Vertigo can be best described as a feeling of spinning, rotating, or rocking, that a patient experiences even when they are standing or sitting perfectly still. Vertigo is often used interchangeably with dizziness & other balance-related problems like motion sickness, walking disorders, lightheadedness, etc.
Most healthcare professionals consider Vertigo to be a separate health issue, different from the other balance disorders. In order to better understand Vertigo, it’s helpful to understand the anatomy of the human ear. Sound waves travel all the way through the outer ear canal to reach the eardrum. In there, sound waves turn into vibrations that transmit in the inner ear via three small bones; the incus, the malleus, & the stapes.
Travelling through these bones, they reach the cochlea, & finally, the vestibular nerve, which is responsible for carrying these signals to the brain & interpret them as various sound waves.
The inner ear, meanwhile, is not involved in this entire hearing process. It has a different purpose, which is to keep our body balanced by transmitting balance & position signals received from various sense inputs, to the brain.
The inner ear is composed of three semicircular canals, all positioned at right angles to each other. These are lined with sensitive nerve cells in the form of hair that act as a sort of gyroscope for the body. This combination of hair cells inside the utricle, saccule, & the otoliths(tiny calcium carbonate crystals inside the inner ear that are responsible for triggering the hair cells in response to any motion stimuli received), form the body’s vestibular system.
This system helps provide accurate & spontaneous feedback regarding our position in space, to the brain.
When a person is suffering from Vertigo, this delicate balance system in the inner ear takes a hit, & the vestibular nerve cells mistakenly send out confusing signals to the brain regarding our position, causing the resultant dizziness & disorientation signals.
Vertigo signs & symptoms
The early Vertigo symptoms & signs include a spinning sensation, loss of balance, whirling, & a loss of balance. The distinguishing feature of Vertigo is that these symptoms are felt even when the person is perfectly still. Head & body movements like sitting up suddenly, turning directions too quickly, rolling over in bed, etc., can trigger these Vertigo signs & symptoms. For many patients, Vertigo symptoms might also occur along with nausea or vomiting. Physical examinations on Vertigo patients often describe a sensation of spinning or nystagmus, which are abnormal movements of the eye. During Vertigo diagnostic tests, your doctor might try to trigger these movements & Vertigo symptoms by moving your head in abrupt manners to determine exactly which type of Vertigo you’re suffering from. It is important for your doctor to determine accurately if your Vertigo is coming from the inner ear region, or the balance centre in the brain called the cerebellum.
For this end, the patient might be asked to perform certain balance tasks that require the active participation of the cerebellum.
Vertigo can have multiple causes, depending on which type of Vertigo the patient is suffering from, Central of Peripheral. Central Vertigo has its roots in the brain or the spinal cord, while Peripheral Vertigo is generally caused by an issue in the inner ear.
Peripheral Vertigo causes:
- The structures in the inner ear may become inflamed spontaneously, leading to displacement of the small crystals & stones normally found in the inner ear canals. These crystals can then cause the tiny hair cells lining the semicircular canal to become sensitive thus making the patient feel dizzy & out of balance.
- Any Vestibular Nerve infection can cause disruptions in the functioning of the vestibular system, leading to dizziness or Vertigo. This condition is termed Vestibular Neuronitis, also called Vestibular Neuritis, or labyrinthitis.
- When fluid buildup occurs in the inner ear or the endolymphatic system, it causes a condition called Meniere’s disease. The Vertigo thus arising can also cause hearing loss or a ringing in the ears, also termed Tinnitus. Doctors have not been able to ascertain any causes for this fluid accumulation yet.
- Peripheral Vertigo can also be brought on by Acoustic Neuroma, or any tumors of the Vestibular nerve.
Central Vertigo causes:
- Central Vertigo can be caused by any concussion or traumatic brain injury.
- Strokes may also lead to Vertigo signs & loss of coordination.
- Multiple Sclerosis is another of Central Vertigo causes.
- Any tumors of the brain & the spinal cord can also be causes of Central Vertigo.
- Some patients suffering from a certain type of Vertigo called the Vestibular migraine, may also go on to develop Central Vertigo.
Risk Factors for Vertigo
Any head injuries may increase the chances of developing Vertigo, along with concussions & severe migraines. Certain Ear infections may damage the vestibular nerve, causing Peripheral Vertigo signs & symptoms. Certain medications like antiseizure medications, blood pressure medications, antidepressants, aspirin, etc., have Vertigo listed as a side effect. Consumption of Alcohol has also been linked to dizziness & nausea, which are both early Vertigo symptoms.
Older women are usually considered as a group that has a major risk of developing BPPV & other types of Peripheral & Central Vertigo signs & symptoms.
Diagnosis of Vertigo
During a usual diagnosis of Vertigo, your healthcare provider will take the history of your Vertigo symptoms & signs, how long you’ve been experiencing them, what movements trigger them, & more. They will also ask about any recent over-the-counter medications or supplements that you’ve been taking, along with any recent illnesses & medical problems.
This information helps them determine the exact cause & type of your Vertigo. After ascertaining your medical history regarding your Vertigo symptoms, your doctor will then move towards physical tests to determine the exact triggers of your Vertigo.
These tests include the dix-Hallpike maneuver, that includes the doctor rapidly moving the patient’s head to induce Vertigo signs in them, so that they can determine any accompanying nystagmus. This is important as it helps the doctor understand if the Vertigo has a Central or a Peripheral cause, which is helpful information when it comes to treatment of Vertigo. For patients who aren’t good candidates for the Dix-Hallpike test, the doctors might perform a ‘roll test’, which includes the doctor moving the patient’s head side to side while they are lying flat on their back.
In certain cases, your doctor might prescribe MRI scans & CT scans to determine the exact cause of your Vertigo.
Vertigo treatment plans include certain exercises & maneuvers, along with certain Vertigo medicines. Particle repositioning maneuvers are a big part of Vertigo treatment plans, of which the EpleyManeuver, also called the canalith repositioning maneuver, is the most well-known.
During this maneuver, the patient is required to perform certain head movements that help the displaced crystals move from the semicircular canals to their original positions.
As a word of caution to patients, it’s only feasible to know that some of these movements can cause dizziness & induce Vertigo symptoms in a patient. Thus, Vertigo patients are advised to not undertake any activity requiring them to focus or maintain their balance like driving, running etc., or operate heavy machinery, for at least some time after performing the Epley Maneuver.
Brandt-Daroff exercises are also very helpful in providing relief from dizziness & Vertigo symptoms to patients. These exercises involve changing from a seated position to lying flat quickly, while keeping the head in a direction opposite the original Vertigo inducing position.
Patients are required to repeat these exercises for multiple times in a day.
Other exercises like the Semont Maneuver & the Foster Maneuver are also noted to be helpful in reducing Vertigo symptoms & signs. Vertigo medicines like Meclizine, Benzodiazepine medications like Diazepam (Valium, etc., have also shown to be effective, but are noted to cause heavy drowsiness as a side effect. Certain home remedies like taking Ginkgo Biloba, adequate hydration, & getting good amounts of sleep, are also effective in helping prevent Vertigo symptoms & signs.