Vertigo Treatment in Delhi, India

Vertigo is a condition in which a person feels dizzy with gait instability and vomiting. There is a sensation that everything around is spinning. In the younger population, it is commonly associated with inner ear infections while in adults, there may be other underlying causes.

Vertigo can be classified into two types:

Central vertigo

Central vertigo is related to dysfunction of vestibule-cochlear system and particularly brainstem of the central nervous system. The most common parts affected are the brainstem and cerebellum. Probable causes can be tumours of the CNS, vestibular migraine, demyelination, and cervical spine issues.

Peripheral vertigo

This is the most common type of vertigo accounting for about 80% of all reported cases. It is usually caused by inner ear or vestibule-cochlear dysfunction.

The most common cause of vertigo is an inner ear issue. The following factors may play a role in triggering vertigo:

Central nervous system disorders

These disorders can affect the brain or spinal cord, which can also cause vertigo. Common central nervous system disorders that cause vertigo include:

Stroke

A stroke is a sudden interruption of blood flow to the brain. It can cause damage to the areas of the brain that control balance and spatial orientation.

Multiple sclerosis

This is a chronic autoimmune disease that affects the central nervous system. Multiple sclerosis can cause vertigo, along with other neurological symptoms such as muscle weakness, fatigue, and vision problems.

Migraine headaches

Migraine headaches can sometimes cause vertigo, along with other symptoms such as Headache, nausea, and vomiting.

Certain medications

Some medications can cause vertigo as a side effect. These medications include anticonvulsants, antidepressants, and sedatives.

Labyrinthitis

An inner ear infection that affects the two vestibular nerves that are responsible for the communication with the brain about bodily balance spatial navigation is called Labyrinthitis. One of the symptoms of this infection is vertigo.

Benign paroxysmal positional vertigo (BPPV)

When small calcium deposits of the ear called canaliths get dislocated from their place and collect in the inner ear, the affected person is off-balanced. This happens because the inner ear signals the brain to maintain body balance.

Meniere’s disease

When fluid builds up in the inner ear, a change in pressure occurs and this may cause ringing in the ear.

Cholesteatoma

Benign skin growth in the middle ear caused by repeated incidences of ear infection is called cholesteatoma. This condition can cause dizziness, hearing loss, and vertigo.

Other causes

Other, less common causes of vertigo include head injuries, inner ear tumours, and low blood pressure.

A person with vertigo may experience the following symptoms:

- Dizziness

- Light-headedness

- A sensation of everything around is spinning

- Loss of balance and feeling unsteady

- Nausea or vomiting

Few accompanying symptoms may be: 

• Headache 
• Tinnitus (ringing sounds in the ear)
• Nystagmus (eyes make involuntary, repetitive movement)
• Hearing difficulties

Assessment of symptoms and physical examination reveal enough information to diagnose vertigo. A few scans may be advised to rule out any underlying medical conditions. Here are some of the tests that a vertigo doctor might advise.

Romberg's test

This test is carried out to assess the functioning of the central nervous system. The patient is asked to stand with the eyes closed, feet together, and arms by the side. Feeling unbalanced or unsteady indicates issues with the central nervous system.

Fukuda-Unterberger's test

In this test, the patient is asked to march while standing, with eyes closed. If the patient rotates or leans towards one side, it would suggest issues with the inner ear labyrinth and could cause vertigo.

Vestibular test battery

A combination of several tests is performed to diagnose inner ear problems. To monitor eye movements, the patient is asked to wear goggles while moving the eyes to follow a target. The patient may be asked to move the head and body even after warm and cool water is dripped into the ear canal.

Head impulse test

While focusing on a fixed target, the patient is asked to move the head gently to each side. This is done to assess the functioning of inner ear balance in controlling eye movements.

Hearing test

Hearing tests are conducted for individuals experiencing tinnitus (ringing in the ears) or hearing loss. In such cases, a general practitioner may refer them to an ear, nose, and throat (ENT) specialist. The specialist employs various hearing tests, including:

• Audiometry Test: In this test, an audiometer is used to expose the individual to a range of sounds with varying volumes and pitches through headphones. The person participating in the examination signals their perception of each sound, commonly through actions such as raising a hand or pressing a button.
• Tuning Fork Test: During the test, a tuning fork, producing sound waves at a fixed pitch, is gently tapped on the base of its handle. The tester then assesses hearing by holding the tuning fork on each side of the individual's head.

Videonystagmography (VNG)

During this diagnostic procedure, specialised goggles with an integrated video camera are placed over the eyes. The individual is prompted to focus on various stationary and moving targets, allowing for a detailed examination of nystagmus—a potential indicator of issues with the organs responsible for balance.

Electronystagmography (ENG)

Similar to VNG, this test assesses nystagmus, but instead of goggles, electrodes are placed around the eyes to record eye movements and provide diagnostic insights.

