Vertigo - Types, Symptoms, Causes, Diagnosis, and Treatments

What Is Vertigo?

The symptom that makes a person feels that he or she is moving when they actually are not moving or has a sense of spinning dizziness or lightheadedness, is called vertigo. It is a symptom of various health conditions, such as problems in the inner ear or brain or nervous system. Vertigo can occur at any age, but it commonly affects people over 65 years of age. It can be either temporarily during pregnancy or ear infection. People with Ménière's disease (a disease affecting the inner ear) also suffer from vertigo.

If you have vertigo, you will feel as if the room is spinning around you. It is not a disease in itself, but a sign that you have some other health conditions. Benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and acute onset vertigo are the most common causes of vertigo.

What Are the Types of Vertigo?

The different types of vertigo are:

1. Peripheral vertigo - The majority of cases (80%) are this type. It is generally due to problems in the inner ear. The organs of the inner ear send messages to the brain about the person's position. They also help people keep their balance while walking and standing up. Any alteration in this system results in vertigo. The common causes include BPPV, inner ear inflammation, infection, Ménière's disease, and acoustic neuroma.
2. Central vertigo - Vertigo that results from problems in the central nervous system is called central vertigo. Any problem in the brainstem or cerebellum results in this type of vertigo. Vestibular migraine, demyelination, and CNS tumors are some common examples.

What Are the Symptoms of Vertigo?

Changing your head position is the most common trigger of vertigo. It feels like your head is spinning, swaying, tilting, you feel unbalanced and pulled to one side. The other symptoms that might be associated with vertigo are:

• Nausea.
• Sweating.
• Vomiting.
• Motion sickness.
• Feeling of ear fullness.
• Nystagmus (jerking eye movements).
• Headache.
• Tinnitus (ringing in the ears).
• Hearing loss.

The symptoms may come and go or last for a few minutes to hours.

What Causes Vertigo?

Usually, an imbalance in the inner ear or problems with the central nervous system (CNS) leads to vertigo. The common conditions that can result in vertigo are:

1. Labyrinthitis - Any ear infection that results in inflammation of the inner ear labyrinth is called labyrinthitis. The vestibulocochlear nerve is present in this area, which sends information about the head movements, position, and sound to the brain. Inflammation affects this exchange of information and results in vertigo. Labyrinthitis can also result in deafness, tinnitus, headaches, earaches, and changes in vision.
2. Vestibular neuritis - Vestibular neuritis is the inflammation of the vestibular nerve due to an infection. The difference between this and labyrinthitis is that vestibular neuritis does not affect the hearing. Along with vertigo, it results in blurred vision, nausea, and balance problems.
3. Cholesteatoma - It is a noncancerous skin growth that originates in the middle ear as a result of repeated infections. It can cause deafness and dizziness, as it grows and damages the bony structures of the middle ear.
4. Ménière's disease - This condition causes fluid to buildup in the middle ear, which leads to vertigo and tinnitus. It commonly affects people between 40 and 60 years of age. This condition is believed to be caused due to blood vessel constriction or viral infection or autoimmune.
5. Benign paroxysmal positional vertigo (BPPV) - The vestibular labyrinth three semicircular canals, which contain fluid and hair-like sensors. The inner ear also contains otolith organs that contain fluid and crystals that are sensitive to gravity. When these crystals get dislodged and go into the semicircular canals, it touches the hair-like sensors during head movement. This results in the middle ear sending wrong information about the patient’s position, which results in vertigo.
6. Pregnancy - Most pregnant women complain of nausea and dizziness. It is due to hormonal changes altering the fluid in the body. This can also alter the fluid in the inner ear resulting in vertigo, loss of balance, tinnitus, hearing problems, and ear fullness.
7. Hereditary - Some genetic and hereditary conditions can result in vertigo, but as such, vertigo is not hereditary. Familial episodic ataxia, migrainous vertigo, bilateral vestibular hypofunction, and familial Ménière 's disease are some examples of conditions that run in families and cause vertigo.

The other conditions that can cause vertigo are:

1. Perilymphatic fistula (inner ear fluid leaks into the middle ear)
2. Migraines.
3. Traumatic brain injury.
4. Head injury.
5. Brain stem disease.
6. Acoustic neuroma (vestibulocochlear nerve benign growth).
7. Ear surgery.
8. Shingles.
9. Otosclerosis (hearing loss due to middle ear bone growth problem).
10. Syphilis.
11. Ataxia.
12. Using certain medications.
13. Stroke.
14. Multiple sclerosis.
15. Prolonged bed rest.

How Is Vertigo Diagnosed?

To determine the cause of vertigo, your doctor will carry out a physical examination, and ask you about the factors that trigger dizziness. To diagnose the cause of vertigo, you might have to take the following tests:

• Romberg's test - You have to stand with your arms by your sides and your feet together and close your eyes. If you become unsteady on closing your eyes, it is a sign of some CNS problem.
• Fukuda-Unterberger's test - You have to march on a spot for 30 seconds with your eyes closed. If you turn to one side, it indicates a lesion in the inner ear.
• Head CT or MRI scan.

How Is Vertigo Treated?

Usually, the treatment depends on the cause of vertigo. In most cases, vertigo gets better on its own as the brain adapts to the changes in the inner ear, and maintains balance through other mechanisms. And for some, one of the following treatment options might be necessary:

1. Medicines - Medications are given to relieve nausea or motion sickness symptoms. Antibiotics and steroids are prescribed if vertigo is due to infection or inflammation. Diuretics are prescribed for Meniere's disease.
2. Vestibular rehabilitation - It is a type of physical therapy that helps strengthen the vestibular system. This therapy will help if you have recurrent episodes of vertigo. It helps you train other senses, which compensates for vertigo.
3. Canalith repositioning maneuvers - These are a series of specific head and body movements done for BPPV. These movements help move the calcium deposits into the inner ear chamber from the ear canal so that they can be absorbed by the body. A physiotherapist will guide you with these movements, and you might experience vertigo while performing them.
4. Surgery - In some cases like tumor or injury to the brain or neck, vertigo needs surgery.

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