Vertigo and dizziness

Signs of vertigo and instability

What are vertigo and dizziness?

Vertigo can be defined as the sensation of movement of the environment or of oneself turning, or of precipitation into the void which does not actually exist. It can be a very uncomfortable feeling that is usually accompanied by nausea, loss of balance or even a feeling of imminent fainting.

Dizziness and vertigo

Dizziness and vertigo should not be confused. While in vertigo a fictitious movement is perceived, (it is not actually taking place), dizziness is a broader feeling of lightheadedness or disorientation.

Vertigo is almost always related to an alteration of the vestibular system, located inside the inner ear, which coordinates our balance, as well as our posture, and can be momentary or last hours or even days. 

Symptoms of vertigo and dizziness

Spinning or the feeling of the body itself in motion can be one of the most frequesnt symptoms of vertigo. However, there are also other  symptoms of vertigo:

  • Ringing in the ears (tinnitus).
  • Hearing loss in one ear.
  • Dizziness
  • Loss of balance
  • Double vision.
  • Facial paralysis.
  • Difficulty speaking
  • Difficulty focusing with the eyes.
  • Weak limbs.
  • Cold sweats.
  • General malaise.

Vertigo and hearing aids

A hearing aid can do much more than just improve hearing: since hearing loss is sometimes also associated with a worsening of balance, hearing aids have been shown to improve balance by reducing vertigo and protecting patients against the risk of falls. Hearing aids allow us to improve orientation skills and detect the origin of sounds and to better understand the space around us which in turn can help in avoiding vertigo or other types of faintings.

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How to diagnose vertigo

During the diagnosis for vertigo, the first step will always be to determine the nature of the problem and its cause. To do this, the ENT doctor will try and understand the symptoms that accompany the dizziness, its duration, possible triggers or what might produce relief.

The specialist will then proceed to vestibular testing, analyzing the ears, nose, oral cavity, nasopharynx and larynx. The vestibular tests are a series of diagnostic tests to learn more about the status and possible involvement of the inner ear, the vestibular labyrinth and the semicircular canals. Among these tests, the most common are electronistagmography or rotation tests , among others. It may be necessary to study nystagmus, a reflex disorder that manifests itself with rapid and uncontrolled movements of the eyes (either side to side, up and down or rotating) and is justified by the connection between the brain, vestibular system and nuclei of eye movements. The physician will attempt to stimulate nystagmus by jerking the patient's head or alternately introducing drops of hot and cold water into the ear canal.

Likewise, a computed tomography or an MRI of the head may be required, which would show, if present, bone alterations or tumors in the facial or acoustic nerve. In case your doctor suspects a meningeal infection, he will perform a lumbar puncture and, to confirm an insufficiency in the blood supply, he might order an angiography. These tests offer the specialist the information they need to determine how to deal with episodes of vertigo.

How to treat vertigo and dizziness

The treatment of vertigo depends on what causes it, so it will not be the same in all cases. Several drugs exist to treat this but the treatment may vary from case to case.

  • Diuretics, to reduce the amount of water in the inner ear and with it the feeling of vertigo
  • Betahistine, which reduces the activity of vestibular neurons
  • Calcium antagonists and cell protectors 

It is very common for all these drugs to cause drowsiness, especially in the elderly, so these prescriptions must be accompanied by a low-salt diet, a combination that is effective in 70% of cases.

If this first option is not effective,  treatment with intratympanic gentamicin, an antibiotic that is injected through the eardrum, passes into the middle ear and acts on the balance cells. If this does not solve the problem either, the only possible way is to go under the knife to undergo a vestibular neuroctomy, where the balance nerve is cut while maintaining the patient's hearing, or a  labyrinthectomy, which involves the removal of all sensory receptors for balance, with consequent hearing loss.

BPPV is triggered by sudden movements and it originates in the deposit of calcareous-type remains ("ear crystals") in one of the semicircular canals of the inner ear. In this case to treat it, the said material must be extracted from an area where it should not be.

Types of vertigo

Peripheral vertigo

Peripheral vertigo is the most frequent type of vertigo and appears as a result of a change in the labyrinth (inner ear) and the vestibular nerve (in charge of transporting information about balance from the inner ear to the brain). It is associated with hearing loss and pressure in the ears.

Central vertigo

Central vertigo, on the other hand, occurs due to the alteration of the neurological mechanisms of the vestibular system itself and can be accompanied by double vision, instability and severe headaches. 

Cervical vertigo

Cervical vertigo, as its name suggests, arises as a result of a cervical problem, be it a bad position of the neck vertebrae or another type of cervical disorder.

Benign paroxysmal positional vertigo

This is a common disorder that causes brief episodes of vertigo in response to changes in the position of the head that stimulate the posterior semicircular canal of the inner ear.

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