Vertigo is a condition in which a person experiences a loss of balance and dizziness as if he or his environment is moving, spinning, or swaying. It can lead to nausea and disability. Vertigo is more common in older people but can affect people of either sex at any age. It can be temporary or permanent.
Causes of vertigo
The organ of balance is the vestibular system in the ear, which is a small network of fluid-filled tubes and sacs. There are two identical vestibular systems in the labyrinth of each inner ear. When you move, the fluid in the tubes also moves, and the level of fluid is read by nerve cells. The information is then sent to the brain, which uses it to determine which way down and what horizontal level you should be at.
All balance problems stem from the vestibular system, which is why people who suffer from frequent dizziness are said to have vestibular disorders. Vestibular disorders can also cause ringing in the ears or hearing loss. Vertigo can also be caused by changes in parts of the brain (cerebellum and brainstem) that also play a role in regulating balance.
The main causes of vertigo are:
- Benign paroxysmal positional vertigo: This is a common form of vertigo, usually caused by a specific position or movement of the head. It is caused by a displacement of the calcium deposit in the organ of balance (the inner ear) that causes the symptoms.
- Head trauma: a severe blow to the head is likely to cause temporary or permanent damage to the inner ear, which may cause imbalance.
- Labyrinthitis: untreated bacterial infections of the middle ear can spread to the inner ear and cause damage to the labyrinth and hearing loss.
- Neuritis: viral neuritis is really just viral labyrinthitis, which affects the nerves of the vestibular system without affecting the cochlea (the hearing organ). However, nerve inflammation can also be caused by clotting of the small blood vessels supplying the inner ear.
- Meniere’s disease: also known as “watchmaker’s disease”, as it usually affects people who work in a precise and delicate profession that requires concentration and precise control of the hands for long periods of time. The cause of Meniere’s disease is unknown.
- Medications: Some antibiotics, used for long periods or in high doses, can cause permanent damage to the vestibular system. Other drugs, such as acetylsalicylic acid (ASA)*, caffeine, alcohol, nicotine, tranquilizers, sedatives, and many illegal drugs can cause temporary dizziness but do not permanently damage the vestibular system.
Symptoms and complications of vertigo
Vertigo is the main symptom of imbalance issues. If you close your eyes, you will feel as if you are spinning or falling. Very severe vertigo can prevent you from walking further and cause vomiting.
Because the vestibular system is connected to the eyes and the brain’s movement center, some people with vestibular disorders find that their vision is impaired or that their muscles have difficulty coordinating and their body does not move as they would like. The muscles can be sore, especially in the neck and back.
Some people also experience other symptoms during vertigo spells, such as memory problems or reading difficulties. Most people find the effort required to fight the dizziness exhausting. Symptoms can last from a few minutes to a few hours.
The symptoms of bacterial labyrinthitis are obvious. Ear infections are usually followed after a few days or weeks by rapid deterioration of hearing and extreme dizziness. Viral labyrinthitis may occur a few weeks or months after the flu or other viral illness. Vertigo is limited and your hearing may remain intact, although you are likely to suffer from tinnitus, or ringing in the ears.
Meniere’s disease is associated with intermittent dizziness and ringing in the ears, which can occur once a year or once a day. The hearing may be temporarily affected, but in the long term, it tends to get worse. About 10-15% of people with Meniere’s disease have both ears affected.
Inflammation of the nerves caused by a blood clot causes a sudden loss of balance that can make walking impossible for several weeks. Your hearing may not be affected.
Many diseases can cause dizziness, especially those that cause poor circulation and low blood pressure. The first step in making a diagnosis is a full medical examination.
Audiometry is a detailed examination of various hearing abilities. Electronystagmography, which measures eye movement in different positions, gives a clue to the nature of the problem. In a Moving Platform Posturography test, you stand on a moving platform and a machine records your responses to movement.
Treatment and prevention
Many vertigo episodes, including severe dizziness such as that associated with labyrinthitis, resolve spontaneously but usually progress slowly. Depending on the cause of vertigo, your doctor may recommend different treatments, from antibiotics and other drugs to surgery. They may also recommend certain exercises to help you cope with the dizziness so that the attacks are less intense and shorter.
For benign paroxysmal positional vertigo, there is an effective treatment called the Epley maneuver. Your doctor or therapist can perform this series of head movements during an acute attack and then teach you how to perform them yourself if the attack recurs. Many commercial tools are available to help you perform the maneuver correctly.
If the dizziness is due to a movement disorder or a particular type of movement, it can be prevented by avoiding the trigger or by using a technique called ‘visual fixation’, which helps to prevent dizziness by focusing the gaze on a specific point on the horizon.
Rehabilitation programs can also help people with vestibular impairment to regain their balance and coordination and to overcome vision problems.