Vertigo : Causes, Types, Treatment and Symptoms

Vertigo is a specific type of dizziness charecterized by a false sense that you or your surroundings are spinning even though there are no actual movements. They are often accompanied by affecting your balance or sensory perception, which typically feels like a tilting or swaying in one direction. Vertigo becomes very distressing when it interferes with your daily activities, such as driving or walking.

Most Common Vertigo Symptoms:

• Spinning sensation or spinning of the surroundings
• Feeling the body balance is off or pulled in a particular direction
• Abnormal jerking of the eye (nystagmus)
• Ringing of the ears (tinnitus)
• Feeling that your ear cavity is blocked
• Slurred speech
• Weakness in the arms and legs
• Trouble moving the face

Common, Uncommon or Underlying Causes of Vertigo

Causes can range from very common and treatable to serious neurological conditions, where the duration and severity of vertigo vary depending on the underlying causes.

• Brain-related causes that involve the brainstem and cerebellum, such as:
  a. Brain tumors – for instance, acoustic neuromas, affecting the hearing and balance nerves.
  b. Stroke or transient ischemic attack (TIA) – sudden disruption in the blood flow to the brain areas responsible for balance.
  c. Multiple sclerosis – plaques in the brain or vestibular pathways
• Problems in the inner ear or vestibular nerve, such as:
  a. Vestibular Neuritis – inflammation in the vestibular nerve that connects the inner ear to the brain.
  b. Labyrinthitis – inflammation of the inner ear structure responsible for balance and hearing.
  c. Meniere’s Disease – a chronic disorder charecterized by fluctuations in the fluid pressure.
  d. Benign Paroxysmal Positional Vertigo (BPPV) – it is caused due to displaced calcium crystals, leading to a sudden spinning sensation.
• Vestibular migraine: Vertigo occurs as a symptom of migraine with episodes of headache and nausea.
• Head injury: trauma to the brain, skull, or ear structure.
• Certain medications: medications like diuretics, anticonvulsants, and antibiotics may affect the inner ear structure
• Psychological causes: anxiety or mood swing with dizziness can manifest as vertigo-like symptoms.
• Infection involving Ramsay-Hunt syndrome: viral infections affecting the nerve involved in balance.
• Autoimmune inner ear disease: an autoimmune attack on the inner ear.
• Perilymphatic fistula (PLF) : a tear in the membranes of the inner ears.
• Superior semicircular canal dehiscence : a lack of bone overlapping the superior semicircular canal in the inner ear.

When to Seek a Specialist for Your Vertigo?

You should visit an otolaryngologist, neurotologist, or physical therapist for vertigo. They can help you accurately diagnose the cause and develop a targeted treatment plan.

• Sudden severe headaches
• Double vision, sudden vision loss, or hearing loss
• Slurred speech or difficulty speaking
• Prolonged confusion or a sudden change in consciousness
• Chest pain or a rapid, irregular heartbeat
• If the initial treatment does not resolve the pending symptoms
• Recurrent or persistent episodes of vertigo
• Episodes that last longer for hours or days

Don’t wait for signs to grow severe. Consult our ENT Specialists today

Diagnostic Approach for Vertigo

In order to distinguish between benign, inner-ear-related (peripheral) and more severe brain-related (central) causes of vertigo, the diagnostic procedure begins with a comprehensive patient history and physical examination. Subsequently, additional testing, such as advanced imaging and specialized vestibular assessments, may be implemented to identify the precise underlying condition.

• Confirmation of the spinning sensation
• Type of onset, whether sudden or gradual
• Noting the duration of the vertigo, if it is confined within seconds to a minute, minutes to an hour, or hours to days
• Identifying triggers
• Addressing the associated symptoms
• Past medical history
• The Dix-Hallpike maneuver, a diagnostic test to confirm BPPV, by positioning the patient from sitting to a reclined position to check for a delayed and brief spinning sensation, and rapid involuntary eye movements
• Romberg’s test is where the patient’s gait and balance are observed with their eyes closed and open, using posturography.
• HINT exam typically stands for:
• Head Impulse (vestibular ocular reflex) using Video Head Impulse Test (vHIT) 
• Nystagmus uses videonystagmography (VNG)
• Test of Skew (vertical misalignment of the eyes)
• Non-invasive vestibular and balancing movements, using vestibular evoked myogenic potentials (VEMP) that measure natural muscle responses to loud clicks.
• Imaging tests that include MRI scans and CT scans, or other tests like blood tests in the case of nutritional deficiencies or vestibular problems.

Types of Vertigo

There are only two types of vertigo, namely peripheral and central, distinguished by their point of origin.

Some common types of Vertigo include:

1. Peripheral vertigo: 

• Caused in the inner ear or vestibular nerve 
• Can be intense and typically short-lived 
• Lasts for days with brief episodes
• Nystagmus tends to be one-directional and can be controlled by focusing on one fixed point.

2. Central vertigo: 

• Caused in the brainstem or cerebellum
• Can be more severe, constant, making walking or standing difficult
• Episodes may last for a few weeks or months
• Nystagmus can change directions and won’t correct with a visual fixed point.

What if Vertigo is Left Untreated?

In some instances, the underlying condition may worsen, and there are several escalating health risks that can result from leaving vertigo untreated. Additionally, the quality of life may be diminished. These complications may vary based on the type of vertigo.

Some possible complications of an untreated Vertigo include:

• Increased risk of falling
• Permanent damage to the inner ear.
• Constant balancing issues.
• Worsening frequency and intensity.
• Increased anxiety and avoidance of activity.
• Long-lasting symptoms of disorientation and unsteadiness.
• Delayed full recovery.
• Permanent brain damage, affecting balance, vision, and speech.
• Worsen neurological symptoms and cause life-threatening complications with tumor involvement.
• Reduced mobility, chronic fatigue and impaired delayed function.

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