Vertigo and Dizziness
Introduction
It is estimated that up to 25% of any population in the industrialized world will experience dizziness, with or without vertigo, at some point in their lives (1999 Prof. Dr W.J. Oosterveld, Academic Medical Centre, Amsterdam). Older people experience it more than the younger population. Most cases of dizziness are not true vertigo, nor is dizziness a serious symptom.
It is important to understand that all vertigo comes with dizziness, but not all dizziness comes with vertigo.
All vertigo = Dizziness
All dizziness
≠ Vertigo
Dizziness
The main symptoms of dizziness include a feeling of light headedness. There are numerous reasons why a person may be experiencing dizziness. It may be related to anxiety and/or panic disorders, or mood disorders. Dizziness in the form of light-headedness may result from a cardiovascular problem such as an irregular heart beat (arrhythmia) or if your blood pressure drops when you change positions (postural hypotension). There are some medications that may cause light-headedness and/or imbalance such as some blood pressure medications (antihypertensives), medications to control convulsions or spasms (anticonvulsants), calming medications (sedatives) or medications that help with sleep (hypnotics). Problems with chemical changes within your body (metabolic problems) may also cause dizziness, such as if your blood sugar drops too low (hypoglycemia) or hormonal imbalances.
Symptoms of Dizziness
• Light headedness
• Motion sickness or nausea
• Faintness or weakness
One important sign that your doctor will look for that may indicate the cause of your vertigo is nystagmus. Nystagmus occurs when your eyes move back and forth in a rhythmic movement, first fast and then slow. Abnormal eye movements indicate a possible dysfunction of the inner ear or its nerve connections to the brain; or the brain itself. If you see a doctor, he/she will do some specific maneuvers with your head and body to see if nystagmus occurs.
Noise in the Ears (Tinnitus)
Another symptom that is sometimes associated with true vertigo is tinnitus. Tinnitus is noise in the ear that may be heard on and off, continuously or in a pulsation form. This noise may be buzzing, ringing, roaring, whistling or hissing. It often goes with many ear disorders, including Ménière's Disease (see below), infections such as an inflammation of the middle ear (otitis media - see our page on Problems of the Ear), or inflammation of the internal ear (labrynthitis), eustachian tube obstruction or noise-induced hearing loss.
Inner Ear Related Vertigo
Inner ear
The Semi-Circular Canals as Balancers
The body senses its different positions and controls it's balance through organs of equilibrium (balance) that make you feel stable, or normal. These organs of balance are located in the inner ear and are called the semicircular canals. These canals look like loops of tubes. Their connections on one side are to the cochlea where they receive sounds, and to the aural nerves going to the brain.
The semicircular ducts are arranged roughly at right angles with each other so that they represent all three planes in three-dimensional space. The horizontal duct lies in a plane pitched up approximately 30 degrees from the horizontal plane of the earth-erect head. The front canals are located in vertical planes that project forward and outward by approximately 45 degrees. The rear canals are located in vertical planes that project backward and outward by approximately 45 degrees.
If you could take the upper portion of each inner ear on each side of the head, they would be symmetrical: the front canal on one side of the head is parallel to the rear canal on the other.
Messages to the brain as to the head's changes in position are generated by calcium carbonate crystals that shift on their bed of sensory hairs in the utriculus and the sacculus. The changes as to which hairs are being stimulated by the presence of crystals are reported to the cerebellum (a part of the brain) which in turn, translates the information into knowledge of the position of the head relative to gravity.
Symptoms of True Vertigo
The symptoms of true vertigo may include a very strong feeling that you are moving or spinning when you are actually still or that the room is moving about you. This illusion may make you feel like you are spinning and circling. This feeling may become worse when you move your head, and it may make you feel nauseated or even make you vomit. These episodes of vertigo usually come and go; and are not constant.
- Sense of movement
- An illusion of spinning and circling
- Worsened with head movements
- Nausea/vomiting
- Episodes come and go
- Rhythmic Eye Movement (Nystagmus)
Causes of Vertigo
The cause of all vertigo is when the semi-circular canals are not functioning properly, ether due to infection, inflammation, trauma, hormonal imbalances, blood disorders, or scarring.
Many people may experience dizziness or vertigo at some point in their lives. Often, it passes quickly and does not return. However, for vertigo that lasts off and on or continuously for a few days, the following are some probable causes.
The most common causes are:
- Low tolerance for vehicular motion such as cars, boats, cruise ships, and airplanes that cause motion sickness.
- A head cold or some infection of the ear or nasal passages that blocks or swells the eustachion tube. The subsequent inability of the middle ear to equalize air pressure in the middle ear chamber, causes undue pressure on the inner ear, and subsequently the semicircular canals where balance is registered.
- High blood pressure
- High cholesterol
- Diabetes
- Anemia
- Calcium disorders
- Alcohol or drug abuse
Other rarer causes are:
Most Common Types of Vertigo
1. Ménière's Disease (vertigo with hearing loss on one-side, noise in the ear and aural fullness)
Ménière's Disease is an inner ear disorder that brings spontaneous episodes of vertigo that can last minutes to hours. Along with the vertigo, there may be some hearing loss in the affected ear that comes and goes, as well as an increase in tinnitus and a sense of fullness in the Ménière's affected ear. Between episodes, you may have a persistent hearing loss and tinnitus in the affected ear. The vertigo associated with Ménière's Disease may happen suddenly, or may build in intensity over several hours and you may begin to experience nausea or vomiting.
