Vertigo

Vertigo is a sensation of spinning dizziness, as though the room or surrounding environment is spinning in circles around the person. Vertigo can happen when a person looks down from a great height, but it usually refers to any temporary or ongoing spells of dizziness that occur due to problems in the inner ear or brain.

It is not an illness but a symptom.

Symptoms A person with vertigo will feel as though their head or the space around them is moving or spinning. Vertigo is a symptom, but it can lead to or occur alongside other symptoms, too. These may include:

• balance problems

• lightheadedness

• a sense of motion sickness

• nausea and vomiting

• ringing in the ear, called tinnitus

• a feeling of fullness in the ear

• headaches

• nystagmus, in which the eyes move uncontrollably, usually from side to side

Causes Various conditions can lead to vertigo, which usually involves either an imbalance in the inner ear or a problem with the central nervous system (CNS). Conditions that can lead to vertigo include the following. Labyrinthitis This disorder can happen when an infection causes inflammation of the inner ear labyrinth. Within this area is the vestibulocochlear nerve. This nerve sends information to the brain about head motion, position, and sound. Apart from dizziness with vertigo, a person with labyrinthitis may experience hearing loss, tinnitus, headaches, ear pain, and vision changes. Learn more about labyrinthitis. Vestibular neuritis An infection causes vestibular neuritis, which is inflammation of the vestibular nerve. It is similar to labyrinthitis, but it does not affect a person’s hearing. Vestibular neuritis causes vertigo that may accompany blurred vision, severe nausea, or a feeling of being off balance. Cholesteatoma This noncancerous skin growth develops in the middle ear, usually due to repeated infection. As it grows behind the eardrum, it can damage the middle ear’s bony structures, leading to hearing loss and dizziness. Ménière’s disease This disease causes a buildup of fluid in the inner ear, which can lead to attacks of vertigo with ringing in the ears and hearing loss. It tends to be more common in people between the ages of 40 and 60 years. The National Institute on Deafness and Other Communication Disorders estimate that 615,000 people in the United States currently have a diagnosis of Ménière’s disease, with doctors diagnosing about 45,500 new cases each year. The exact cause is unclear, but it may stem from blood vessel constriction, a viral infection, or an autoimmune reaction. There may also be a genetic component that means that it runs in some families. Find out more about Ménière’s disease. Benign paroxysmal positional vertigo (BPPV) The inner ear contains structures called the otolith organs, which contain fluid and particles of crystals of calcium carbonate. In BPPV, these crystals become dislodged and fall into the semicircular canals. There, each fallen crystal touches sensory hair cells within the cupula of the semicircular canals during movement. As a result, the brain receives inaccurate information about a person’s position, and spinning dizziness occurs. People typically experience periods of vertigo that last less than 60 seconds, but nausea and other symptoms may also occur. Learn more here about BPPV. Other factors Vertigo can also occur with:

• migraine headaches

• a head injury

• ear surgery

• perilymphatic fistula, when inner ear fluid leaks into the middle ear due to a tear in either of the two membranes between the middle ear and inner ear

• shingles in or around the ear (herpes zoster oticus)

• otosclerosis, when a middle ear bone growth problem leads to hearing loss

• syphilis

• ataxia, which leads to muscle weakness

• a stroke or a transient ischemic attack, which people sometimes refer to as a mini stroke

• cerebellar or brain stem disease

• acoustic neuroma, which is a benign growth that develops on the vestibulocochlear nerve near the inner ear

• multiple sclerosis

Prolonged bed rest and the use of some medications can also lead to vertigo. Vertigo in pregnancy Nausea and dizziness are common problems during pregnancy. Hormonal changes appear to play a role, as they affect the characteristics of the fluid in the body. Changes in fluid characteristics in the inner ear can lead to symptoms such as:

• vertigo

• instability with loss of balance

• tinnitus and hearing difficulties

• a feeling of ear fullness

A 2010 study surveyed 82 women during pregnancy. More than half of them reported experiencing dizziness during the first two trimesters, while one-third reported dizziness in the third trimester. Nausea is common throughout pregnancy, but it tends to reduce as the pregnancy progresses. Many women in the survey linked nausea with dizziness. Balance problems were also common, but these tended to worsen during the second and third trimesters. The authors suggested that during pregnancy, hormonal changes bring about alterations in the inner ear. They proposed that as time goes on, the woman gets used to the new balance in the ear, and the symptoms of nausea and dizziness improve. The worsening of balance problems could be due to the changes in body weight and posture that occur during pregnancy. In 2017, scientists published research involving four case studies. The authors suggested that hormonal changes may lead to BPPV during pregnancy and that estrogen, specifically, may play a role. Drug treatment may be available for reducing nausea, dizziness, and other vertigo-related symptoms during pregnancy, but a woman should ask her doctor for advice. Some treatments may not be suitable to use at this time. Is it hereditary? Vertigo itself is not necessarily hereditary, but it is commonly a symptom of various conditions and syndromes. Some of these appear to involve specific genetic factors and may run in families. If a person has recurrent vertigo, it may have a hereditary or genetic component. Scientists have been looking into the genetic profile of various conditions that involve vertigo. Examples of conditions that can trigger vertigo and appear to involve genetic factors include:

