Most people experience dizziness at some time or other, but some people also experience vertigo – a feeling as if their surroundings are spinning, tilting or moving around. Because this sensation causes unsteadiness and a loss of balance, it can also result in accidents and injuries. Since there are a number of different factors that can cause vertigo, effective treatment depends on accurate diagnosis.
First, we need to start by understanding the difference between dizziness and vertigo. Dizziness is the feeling of being lightheaded and giddy. The symptoms are often nonspecific and can be caused by a variety of illnesses, including vascular disease, neurological disorders, and anemia.
Vertigo, on the other hand, is the often overwhelming sensation that one’s surroundings are spinning, tilting, or moving around even when the person with the condition remains motionless. In severe cases, the symptoms may include nausea, vomiting, pressure in the ear, hearing loss and ringing in the ear or a feeling of floating.
These symptoms are caused by a disturbance to the balance system in the inner ear and/or central nervous system. This balance system provides the brain with information about changes in movement, so when it is damaged in any way, it affects balance and orientation. The disturbance leading to vertigo can be caused by several conditions.
- The most common of these conditions is Benign Paroxysmal Positioning Vertigo (BPPV), which is the degeneration of the inner ear, a condition which affects people increasingly as they age. Prominent symptoms include feeling as if everything is spinning around each time someone with the condition moves their head, such as when lying down, getting up, raising their head, or lowering it. However, these symptoms don’t last long and there is no pressure in the ear, hearing loss, ringing in the ear (except in patients with previous ear problems) or neurological symptoms such as weakness or numbness in the arms and legs.
- Another cause of vertigo is Meniere’s Disease. The exact cause of this condition is not known, but the symptoms are linked to excess fluid in the inner ear which causes intense vertigo with nausea, vomiting, loss of balance and unsteadiness. The symptoms may last from minutes to hours. While experiencing the symptoms, patients should remain still without moving their head in order to minimize the dizziness. Patients may also experience hearing loss, ringing in the ear, or pressure in the ear.
- Labyrinthitis, which is an inflammation of the inner ear, is another cause of vertigo. Labyrinthitis results from a viral or bacterial infection. Patients with this condition will have intense vertigo that lasts for several days and is accompanied by hearing problems. If it is a bacterial infection in patients with previous middle ear inflammation and otitis leading to inner ear inflammation, the symptoms are usually severe and include significant hearing loss.
- Acoustic Neuroma is a tumor that originates in the canal connecting the brain to the inner ear. Patients with this condition experience dizziness, gradual hearing loss, and ringing or buzzing in the ear. In case of an untreated tumor which has grown large, there may be facial tingling on the side of the tumor, facial paralysis, imbalance and other neurological symptoms due to the tumor pressing on the nerve.
- Vestibular Neuronitis is an inflammation of the inner ear and/or the nerve connecting the inner ear to the brain. This condition leads to severe vertigo that lasts from days to weeks, but does not affect hearing. Other causes of vertigo include a temporal bone fracture and vertebro-basilar insufficiency.
As you can see, vertigo can be caused by a number of conditions. This means that accurate diagnosis is very important, and early treatment achieves better results. If you are suffering from dizziness or vertigo, it is important that you seek out professional medical advice so as to determine the cause of the dizziness and prescribe the best treatment.
As part of the diagnosis process, the doctor will ask you about your medical history and perform a physical examination that includes checking eye movement and tests of the ear, nerve and balance system and the balance organ in the inner ear. In some cases, the doctor may perform additional tests to detect any abnormal function in the inner ear. These tests include an audiogram (hearing test); videoelectronystagmography (VNG), which is an examination of the balance organ in the inner ear); electrocochleography (ECOG), which is a fluid pressure test; a posturography, which is an assessment of balance; and an evoke response audiometry, which is a neurologic test of auditory functioning.
Accurate diagnosis is very important as the treatment options vary depending on the underlying cause. The doctor will choose the most appropriate treatment plan for each patient depending on the diagnosis and symptoms.
Controlling the condition or preventing it from developing include lifestyle changes and the avoidance of certain risk factors. It is recommended that patients with the condition avoid actions that can cause dizziness, such as turning the head quickly, moving around quickly, or bending or twisting the neck fully in any direction. Situations that can lead to accidents, such as driving or climbing, should also be avoided.
To prevent the condition, or stop it from worsening, doctors recommend reducing or quitting tobacco and caffeine as well as avoiding factors that can cause dizziness, such as stress, anxiety, allergens and inadequate sleep.
Understanding vertigo is the first step to recovery. If you would like to speak to one of our medical professionals about vertigo or make an appointment with one of our doctors, simply click on the following buttons.
By Assoc. Prof. Dr. Saowaros Patarapak, Otolaryngologist, Hearing and Balance Clinic, Bumrungrad Hospital.