Balancing is the outcome of a reflex mechanism where the vestibule of the ear, eyes and sensory receptors of joints and muscles send sensory impulses to the central nervous system (brain and spinal cord). The integration occurs here, and finally, ordered impulses travel through motor nerves to postural muscles to maintain posture and balance. Dizziness, unsteadiness, and lightheadedness are symptoms expressed by the patient, which indicate the patient has a problem balancing.

What Is Vertigo?

Spinning dizziness is an essential characteristic feature of vertigo. The person feels like the space around them is spinning in circles. However, this feeling of spinning is a false sense and does not happen in reality. Vertigo, in itself, is not a disease but a symptom of an underlying condition.

What Are the Types of Vertigo?

So, vertigo is divided into two depending on the site of lesion in the above reflex mechanism:

Central Vertigo - It occurs due to problems affecting the brain.
Peripheral Vertigo - Diseases of the ear's vestibular labyrinth and semicircular canals result in peripheral vertigo. Any problem with the vestibular nerve, which connects the brain and the inner ear, can also cause this type of vertigo. This is very important because most of the patients with vertigo are found to be of vestibular origin. In a majority of the cases, it is reversible, and patients are found to be having an excellent spontaneous recovery. Recovery takes place in about two to four weeks.

What Causes Vertigo?

A few common vestibular diseases causing vertigo are:

Benign Paroxysmal Positional Vertigo (BPPV) - The most common type of vertigo that produces an intense spinning sensation. A sudden change to the head movement is an important triggering factor for this type of vertigo.
Transient Ischemic Attack (TIA) - Transient loss of blood flow to the brain can cause vertigo.
Meniere's Disease- A disease of the inner ear characterized by excessive fluid build-up is called Meniere's disease, which can cause hearing and balance defects, resulting in vertigo.
Viral Infection- A viral infection of the inner ear results in hearing and balance defects. Infection can occur involving the vestibular nerve or vestibular labyrinth. If it consists of the nerve, it is called vestibular neuritis, and if it involves the labyrinths, it is called vestibular labyrinthitis.
Migraine- Chronic migraine headaches can be associated with vertigo and last several hours.
Head Injury - Any injury to the head and neck region that can bring about a blow to the vestibular system can cause vertigo.
Medications - Medicines toxic to the inner ear structures like diuretics, aminoglycoside antibiotics, salicylates, and Cisplatin can cause vertigo.
Vestibular Nerve Impingement - Noncancerous growths like schwannoma and meningioma might impinge against the vestibular nerve, resulting in vertigo.
Cholesteatoma - Cholesteatoma is also a noncancerous condition due to subsequent ear infections. This can result in vertigo, dizziness, and sometimes loss of hearing.

Central vertigo can happen due to the following:

Stroke.
Seizures.
Brain tumors.
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Vascular disorders of the brain.
Medications like Aspirin and anticonvulsants.
Alcohol intake.
Multiple sclerosis.

Below are some other common causes of vertigo:

Arrhythmia.
Shingles.
Diabetes.
Surgery involving the ear.
Ataxia (muscle fatigue).
Perilymphatic fistula, in which there is leakage of inner ear fluid into the middle ear.
Otosclerosis, which is characterized by hearing loss due to extra growth of the middle ear bone.
Acoustic neuroma, a benign growth that develops adjacent to the inner ear along the vestibulocochlear nerve.
Orthostatic hypotension characterized by a decrease in blood pressure when standing.
Syphilis.
Taking bed rest for an extended period of time.
Hyperventilation.

What Are the Symptoms of Vertigo?

One common symptom characteristic of central and peripheral vertigo is spinning sensation and dizziness.

In the case of peripheral vertigo, below are the accompanying symptoms:

Unilateral loss of hearing.
Ringing sensation in the ears or tinnitus.
Balance loss.
Difficulty in focusing the eyes.
Nausea and vomiting.
Profuse sweating.

While in central vertigo, the following symptoms are seen:

Problems with eye movement.
Slurring of speech.
Facial paralysis.
Problems with swallowing.
Double vision.
Fatigue of the lower extremities.

How Is Vertigo Diagnosed?

