Introduction

Vertigo is a common symptom that causes individuals to feel a false sensation of movement or spinning, either of themselves or their surroundings. It is important to note that vertigo is a symptom, not a diagnosis, and can result from various conditions affecting the vestibular system (inner ear and balance pathways) or the brain. Proper diagnosis and treatment are crucial, as vertigo can interfere with daily activities and cause falls or accidents.

Types of Vertigo

1. Peripheral Vertigo: Originates from the inner ear or vestibular nerve.
2. Central Vertigo: Arises from issues in the brainstem or cerebellum.

Vertigo can broadly be divided into two categories:

Common Causes, Symptoms, and Management

1. Benign Paroxysmal Positional Vertigo (BPPV)

• Cause: BPPV is caused by dislodged calcium crystals (canaliths) moving into the semicircular canals in the inner ear, disrupting the flow of fluid that helps detect head movements.
• Symptoms:
  • Brief episodes of spinning triggered by sudden changes in head position (e.g., turning in bed, bending over).
  • Nausea or unsteadiness.
  • No hearing loss or tinnitus.
• Management:
  • BPPV is often treated with canalith repositioning maneuvers (specific head movements to relocate the crystals).
  • Recurrences are common but usually manageable with these exercises.

2. Ménière’s Disease

• Cause: This condition results from an abnormal buildup of fluid (endolymph) in the inner ear, which interferes with normal sensory signals.
• Symptoms:
  • Episodes of severe vertigo lasting from 20 minutes to several hours.
  • Hearing loss (often fluctuating and initially affecting one ear).
  • Tinnitus (ringing in the ear).
  • A feeling of fullness or pressure in the ear.
• Management:
  • Lifestyle changes, including diet modifications (e.g., reducing salt to manage fluid levels).
  • Balance therapy can help improve stability.
  • If symptoms persist, consult a specialist for advanced interventions.

3. Vestibular Neuritis or Labyrinthitis

• Cause: These conditions are caused by viral infections affecting the vestibular nerve or inner ear.
  • Vestibular neuritis affects the balance portion of the inner ear.
  • Labyrinthitis involves both the balance and hearing structures.
• Symptoms:
  • Sudden onset of vertigo lasting for several hours to days.
  • Nausea and vomiting.
  • Labyrinthitis may also cause temporary hearing loss in one ear.
• Management:
  • Bed rest, physical therapy, and supportive care can help during acute episodes.
  • Vestibular rehabilitation exercises improve balance and reduce dizziness in recovery.

4. Vestibular Migraine

• Cause: This condition is linked to migraine headaches, with vertigo occurring as part of the migraine spectrum.
• Symptoms:
  • Episodes of vertigo lasting from minutes to days, often accompanied by a headache or migraine aura.
  • Sensitivity to light, sound, and motion.
  • No hearing loss or tinnitus.
• Management:
  • Avoiding known triggers (such as stress, sleep deprivation, or certain foods).
  • Physical therapy for balance and coordination may be useful in chronic cases.

5. Acoustic Neuroma (Vestibular Schwannoma)

• Cause: This is a benign tumor that develops on the vestibular nerve, which connects the inner ear to the brain.
• Symptoms:
  • Gradual hearing loss in one ear.
  • Tinnitus and occasional vertigo.
  • Imbalance and coordination issues in advanced cases.
• Management:
  • Early-stage tumors are monitored with regular imaging (MRI).
  • Depending on the size and progression, surgical intervention or radiation therapy may be needed.

6. Central Causes of Vertigo

• Cause: Central vertigo arises from conditions affecting the brainstem or cerebellum. These include:
  • Stroke or Transient Ischemic Attack (TIA).
  • Multiple sclerosis.
  • Brain tumors.
  • Traumatic brain injury.
• Symptoms:
  • Gradual onset of vertigo with associated neurological symptoms (e.g., difficulty speaking, limb weakness, double vision).
  • Unsteady gait or difficulty walking.
• Management:
  • Immediate medical attention is needed for stroke or neurological causes.

When to Seek Medical Attention

While some forms of vertigo, like BPPV, are benign, other cases may indicate serious underlying conditions. Visit a healthcare provider or emergency department if you experience:

• Sudden, severe vertigo with neurological symptoms (e.g., slurred speech, limb weakness).
• Persistent vertigo lasting for several days without improvement.
• Vertigo accompanied by hearing loss or facial numbness.

A history of head injury followed by dizziness.

Management and Rehabilitation

• Vestibular Rehabilitation Therapy (VRT): A specialized form of physical therapy designed to help individuals with chronic vertigo improve balance and reduce dizziness.
• Lifestyle Adjustments: Staying hydrated, getting sufficient sleep, and avoiding rapid head movements can help manage vertigo.
• Avoiding Triggers: Identifying and avoiding specific triggers (like caffeine, alcohol, or stress) may prevent vertigo episodes in conditions like vestibular migraine.

Conclusion

Vertigo is a complex symptom with a wide range of potential causes, from benign inner ear conditions to serious neurological diseases. Timely diagnosis and appropriate management are essential to improve quality of life and prevent complications like falls. If you or a loved one experience persistent or severe vertigo, please visit Medikeri’s ENT and Head-Neck Centre for comprehensive evaluation and management. The expertise of specialists and access to advanced diagnostic tools will ensure the best possible care for your condition.