What is Vertigo ?
The word vertigo is derived from the Latin phrase verto, which means, “to revolve”. Vertigo is a false sense of motion, spinning or feeling of imbalance. Sufferers often call it dizziness, imbalance, light-headedness or “chakkar aana (in hindi)”. Often the imbalance is associated with nausea, vomiting or unsteadiness on walking. It may worsen when you move your head. Vertigo should not be mixed up with acrophobia, which is an extreme fear of heights. Vertigo and dizziness are common complaints presented by patients to doctors of all specialties, and they affect all age groups. It is a fact that 20-40% people are affected by dizziness at some point in time in their life; 15% people have dizziness; 5% have vertigo in any given year; 2.5% of all primary care visitors report dizziness, and 2-3% of emergency visits in the developed world is for vertigo. But it must be noted that vertigo is not a disease. It is only a symptom of a disorder. Therefore, suppressing the symptom is not the solution. Proper diagnosis of what is causing vertigo/dizziness is possible only when the doctor makes a systematic evaluation. A neuro-otological workup alone will help to find out if a vertigo patient is suffering from disorders like BPPV, Meniere’s Disease, Vestibular Neuritis, Labyrinthitis, Acoustic Neuroma, Otolith Dysfunction, Vestibular Migraine, Central Vestibulopathy or psychogenic disorders. Different disorders causing vertigo have different presentations and require diverse treatment protocols. A correct diagnosis will enable the doctor to offer the right treatment, which is the only way to give the patient lasting benefit.
Symptoms of Dizziness
Patients suffering from persistent or intermittent dizzy spells usually describe their symptoms as though they are
• Spinning (Matha ghura in Bangla)
• Feeling unsteady or imbalanced
Vertigo patients may also complain of nausea, difficulty in focusing on moving objects, headaches, change in hearing or ringing in the ears, and difficulty in concentration. Their symptoms can come and go and can range from a few seconds to minutes, hours, even days.
Causes, Diagnosis & Treatment
It is a disorder of the inner ear, which is characterised by episodes of hearing loss and fullness in one ear, tinnitus and vertigo. Meniere’s disease is caused by increased pressure of the inner ear fluid. If not treated timely, Meniere’s disease can lead to a progressive hearing loss. Meniere’s disease usually affects one ear, but it may be bilateral in 15% of cases.
Vestibular Neuritis is caused by a viral infection leading to inflammation of the vestibular nerve. The inflammation disturbs the balance function and causes dizziness.The dizziness symptom is accompanied by blurred vision, nausea, vomiting and difficulty in focusing during head movement. Vestibular Rehabilitation should be started at the earliest to help attain rapid recovery.
Damage to otolith organs (utricle and saccule) cause disequilibrium of the body and affects visual stability. Until recently, there was no precise method to check the impairment of otolith organs. But now Otolith disorders can be diagnosed with the Subjective Visual Vertical test and VEMP. Otolith stimulation through vestibular rehabilitation therapy works well in treating the disorder.
10% of the population is affected by a migraine, most of them are women. The most common presentation of a migraine is headaches. But in a vestibular migraine, the patient has dizziness which may be associated with headaches. A severe headache coupled with dizziness indicates a vestibular migraine. Along with the spinning sensation associated with headaches, motion sickness and hypersensitivity to light and sound prominently show up in the patient. A vestibular migraine is controlled with diet and lifestyle modifications. In cases of frequent dizzy spells, migraine prophylaxis is prescribed.
The unusual movements of carbonate crystals from their chamber into fluid-filled semicircular canals disturbs the way the balance nerve senses gravity and adjusts its movement. The result is vertigo or the sensation of spinning. BPPV is a common cause of vertigo. It is seen more frequently in old aged population after an ear infection, head injury, surgery or after prolonged rest. The canalith repositioning exercises are the best method to cure dizziness caused by BPPV in which the offending particles are repositioned according to the type of BPPV by maneuvers like Epley Maneuver, Semont Maneuver etc.
The infection causes labyrinthitis in the labyrinth of the inner ear leading to vertigo, hearing loss and tinnitus. The difference between labyrinthitis and vestibular neuritis is; in labyrinthitis both vestibular and cochlear nerves are affected and cause dizziness, ringing in the ear and hearing loss. While in Vestibular neuritis only vestibular nerve is affected leading to vertigo but the hearing ability is not affected. Labyrinthitis causes severe dizziness bouts that may last for days! Vestibular suppressants may be prescribed by the doctors to treat dizziness and its associated symptoms, for a very short duration of 3 to 5 days. Vestibular rehabilitation should be started at the earliest to ensure rapid recovery
Dizziness, fullness in the ear, vertigo spells are the symptoms of a perilymph fistula. A small tear in the fluid-filled inner ear causes fluid to leak into the middle ear. This leakage disturbs the equilibrium and leads to vertigo spells especially when the patient does straining activities or coughs vigorously. This condition may also lead to tinnitus and hearing loss. Videonystagmography (VNG) and vestibular examination help diagnose the presence of the perilymph fistula.
The compression of the vestibular nerve due to an inflamed blood vessel, radiation, surgery, or vestibular neuritis may cause vestibular paroxysmia. Microvascular compression is the most common reason for vestibular paroxysmia. The patient may have frequent short spells of vertigo episodes recurring throughout the day. VNG/ ENG and MRI scanning are recommended to diagnose Vestibular paroxysmia .
A rare condition of SSCD may occur as a result of thinning, or damage to the bony part of the labyrinth. It affects the patient’s hearing ability too. A natural coughing or sneezing can trigger dizziness in this condition. These patients have an extreme sensitivity to loud sound. VNG guided Valsalva manoeuvre, VEMP and CT scan of the temporal bone confirm SSCD. The treatment for SSCD is to avoid actions which aggravate dizziness. Surgical repair of the bony dehiscence is advocated for lasting results.
The patient experiences a continuous rocking or sense of motion as a result of long travel, either by ship or aeroplane. Some individuals may develop MdDs even without exposure to long travel.A thorough vestibular evaluation and studying the history of the patient can diagnose MdDS. Antidepressant medication is prescribed to treat the swaying sensation. Vestibular rehabilitation treatment is the best technique to treat MdDS. Virtual reality training is also advised for these patients.
Acoustic Neuroma/ Vestibular Nchwannoma
Acoustic neuroma is a noncancerous growth on the balance nerve which causes unsteadiness, dizziness, facial numbness or tingling sensation, change in taste etc. A tumour grows slowly, and hence the patient often does not notice the symptoms. However, it may prove life-threatening if a tumour grows big enough to press on the brain stem. Surgery and radiation are widely used methods to treat acoustic neuroma.
Multiple sclerosis is an autoimmune disorder which attacks the protective shield of the nerve cells and hampers the signal transmission to the brain. Loss of focus, visual problem, vertigo spells are some of the symptoms of multiple sclerosis. Under this condition, the CNS is affected Spinal tap, VNG and MRI brain are
Senior Citizen Healthcare finest of the doctors to treat vertigo patients