Vertigo

Vertigo induces feelings of dizziness and a sensation of spinning, even when there is no actual movement. It typically arises from inner ear problems but can also result from brain-related conditions such as tumors or strokes. Treatment approaches range from medications to repositioning maneuvers and surgical interventions.

Overview

What is Vertigo

Vertigo is the false sensation that the individual or environment is moving. This is commonly described as a “room spinning” sensation. The false sensation of movement can be in the horizontal, vertical or in oblique axis. Our body balance is dependent on multiple sensory multiple sensory inputs including vision, vestibular and proprioception. Vertigo results from mismatched information from these input systems. When a diagnosis of true vertigo is made it is important to differentiate between central and peripheral causes.

Causes

Causes of Vertigo

Causes of Vertigo can be broadly classified into Peripheral and Central.  

Peripheral causes

Peripheral causes of vertigo are the most common type of vertigo, and it occurs when there is an issue with the balance organ in the inner ear system (semicircular canals, utricle and saccule) and/or the balance nerve (Vestibular nerve). They are more likely to produce auditory symptoms, such as ringing in the ears (tinnitus), fulness in the ear (aural fulness) or hearing difficulties. 

Some of the causes for peripheral vertigo includes; 

  • Benign Paroxysmal Positional Vertigo (BPPV) 
  • Vestibular Neuritis 
  • Labyrinthitis 
  • Meniere’s Disease 
  • Superior Semicircular Canal Dehiscence (SSCD) 
  • Perilymphatic Fistula 
  • Late stage of Otosclerosis 

Central causes

Central causes of vertigo are less common. It happens when you have a brain-related/Central nervous system related issues. As peripheral vertigo is more likely to produce auditory symptoms, central vertigo/disorders will often be associated with neurological symptoms such as weakness on face, falls while walking, imbalance, difficulty while speaking. 

Some of the causes for central vertigo includes; 

  • Stroke/Cerebrovascular Accident 
  • Vestibular Migraine 
  • Demyelinating diseases (such as Multiple Sclerosis) 
  • Central Positional Vertigo 
  • Cranial Tumors 
  • Meningitis 
  • Encephalitis 
  • Vertebrobasilar insufficiency 
Diagnosis / Tests

Tests for Diagnosing Vertigo

Diagnosing the cause of vertigo is a comprehensive process that may involve a combination of patient history, physical examination, objective tests (VNG, VEMP, vHIT etc), imaging studies, and collaboration with various specialists. The diagnostic approach may vary based on the suspected underlying cause, and a multidisciplinary approach often leads to the most effective outcomes. 

Patient History 

  • Detailed history about the onset, duration, and characteristics of vertigo. 
  • Any associated symptoms such as hearing loss, tinnitus etc. 
  • Inquiring about any pre-existing conditions, medications or recent illness. 

Physical Examination 

  • Neurologic Examination – Assessing coordination, reflexes, and muscle strength. 
  • Vestibular Examination – Checking for abnormal eye movements (nystagmus) and assessing balance. 
  • Blood Pressure Measurement. 

Objective Evaluation 

  • Audiological evaluation (Tympanometry, Pure Tone Audiometry (PTA), Acoustic reflexes, OAE, other electrophysiological tests) 
  • Video Nystagmography (VNG) 
  • Video Head Impulse Test (vHIT) 
  • Vestibular Evoked Myogenic Potentials (VEMP) 
  • Electrocochleography (ECochG) 
  • Rotational Chair Test 
  • Dynamic Visual Acuity (DVA) test 

 

Imaging Studies  

  • Used to rule out structural issues in the central nervous system (Brain), such as tumors or strokes.
Treatment

Treatment options for Vertigo

Treatment option for vertigo vary depending on the underlying cause and severity of the symptoms. 

Vestibular Rehabilitation Therapy (VRT):

VRT is a specialized exercise-based program designed to improve balance and reduce dizziness symptoms. It involves a series of exercises and maneuvers tailored to the individual’s specific needs, aiming to promote compensation for vestibular deficits and enhance overall vestibular function.

Canalith Repositioning Procedure (CRP):

CRP is a technique used to treat BPPV by repositioning displaced calcium carbonate crystals within the semicircular canals of the inner ear. It involves specific head movements guided by a healthcare professional to facilitate the return of crystals to their proper location, thereby reducing vertigo episodes. 

Lifestyle Modifications:

Making certain lifestyle adjustments can also help manage vertigo symptoms. These may include avoiding triggers such as caffeine, alcohol, or certain medications that exacerbate dizziness, maintaining hydration, practicing stress-reduction techniques, and ensuring adequate rest and sleep. 

Medications:

Certain medications can help alleviate symptoms of vertigo, including anti-nausea medications such as dimenhydrinate or meclizine, as well as vestibular suppressants like benzodiazepines or anticholinergics. In some cases, corticosteroids may be prescribed to reduce inflammation associated with inner ear disorders. 

Surgery:

In rare cases where vertigo is caused by structural abnormalities or persistent inner ear disorders resistant to conservative treatments, surgical intervention may be considered. Surgical procedures such as vestibular nerve section or endolymphatic sac decompression aim to alleviate symptoms by addressing underlying anatomical issues or reducing fluid pressure within the inner ear. 

When to Call Doctor

When to Call Doctor

Patient should seek help from a healthcare professional if they experience any of the following: 

  • Persistent or recurrent episodes of vertigo lasting more than a few minutes. 
  • Severe dizziness accompanied by nausea, vomiting, or difficulty walking. 
  • Vertigo episodes that occur suddenly and without an apparent trigger. 
  • Dizziness that interferes with daily activities, work, or driving. 
  • New or worsening symptoms of vertigo, especially if accompanied by hearing loss, ringing in the ears (tinnitus), or other neurological symptoms. 
  • Vertigo associated with head trauma or injury. 
  • Presence of other medical conditions or risk factors that may exacerbate vertigo, such as cardiovascular disease or diabetes. 

It’s important for individuals experiencing vertigo to seek prompt health care attention to determine the underlying cause and receive appropriate treatment. Delaying treatment may lead to worsening symptoms or complications, so early intervention is key to managing vertigo effectively. 

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Resources:

  • Jacobson, G. P., Burkard, R. F. (2019). Balance Function Assessment and Management: Third Edition. United States: Plural Publishing, Incorporated.
  • Herdman, S. J. (2015). Vestibular Rehabilitation. United States: F. A. Davis Company.

Professionally Reviewed

Last reviewed by Sidharth Rajeev, Dr. Yugandhar Ramakrishna on April 27, 2024