Vertigo is a common condition in which a person feels dizzy with gait instability and vomiting. It is a sensation that feels like everything around is rotating. In the younger population, it is commonly associated with inner ear infections while in adults, there may be other underlying causes.
A person with vertigo may experience the following symptoms:
Nystagmus (eyes make involuntary, repetitive movement)
Vertigo can be divided into two types:
Central vertigo is related to dysfunction of vestibule-cochlear system and particularly brain stem of the central nervous system. The most common parts affected are the brainstem and cerebellum. Probable causes can be tumors of the CNS, vestibular migraine, demyelination, and cervical spine issues.
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:
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.
When fluid builds up in the inner ear, a change in pressure occurs and this may cause ringing in the ear.
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.
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:
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.
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.
Other tests which can be performed are CT Scan and MRI
Vertigo usually subsides on its own. Certain medications may be required to treat underlying conditions or associated sickness in some cases:
Some medicines may be used to provide symptomatic relief. Anti-emetics help alleviate nausea and vomiting, antibiotics may be required to treat middle ear infections.
Anti-histamines, such as prochlorperazine can help deal with the initial stages of vertigo.
People who are off-balanced and feel dizzy can opt for simple vestibular rehabilitation training which includes a series of exercises to restore balance.
Some medications may be useful to suppress vestibular symptoms in acute episodes that may last a few hours to days.
In patients diagnosed with vestibular neuritis, corticosteroids are recommended in addition to vestibular rehabilitation.
In patients with Meniere disease, lifestyle adjustments along with medication and vestibular rehabilitation have proven to be effective.
Some exercises may be performed for vertigo. These include Dar off exercises, the Semont maneuver, and the Foster maneuver.
Epley maneuver: BPPV can be treated with head rotation maneuvers that help displace calcium deposits into the vestibule through canalith repositioning termed Epley maneuver. This maneuver can be performed by the patient at home as below:
To perform Epley’s maneuver, the patient is asked to sit upright on a bed with their head turned 45 degrees to the left, and a pillow is kept behind them.
The pillow should be kept in such a way that when lying, the pillow is directly under the shoulders. Once the patient is in position, they should lie down on the bed quickly onto the pillow, so the head is reclined onto the bed.
This position should be held for 30 seconds.
Next, without raising the head, they should turn the head 90 degrees to the opposite side (right) and hold this position for another 30 seconds.
30 seconds later, the body and head should be turned another 90 degrees to the right and wait for another 30 seconds.
Finally, on the right side of the bed, they should sit up.
Repetition of this maneuver can be done starting on the opposite side. It should be performed at least three times a day. This should be practiced till no new episodes of positional vertigo arise for 24 hours.
An accurate diagnosis of vertigo is essential so that one does not overlook any life-threatening conditions such as having neoplasms, infection, and any cerebrovascular accidents.
Certain lifestyle changes that help reduce the effects of vertigo are as follows:
When a person feels that the head is spinning, lying still in a quiet, dark room can be soothing.
Sitting down helps lower dizziness.
Squatting instead of bending over can prevent the onset of dizziness.
Taking longer to perform triggering activities such as standing up, sitting, looking up, or even turning the head.
Using a walking stick
Making adaptations such as sleeping with additional pillows under the head.
Patients suffering vertigo have a fair prognosis and once the underlying cause is taken care of, vertigo would disappear completely.