Caloric testing

This diagnostic method involves the introduction of warm or cool water or air into the ear for about 30 seconds. The resulting temperature change stimulates the balance organ, allowing specialists to assess its functionality. Dizziness may occur during and shortly after the test.

Posturography

Using a specialised balance-testing machine, this test provides valuable information about how vision, proprioception (sensations from the feet and joints), and ear input contribute to maintaining balance. The results can assist in planning rehabilitation and monitoring treatment progress. Other tests which may be performed are CT Scan and MRI.

The treatment for vertigo depends on the underlying cause. Some common treatments and management strategies for vertigo include:

Canalith repositioning manoeuvres (Epley manoeuvre)

This is a series of head and body movements performed under the guidance of a healthcare professional to reposition displaced ear crystals (otoconia) in the inner ear.

Vestibular Rehabilitation Therapy (VRT)

VRT is a specialised form of physical therapy that aims to improve balance and reduce dizziness through exercises that promote adaptation and compensation for inner ear deficits.

Medications

• Antihistamines: These may be prescribed to alleviate symptoms of motion sickness and reduce dizziness.

• Anti-vertigo medications: Medications such as meclizine or dimenhydrinate may be used to relieve vertigo symptoms.

Treatment of Underlying Conditions

If vertigo is caused by an underlying condition such as Meniere's disease or vestibular migraines, specific treatments or medications targeting those conditions may be recommended.

Surgery

In certain cases, surgical procedures may be considered, particularly if vertigo is caused by structural issues in the inner ear.

Seeking medical advice for vertigo is crucial. A Vertigo doctor, often a neurologist, can help diagnose the cause and develop a treatment plan. Self-diagnosis and treatment without professional guidance can be risky, as different causes of vertigo may require different approaches.

Vertigo has the potential to lead to falls, resulting in bone fractures or other injuries. It can significantly impact an individual's quality of life and impede their ability to drive or maintain regular work activities.

Patients suffering vertigo have a fair prognosis and once the underlying cause is taken care of, vertigo would disappear completely.

Can vertigo be cured?

The possibility of curing vertigo depends on the underlying cause. While some cases of vertigo can be resolved or managed effectively, others may be chronic or recurrent, requiring ongoing symptom management.

Can stress and anxiety trigger vertigo?

Yes, stress and anxiety can trigger or exacerbate vertigo symptoms in some individuals. Emotional stress can disrupt the balance centres in the brain, leading to an increased perception of dizziness or spinning.

Can certain dietary changes help with vertigo?

In some cases, certain dietary changes like reducing salt intake or avoiding trigger foods (such as caffeine, alcohol, and processed foods) may help manage vertigo symptoms, especially in individuals with conditions like Meniere's disease.

Is vertigo a symptom of a more serious underlying condition?

Vertigo can sometimes be a symptom of a more serious underlying condition, such as a stroke, transient ischemic attack (TIA), or a brain tumour. It is important to seek medical evaluation to determine the cause of vertigo.

Can neck or head injuries lead to vertigo?

Yes, neck or head injuries, such as whiplash or concussion, can damage the vestibular system and result in vertigo symptoms.

Can hormonal imbalances contribute to vertigo?

Yes, hormonal imbalances, such as those occurring during pregnancy or menopause, can sometimes contribute to the onset or worsening of vertigo symptoms.

Can vertigo be a side effect of high blood pressure medications?

In some cases, certain high blood pressure medications, such as diuretics or beta-blockers, may have vertigo as a potential side effect.

Can certain sleeping positions trigger vertigo?

Yes, certain sleeping positions, particularly those that involve the head in a dependent position or with rapid changes in head position, can trigger vertigo in susceptible individuals.

Can caffeine or alcohol worsen vertigo symptoms?

Yes, caffeine and alcohol can potentially worsen vertigo symptoms in some individuals by affecting blood flow, triggering dehydration, or interfering with the central nervous system

Can vertigo be triggered by changes in position, such as bending over or looking up?

Yes, certain positional changes, such as bending over, looking up, or getting up from a lying position, can trigger vertigo in individuals with conditions like BPPV.

Can vertigo episodes last for extended periods?

Vertigo episodes can vary in duration, ranging from a few seconds to several hours or even days, depending on the underlying cause and individual factors.

Can vertigo affect concentration and cognitive function?

Yes, vertigo can impact concentration and cognitive function, as the constant sensation of dizziness or spinning can be mentally distracting and exhausting.

Can vertigo be hereditary?

There may be a genetic component to some forms of vertigo, such as Meniere's disease or familial episodic ataxia. However, the exact genetic factors and inheritance patterns are still being studied.

Can vertigo occur during pregnancy?

Yes, hormonal changes and fluid shifts during pregnancy can lead to an increased susceptibility to vertigo in some women.

Can allergies contribute to vertigo symptoms?