• familial episodic ataxia

• migrainous vertigo

• bilateral vestibular hypofunction

• familial Ménière ‘s disease

A doctor may ask a person with vertigo about their family medical history. Vestibular migraine can involve vertigo. Find out more about this condition here. Treatment Some types of vertigo resolve without treatment, but a person may need treatment for an underlying problem. A doctor may, for example, prescribe antibiotics for a bacterial infection or antiviral drugs for shingles. Medications are available that can relieve some symptoms. These drugs include antihistamines and anti-emetics to reduce motion sickness and nausea. Surgery may be necessary if other treatments are not effective. BPPV and acoustic neuroma are two conditions for which this may be appropriate. Antihistamines are available over the counter or to purchase online. Treating Ménière’s disease A doctor may prescribe drugs for people with Ménière’s disease. These may include meclizine, glycopyrrolate, or lorazepam, which can help relieve dizziness due to this condition. Other options include:

• limiting sodium intake and using diuretic therapy to reduce fluid levels

• trying pressure pulse treatment, which involves fitting a device to the ear

• having a doctor inject antibiotics or corticosteroids into the middle ear

• avoiding caffeine, chocolate, and alcohol and not smoking tobacca Home remedies Individuals can take steps at home to help resolve vertigo and limit its effects. Lifestyle changes Steps that can help reduce the effects of vertigo include:
  

• lying still in a quiet, dark room when the spinning is severe

• sitting down as soon as the feeling of dizziness appears

• taking extra time to perform movements that may trigger symptoms, such as getting up, looking upward, or turning the head

• squatting instead of bending over to pick something up

• using a cane when walking, if necessary

• sleeping with the head raised on two or more pillows

• making adaptations in the home

• turning on lights when getting up at night to help prevent falls

Anyone who experiences vertigo or other types of dizziness should not drive or use a ladder. .Exercises Exercises can help relieve symptoms in some cases. The Epley maneuver for BPPV A technique known as the Epley maneuver can help some people with vertigo that stems from BPPV. The maneuver aims to move calcium carbonate particles from the semicircular canals back to the otolith organs of the vestibule, where they are less likely to cause symptoms in the inner ear. For BPPV involving the left inner ear:

1. Sit on a bed and place a pillow behind the body where the shoulders will be on lying down.

2. Rotate the head 45 degrees to the left.

3. Keeping the head in position, lie down on the back with the shoulders on the pillow so that the head tilts back slightly and touches the bed. Hold for 30 seconds.

4. Rotate the head to the right by 90 degrees and hold for 30 seconds.

5. Turn the body and head, in their current positions, 90 degrees to the right. Hold for 30 seconds.

6. Slowly sit up and lower the legs on the right-hand side of the bed.

7. Hold for a couple of minutes while the inner ear makes adjustments.

Types There are different types of vertigo, which vary in their cause. Peripheral vertigo About 80% of cases are of this type. Peripheral vertigo usually results from problems in the inner ear. Tiny organs in the inner ear respond to gravity and the person’s position by sending messages via nerve signals to the brain. This process enables people to keep their balance when they stand up. Changes to this system can produce vertigo. BPPV and inflammation are common causes. Other causes include Ménière’s disease and acoustic neuroma, among others. Central vertigo Central vertigo relates to problems with the CNS. It usually stems from a problem in a part of the brain stem or cerebellum. Approximately 20% of cases are of this type. Possible causes include vestibular migraine, demyelination, and tumors involving the affected CNS region or regions. A problem with the cervical spine can lead to vertigo. Learn more here. Diagnosis The doctor will try to find out what is causing the dizziness. They will carry out a physical examination, ask the person how their dizziness makes them feel, and take their medical history. The doctor may also carry out some simple tests. Here are two examples: Romberg’s test: The doctor will ask the person to stand with their arms by their sides and their feet together and ask them to close their eyes. If the person becomes unsteady on closing their eyes, this could be a sign of a CNS problem. Fukuda-Unterberger’s test: The doctor will ask the person to march on the spot for 30 seconds with their eyes closed. If they rotate to one side, this may indicate a lesion in the inner ear labyrinth, which could cause peripheral vertigo. Depending on the results of these and other tests, the doctor may recommend a head CT or MRI scan to obtain more details.