Vertigo

What is vertigo/dizziness?

Vertigo/dizziness is the second most common cause of patient presentation to practitioners and the number one complaint of people over the age of 70. Vertigo and dizziness are two terms that are often used interchangeably but in reality, they are two distinct medical entities. Vertigo is often described as feeling that you are spinning or that the world is spinning around you. Dizziness on the other hand is described as feelings of giddiness, lack of  balance and feeling off-kilter. Both vertigo and dizziness are often a result of inner ear diseases, but there are other pathologies that can cause these symptoms.  

What causes it?

Vertigo/dizziness is not a disease, rather they are an indication of an underlying illness.

Pathologies of auditory system are among the most common causes of dizziness/vertigo because the auditory system is not only responsible for the sense of hearing, but is also plays a crucial role in maintaining balance and posture. That is why hearing assessments are critical in identifying the cause of your dizziness/vertigo.

Auditory system maintains our balance in coordination with other systems including visual, proprioception and central nervous system. As a result, a disease in any of these systems can lead to dizziness/vertigo/imbalance.

vertigo caused by BPPV
vertigo caused by BPPV

Diagnosis

Diagnosis and treatment of dizziness/vertigo requires extensive attention to the details, history of the patient and examination of signs and symptoms.

Unfortunately, many people with vertigo and dizziness go through extensive investigations without finding an answer.Vertigo/dizziness is rarely a sign of a sinister illness such as stroke or brain haemorrhage.

In those cases, patients often experience other neurological symptoms such as facial numbness, double vision and difficulty coordinating limbs movements.Nevertheless, detailed consultation, examination and proper referral are essential to ensure the integrity of the neurological system.

Common causes of Vertigo

The leading causes of vertigo include :

Benign Paroxysmal Positional Vertigo (BPPV) ,Vestibular Migraine (VM),Vestibular Neuritis (VN),Meniere’s disease (MD),Acoustic Neuroma (AN).

Benign Paroxysmal Positional Vertigo (BPPV):

BPPV presents with rotational vertigo lasting for a few second and is mostly associated with head movements or rolling over in bed.Treatment of BPPV requires professional help from vestibular audiologists or vestibular physiotherapists.Medication is usually only prescribed for symptom-control and does not lead to full treatment of BP.

Vestibular Migraine (VM):

VM is a very common illness particularly in neurology clinics.Similar to migraine, VM is often trigged by light, sound and some food such as wine and cheese.Treatment of VM includes a combination of medication, vestibular rehabilitation and some changes in the patients life-style.Hearing and balance examinations are crucial in diagnosing VM and ruling out other illnesses.

Vestibular Neuritis (VN):

VN often happens as a result of inflammation of vestibular nerve due to an inner ear infection.Vestibular nerve is responsible for our balance.Patients might experience severe rotational vertigo, vomiting, and imbalance.A hearing assessment might show hearing loss or normal hearing.Treatment often includes medication and in some cases vestibular rehabilitation.

Meniere’s disease (MD):

A disease of inner ear, Meniere’s disease is another common vertigo-inducing illness which results from inflammation of inner ear.Patients often experience hearing loss and vertigo which are usually triggered by salty food.Treatment of Meniere’s disease requires medication intervention and life-style modifications.In Meniere’s disease, hearing loss is often permanent.

Acoustic neuroma (AN):

AN is a slow-growing tumour of vestibular nerve.Patients experience hearing loss and imbalance.Treatment often involves surgery but in some cases, the specialist might decide to monitor the growth of the tumour for a while before performing the operation.However, in most cases hearing loss will be permanent even in case of surgery.

Vertigo treatment

Vertigo treatment

Using your hearing test results and other medical assessment, your practitioner might discuss various treatment options with you.Treatment of vertigo depends on the type of illness but in most cases it will disappear without medical intervention.

The common vertigo treatments include the following: 

  • Vestibular rehabilitation or balance training – this is a type of physical therapy that strengthens the vestibular system amd can be helpful if you find yourself struggling with daily life activites.
  • Repositioning measures – this is useful if the cause is BPPV. The treatment moves calcium deposits out of the canal so they can be absorbed by the body.
  • Medication – motion sickness medication can be used to relieve some symptoms of vertigo/dizziness such as nausea and vomiting. Your doctor might also prescribe antibiotics if he/she suspects that an infection is causing  your vertigo. Diuretics, or water pills, may be prescribed to reduce the swelling associated with Meniere’s disease.
  • Surgery – surgery is only needed in a few cases such as acoustic neuroma and needs and is a decision to be made in consultation with a specialist.