A physical examination along with specific diagnostic tests help in the diagnosis of vertigo.

1. Physical Examination:

The doctor takes a complete medical history along with an evaluation of symptoms to diagnose the condition of vertigo.

2. Romberg's Test:

In this test, the individual is asked to stand straight by keeping the feet together, arms on the side, and closing the eyes. When there is any problem with the central nervous system, an unbalance is felt.

3. Fukuda-Unterberger's Test:

The patient is asked to close their eyes and do marching in a particular place for about 30 seconds. Rotation or leaning towards the side may indicate the patient has problems with the inner ear.

4. Videonystagmography:

Eye movement is monitored with the help of goggles placed on the eyes, and the individual is asked to follow the target by moving the eyes and moving the head and body along various positions. This test also records eye movement after warm or cold water is poured into the ear canal.

5. Head Impulse Test:

The individual is asked to focus on a stable object while the test taker moves the head to the side. This helps in investigating the work of inner ear balance to keep the eye movements in control during a change in the head position.

In addition to this, certain tests that are employed in determining the cause and type of vertigo include:

Computed tomography (CT) scan of the head.
Magnetic resonance imaging (MRI) of the brain and Magnetic resonance angiography (MRA) of the brain's blood vessels.
Electroencephalogram.
Lumbar puncture.

What Is the Treatment for Vertigo?

Treatment of vertigo is a multifactorial approach and depends on the cause. In many cases, treatment for vertigo is not needed. However, a causative treatment may be required in some.

The following are the modalities available for the treatment of vertigo:

1. Medications:

The symptoms of vertigo can be best managed by treating the underlying cause. For example, vertigo that occurs due to viral infection is treated with the help of antibiotics. Medicines can treat motion sickness and nausea associated with vertigo. Meclizine is an antihistamine drug that is used in the treatment of motion sickness. Also, steroids can be used in the treatment of inflammation. However, there are risks of developing amnesia or confusion when taken by older people.

2. Repositioning Maneuvers:

It is exclusively employed in the treatment of benign paroxysmal positional vertigo. Also called the canalith repositioning maneuver or Epley maneuver, it is a procedure in which the calcium deposits in the inner ear are repositioned by making the patient stand in a particular position. The patient is asked to maintain four different positions, with each position lasting for about half a minute to a minute. This is done initially with the guidance of a healthcare provider; later on, this can be performed at home by following the instructions.

3. Vestibular Rehabilitation:

Vestibular rehabilitation therapy includes exercises specifically designed for every individual depending on their symptoms. The following are the procedures employed in vestibular rehabilitation therapy:

Habituation, that helps in managing dizziness.
Training for balance that helps the patient to be steady.
Gaze stabilization, a method employed to enhance eye movements with respect to head positions.

4. Surgery:

In conditions like a head injury or tumors of the brain, surgery is the best option to improve the symptoms of vertigo.

How Can We Prevent Vertigo Attacks?

The following can help in reducing the risk of vertigo attack:

When you feel dizzy, sit down as soon as you can.
Avoid bending over to pick items from the floor; instead, squat.
Keep two pillows under your head while sleeping.
While standing up, rotating your head, or performing any triggering factors, take it slow.

What Is the Prognosis With Vertigo?

Central vertigo usually has a bad prognosis and is treated by neurosurgeons, whereas vestibular vertigo has a good prognosis and is treated by otolaryngologists.

Is Vertigo Associated With Pregnancy?

During the first trimester of pregnancy, vertigo is a widely prevalent symptom. Vertigo during pregnancy is attributed to the following factors:

Staying on bed rest for a long time.
Alterations in the metabolism of nutrients like calcium and vitamin D.
Changes in hormone levels.

Is Vertigo a Life-Threatening Condition?

Vertigo is not a serious condition by itself. However, the cause of vertigo can be. Therefore it is essential to get yourself tested with the help of a healthcare provider to rule out life-threatening causes.

Conclusion:

Vertigo is a condition that produces dizziness and a spinning sensation. Several causative factors can contribute to vertigo. Treating the underlying causes is the best approach in managing vertigo. Reach out to an ENT specialist or neurologist in the case of symptoms of dizziness to opt for the best treatment.