Vertigo: symptoms, causes and treatments

Vertigo and dizziness?

Learn more about vertigo, which is usually closely related to the inner ear.

What is vertigo and dizziness?

Vertigo is 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 is a very uncomfortable feeling that is usually accompanied by nausea, loss of balance (dizziness) and a feeling of imminent fainting.

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. This disorder can affect anyone, although in children it presents in the form of spontaneous and temporary crises and in the elderly it can evolve into chronic instability.

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. In addition, it can be objective or subjective, depending on whether the patient feels that they revolve around things or if they perceive that it is their environment that seems to revolve around them, respectively.

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.

BPPV

Benign paroxysmal positional vertigo 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.

Causes of vertigo

One of the most common causes of vertigo is alterations in the nerve connection from the ear to the brain or in the brain itself, but there are many more, such as:

  • Infections: viral or bacterial ear infections that affect the inner ear such as labyrinthitis.
  • Menière's disease: a disorder whose cause is unknown which produces sudden bouts of vertigo is often accompanied by tinnitus (ringing in the ears), hearing loss, and nausea.
  • Abnormal blood pressure: this is especially the case in older people who take drugs to control hypertension or other heart diseases and may faint when they stand up abruptly, precisely because of a drop in blood pressure (orthostatic hypotension).
  • Neurological disorders: multiple sclerosis, skull fractures, tumors (especially those that develop at or near the base of the brain), or strokes.

Main symptoms of vertigo

The most frequent clinical sign that shows if you are suffering from vertigo is the sensation that the room you are in is spinning or that the body itself is in motion. 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 diagnosis

To perform a 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 have the patient fill out a questionnaire to 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.

 

Treatment for vertigo

The treatment of vertigo depends on what causes it, so it will not be the same in all cases. Several drugs exist to treat is, which are always suggested depending on each patient's 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.

Preventing vertigo

Do you want to know how to  reduce the risk of vertigo? Some recommendations to achieve this would be to avoid or rapid movements or extreme positions of the head, as well as to minimize the circumstances that can trigger this condition, such as anxiety, the use of substances that cause allergies or stress.

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