1.b Causes of Ménière's Disease
The underlying cause of Ménière's Disease is unknown. Ménière's Disease is felt to be due to an abnormality in the fluid balance of the inner ear.
1.c Symptomsof Ménière's Disease
- Lasts minutes to hours
- Usually an accompanying hearing loss or a change in hearing
- Tinnitus
- Feeling of pressure in ears
1.d Possible Treatments
The treatment of Ménière's Disease is two fold.
- The first is to treat the symptoms of vertigo with anti-vertigo medication. Often an anti-nausea agent is necessary to combat the sick feeling that comes with vertigo. During and following a vertigo attack, the affected patient should avoid movements as they may increase the severity of the symptoms.
- The second form of treatment is prevention of further vertigo attacks. Certain medications are effective in reducing the frequency and severity of vertigo attacks.
1.e Other Treatments - Surgery
Surgery may be necessary to treat Ménière's Disease. One option is having surgery to place an antibiotic directly into the inner ear. This may reduce the attacks of vertigo.
1.f Lifestyle Changes
There are some changes to diet and lifestyle that may help you manage Ménière's Disease. These include a low-salt diet to help reduce fluid retention as well as taking a medication that encourages urination (diuretics). You should also avoid sudden movements as they may aggravate these symptoms.
2. Recurrent Vestibulopathy (Severe vertigo, with or without hearing loss)
Patients who suffer multiple episodes of severe vertigo without hearing loss likely have what is known as recurrent vestibulopathy. These attacks of vertigo come and go, and last from minutes to hours. This inner ear disorder is therefore similar to Ménière's Disease, but without any hearing loss or noise in the ear. There is no evidence of brain dysfunction with recurrent vestibulopathy, and it usually goes away over time. Some recurrent vestibulopathy may turn into Ménière's Disease or benign paroxysmal positional vertigo (BPPV).
2.b Causes. The cause of recurrent vestibulopathy is unknown.
2.c Symptoms of Recurrent Vestibulopathy
• Lasts minutes to hours
• No hearing loss or tinnitus
2.d Possible Treatments
Treatment for recurrent vestibulopathy is similar to Ménière's Disease. These may include an anti-vertigo medication and anti-nausea agent to combat the sick feeling that comes with vertigo.
There are some changes to diet and lifestyle that may help you manage this type of vertigo. These include a low-salt diet to help reduce fluid retention as well as taking a diuretic.
3. Benign Paroxysmal Positional Vertigo or BPPV (Vertigo caused by free floating particles in the inner ear organ of balance or vestibule)
Debris in the posterior semicircular canal of the inner ear (BPPV)
The vestibular system located in and around the ear controls our body's sense of balance. When your head moves, the vestibular system sends information to the organs inside the ear, and these organs then pass the information on to the brain.
Benign paroxysmal positional vertigo (BPPV) results from debris particles that move freely within fluid in the canals of the inner ear. The debris is not related to getting anything in the ear canal; it just forms on its own.
A change in your head position, lying down, getting up, turning over in bed, or tipping your head backwards to look up may cause the debris to shift. This shifted debris affects the balance receptor in the ear and causes vertigo. The vertigo associated with BPPV comes on suddenly and usually only lasts for seconds to minutes. There are usually no hearing symptoms.
Symptoms of BPPV
- Lasts seconds to minutes
- No hearing problems
Possible Treatments for BPPV
A skilled doctor can perform some maneuvers that can move the debris out of the sensitive part of the ear (posterior canal). Your doctor can also teach you how to do certain exercises at home, placing your head in various positions at different angles. This may help move the debris in your ear as well.
The need for surgery is very rare, but in such cases a procedure known as "posterior canal plugging" can be done. This blocks most of the canal's function, which can reduce the symptoms.
4. Viral Labyrinthitis (Viral infection of the inner ear)
and
Vestibular Neuronitis (Disruption of vestibular input to the brain)
The brain and the inner ear communicate information via nerves. The cochlear nerve carries information about noise and hearing; the vestibular nerve carries information about balance and body position. Viruses can affect either or both nerves and the symptoms will vary according to which nerve has been affected.
4.a Viral labyrinthitis is a sudden disruption of the messages to the brain from within the inner ear as a result of a sudden viral infection. As a result of this virus, you may experience severe vertigo that usually comes on suddenly and can last from days to weeks, depending on the length of time the body builds up anti-bodies to the virus. There are no other symptoms related to the ear.
Symptoms of Viral labyrinthitis
• Vertigo Lasts days to weeks
• May have hearing changes
4.b Vestibular neuronitis is an inflammation of the vestibular nerve that causes a disruption of the message sent by the vestibular nerve to the brain. The first attack of vertigo is usually severe, and is associated with nausea and vomiting, lasting days to weeks. People with vestibular neuronitis do not have hearing loss or tinnitus.
Symptoms of Vestibular neuronitis
• Vertigo Lasts days to weeks
• No hearing changes
Possible Treatments for Either Cause
It is important for people suffering from such symptoms to be examined and diagnosed by an ENT (Ear Nose Throat) specialist since other conditions, such as stroke can present with similar symptoms. There are several medications that your physician may recommend if they feel that the vertigo associated with the vestibular neuronitis or viral labyrinthitis requires treatment. These include anti-vertigo agents, antihistamines, sedatives and or anti-nausea agents.
There are some other things that you can do to help alleviate the symptoms. Bed rest is recommended for the first 2 to 3 days from the initial onset of your symptoms. If your vertigo symptoms last more than a few days, staying active may be more helpful.
There are also some exercises that your doctor may suggest once the vertigo has subsided.
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