In some cases, allergies, particularly those affecting the nasal passages and sinuses, can cause inflammation and fluid buildup that may indirectly contribute to vertigo symptoms.

Can vertigo be associated with certain autoimmune disorders?

Yes, certain autoimmune disorders, such as autoimmune inner ear disease (AIED), can cause inflammation and damage to the inner ear structures, leading to vertigo.

Can vertigo be a sign of a brain tumour?

While rare, vertigo can be a symptom of a brain tumour, particularly if it is accompanied by other concerning signs such as persistent headache, vision changes, or neurological deficits.

Can age-related changes in the inner ear lead to vertigo?

Yes, age-related changes in the inner ear, such as decreased blood flow or degeneration of the vestibular structures, can contribute to the development of vertigo in older individuals.

Can vertigo be prevented?

Prevention strategies for vertigo depend on the underlying cause. In some cases, avoiding triggers such as certain medications, stress, or dietary factors may help reduce the frequency or severity of vertigo episodes. However, not all causes of vertigo can be prevented.

Are there any home remedies or exercises for vertigo?

Yes, certain home remedies and exercises can help manage vertigo symptoms. These may include the Epley manoeuvre, Semont manoeuvre, Brandt-Daroff exercises, and lifestyle modifications like avoiding triggers, maintaining good hydration, and managing stress.

What is vertigo?

Vertigo is a sensation of spinning or dizziness often caused by problems with the inner ear or the brain's perception of balance.

What are the common causes of vertigo?

Some common causes of vertigo are benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, labyrinthitis, migraines, inner ear infections, head injuries, and certain medications.

How is vertigo diagnosed?

Vertigo is diagnosed by medical history evaluation, physical examination, and diagnostic tests such as the Dix-Hallpike manoeuvre, electronystagmography (ENG), or magnetic resonance imaging (MRI).

What are the treatment options for vertigo?

Treatment options for vertigo depend on the underlying cause. They may include canalith repositioning manoeuvres, medication (such as anti-vertigo drugs or anti-nausea medications), vestibular rehabilitation therapy, lifestyle changes, and surgical interventions in some cases.

Can medication be used to treat vertigo?

Yes, medications such as antihistamines, anticholinergics, and benzodiazepines may be prescribed to alleviate vertigo symptoms or manage associated nausea and vomiting.

What is vestibular rehabilitation therapy?

Vestibular rehabilitation therapy involves exercises and manoeuvers to help improve balance and reduce vertigo symptoms. It is often recommended for individuals with inner ear disorders or vestibular dysfunction.

Can surgery be performed to treat vertigo?

In certain cases, surgical interventions may be considered for vertigo treatment. Surgical options include endolymphatic sac decompression, vestibular nerve section, or labyrinthectomy. However, surgery is typically reserved for severe or refractory cases.

Can migraines cause vertigo?

Yes, migraines can cause a type of vertigo called vestibular migraine. In vestibular migraines, individuals experience dizziness or spinning sensations with other migraine symptoms.

Can certain medications cause vertigo?

Yes, certain medications, such as certain antibiotics, anti-seizure drugs, and high blood pressure medications, can have vertigo as a potential side effect.

Can inner ear infections cause vertigo?

Yes, inner ear infections, such as vestibular neuritis or labyrinthitis, can cause severe vertigo due to inflammation or infection of the inner ear structures responsible for balance.

Can Meniere's disease be a cause of vertigo?

Yes, Meniere's disease is a chronic condition of the inner ear that can cause recurring episodes of vertigo, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the affected ear.

Can vestibular neuritis or labyrinthitis result in vertigo?

Yes, both vestibular neuritis and labyrinthitis are conditions that involve inflammation of the inner ear and can lead to severe vertigo episodes.

Can vertigo affect balance and coordination?

Yes, vertigo can impact balance and coordination, making it difficult for individuals to perform everyday activities and increasing the risk of falls.

Can vertigo cause nausea and vomiting?

Yes, vertigo can cause severe nausea and vomiting, especially during episodes of acute dizziness or spinning sensations.

Can vertigo be a symptom of a stroke or transient ischemic attack (TIA)?

Yes, vertigo can be a symptom of a stroke or transient ischemic attack (TIA), especially if it is sudden in onset, severe, and accompanied by other neurological signs.

How can individuals manage or alleviate symptoms of dizziness and vertigo?

Here are some tips individuals must follow.

1. When a person feels that the head is spinning, lying still in a quiet, dark room can be soothing.
2. Sitting down helps lower dizziness.
3. Squatting instead of bending over can prevent the onset of dizziness.
4. Taking longer to perform triggering activities such as standing up, sitting, looking up, or even turning the head.
5. Using a walking stick
6. Making adaptations such as sleeping with additional pillows under the head.

Reviewed by Dr. Mukesh Kumar, Associate Director and Head (Parkinson's Disease Unit), Neurosciences, Neurology on 24-Apr-2024.