterns of light on a screen. Patient is asked to move into different positions while watching the light pattern. Then warm and cool water or air will be put in each ear. This should cause the eyes to move in specific ways. If the eyes don't respond, it indicates damage to the nerves of the inner ear.

Imaging tests

Radio imaging tests may be performed to determine the cause of vertigo. The following tests can help determine whether the cause is inner ear disturbances or other head and neck conditions like cervical spondylosis, brain tumor, etc.

• CT Scan (Head)

• CT Neck

• MRI Brain

• MRI Cervical Spine

Other specific tests

Audiometry

It helps in the diagnosis of Ménière's disease, a rare disorder of the inner ear that causes episodes of vertigo.

Brainstem auditory evoked potentials (BAEPs)

This test evaluates the function of the auditory nerve and auditory pathways in the brainstem, which could cause vertigo.

Prevention Of Vertigo

By avoiding certain activities, it is possible to prevent spells of vertigo.

1. Do not suddenly move your head from one position to another.

2. Do not insert sharp objects or foreign matter deep into your ears for cleaning purposes. It may damage the inner ear.

3. Do not engage in activities that involve swift, fast movements, such as joy rides.

4. Always cover your ears while deep diving or swimming for a prolonged period as prolonged exposure to water may irritate the inner ear.

5. Take care of your cervical spine by following the prescribed treatment if you have cervical spondylosis.

6. Certain medications may precipitate spells of vertigo. In such cases, consult your doctor to make the necessary adjustments.

Specialist To Visit

• ENT specialist
• Neurologist

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Treatment Of Vertigo

Often, episodes of vertigo are mild and resolve on their own without requiring treatment. In case the attacks do not go away or are so severe that they interfere with a patient’s day-to-day activities, treatment is needed. The treatment for vertigo depends on the cause and severity of the symptoms.

Antivertigo medications: These are a group of medications that are known to relieve vertigo (dizziness). One of the most commonly used drugs to treat vertigo arising out of Meniere’s disease is betahistine. It improves the blood flow to the inner ear and reduces the pressure of the excess fluid, which causes the symptoms of vertigo. Other examples include cinnarizine.

Antiemetics: This is a class of drugs that help ease the symptoms of nausea and vomiting, frequently associated with Vertigo. Some of the commonly used preparations that are effective against nausea and vomiting associated with vertigo include

• Promethazine

• Ondansteron
  
  

Antibiotics: If the cause for vertigo is a middle or inner ear infection, it must be treated with antibiotics to resolve the infection, and thereby vertigo. Oral antibiotics and antibiotic ear drops help fight bacterial infections of the ear, thereby reducing the inflammation that causes Vertigo.

Vestibular suppressants: These are medications that reduce the intensity of vertigo due to vestibular imbalance. There are three main categories of drugs.  

1. Antihistamine preparations are the most commonly prescribed medicines that help reduce symptoms, such as dizziness and can prevent motion sickness.

2. Anti-anxiety medications like benzodiazepines can also act as vestibular suppressants in low doses and can help reduce the symptoms of an acute vertigo episode. These medicines are not routinely prescribed as their use is restricted to acute severe vertigo episodes or to manage the anxiety associated with vertigo.

3. Anticholinergic drugs like scopolamine help with dizziness and motion sickness.

Living With Vertigo

Vertigo can often impose certain restrictions on an individual's lifestyle. As symptoms of Vertigo are aggravated by sudden rapid movements of the head, a person with vertigo may not be able to enjoy adventure activities like joyrides and may face aggravated motion sickness, which may hinder traveling. Patients with vertigo may also be sensitive to bright lights, loud, and startling noises. Thus, they may not interact well in crowds or noisy places.

Severe forms of vertigo that impair balance may predispose the patient to increased chances of falls and complications arising out of such falls.

Home-care For Vertigo

 A one-off episode of vertigo does not require any special care. However, if the episodes are severe and frequent, the patient needs to take utmost care.

1. Avoid sudden, jerky movements of the head and neck.

2. Sit down or lie down immediately when symptoms occur.

3. Use walking aids, such as a cane or walking stick if you have severe vertigo and have an increased risk of falling.

4. Avoid places with crowds, bright lights, and loud startling noises.

5. Sleep with your head slightly raised on 2 or more pillows. 

6. Get out of bed slowly and sit on the edge of the bed for a while before standing up. Try to relax because anxiety can worsen vertigo.

7. Do not bend over to pick things up. Squat to lower yourself instead.

8. Do not stretch your neck - for example , while reaching up to a high shelf.

Since vertigo can occur repeatedly, here are some effective tips to help you to cope with this disorder. Here’s more about the practical ways to treat vertigo effective.
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Complications Of Vertigo

If vertigo is left untreated, the underlying cause may worsen and lead to several complications, such as: 

1. Increased falls due to loss of balance

2. Loss of hearing

3. Loss of consciousness

Alternative Therapies For Vertigo

Along with medications, alternative therapies are known to improve the symptoms of vertigo.

Canalith repositioning maneuver: These are a specific sequence of movements of the head wherein the doctor places the head in different positions slowly to allow the semicircular canals in the ear to adjust to normalcy. The doctor gently turns the patient's head in predetermined positions which change the position of the inner ear and semicircular canals. These changes in position may dislodge any debris, etc. in the inner ear that may be exerting pressure and causing the symptoms of vertigo.   

Physiotherapy: Vestibular rehabilitation and balance training exercises are a specific set of exercises that can help improve balance, thereby decreasing the chances of falls and reducing dizziness. Vestibular rehabilitation consists of certain head and neck exercises that help a patient to deal with the symptoms and may also treat the underlying cause if it is due to any physical changes such as vertigo, arising from an improper posture of the neck that occurs with cervical spondylosis. 

Balance training includes exercises such as maintaining balance with an increasingly unstable surface such as standing on a wobble board or a disc, standing with eyes closed, ball catch and throw on an unstable surface, walking with side to side head turns, etc.

Homeopathy: Studies with homeopathic preparations have shown that homeopathy is as effective as conventional medications in controlling the symptoms of vertigo. Homeopathic medicines made from Ambra Grisea, Anamirta Cocculus, Conium Maculatum, and Petroleum Rectificatum are found to be effective in treating vertigo.