Who Does Vertigo Affect?
Vertigo is a common problem that can affect people of all ages.
Activities that bring on a dizzy spell can vary. They often involve moving your head into a certain position suddenly, like:
- looking up,
- lying on one ear,
- rolling over in bed,
- getting out of bed, and
- bending over.
This causes the spinning sensation.
What Causes Vertigo?
The causes of vertigo can be divided into two categories:
Peripheral Causes
These are related to areas in our inner ears and the nerve-brain connections or the general degeneration of inner ear structures. including:
- Acute labyrinthitis or vestibular neuronitis,
- Benign positional vertigo,
- Meniere’s disease,
- Head trauma,
- A stroke affecting the labyrinth,
- Drugs and toxins, and
- Acoustic neuroma.
Central Causes
These are related to the brainstem and cerebellum, including:
- Brainstem and cerebellar strokes,
- Multiple sclerosis,
- Migraine and
- Epilepsy.
For some people, the cause may not be found.
Vertigo Symptoms
Vertigo can be hard to describe. It is a type of dizziness that consists of an illusion of movement of the body or the environment.
Terms like a sensation of:
- Dizziness, loss of balance or falling is quite common,
- Spinning, tilting or rocking to-and-fro or up-and-down like being on a boat
- Veering to one side on walking or being pulled to one side as though with a strong magnet,
- Nausea, vomiting, and unsteadiness in walking.
Vertico can be difficult to differentiate from sensations like lightheadedness, disorientation or brain fog. We provide extensive examinations to help diagnose the various causes of vertigo. Differentiating vertigo from other sensations like lightheadedness, disorientation or brain fog is also important.
Vertigo is a frequent complaint and a common cause of referral to a neurologist.
Vertigo Triggers
Vertigo is a symptom and not a disease. There are several conditions related to different types of vertigo that your Neurologist may consider.
Common vertigo triggers include:
- Benign paroxysmal positional vertigo (BPPV): BPPV is typically triggered by a change in your head’s position, e.g., when lying down, sitting up or turning over in bed.
- Meniere’s disease: Causing fluids to build up inside the ear, leading to vertigo attacks.
- Labyrinthitis: When the inner ear labyrinth becomes infected and affects the vestibulocochlear nerve, which control’s the head's position, movement and hearing.
- Vestibular neuritis: vestibular nerve inflammation is like Labyrinthitis without impact on hearing but can cause nausea or blurred vision.
- Cholesteatoma: Repeated ear infections can cause noncancerous skin growth in the middle ear and lead to dizziness, vertigo and hearing loss.
Other drivers of vertigo include:
- Migraine headaches.
- Certain medications.
- Stroke.
- Arrhythmia.
- Diabetes.
- Head injuries.
- Prolonged bed rest.
- Shingles in or near the ear.
- Ear surgery.
- Perilymphatic fistula (when inner ear fluid leaks into the middle ear).
- Hyperventilation.
- Low blood pressure (hypotension)
- Ataxia, or muscle weakness.
- Syphilis.
- Otosclerosis (a bone growth problem affecting the middle ear).
- Brain disease.
- Multiple sclerosis (MS).
- Acoustic neuroma.
How Is Vertigo Diagnosed?
Patients presenting with vertigo need to be assessed to ascertain the cause of their vertigo.
Often physical examination with manoeuvres to elicit vertigo in certain head positions can clinch the diagnosis, e.g. in benign positional vertigo.
We provide extensive examinations to help diagnose the various causes of vertigo. Some tests can include:
- Fukuda-Unterberger’s test: Marching in place for 30 seconds with your eyes closed. Any rotation or leaning could mean you have a problem with your inner ear labyrinth.
- Romberg’s test: Standing with eyes closed and feet & arms closed. Any sense of unsteadiness could indicate an issue with your central nervous system.
- Head impulse test: While gently moving your head side, you focus on a stationary target. Your eye movements are reviewed and assessed.
- Vestibular test battery: Use goggles to monitor eye movement while your head and body, and combine this with water in your ear canal to identify inner ear issues.
- Sometimes ancillary tests are necessary, such as
- MRI of the brain and
- Vestibular Function Tests (e.g. electronystagmography) and
- hearing tests.
We also have allied professionals available to assist with vestibular testing, as well as balance and physiotherapy.
Treatments for Vertigo?
The vertigo treatment that’s right for you depends on the underlying cause of vertigo. Some of the most notable vertigo treatments include:
- Medication: Treating the underlying cause of your vertigo can help ease symptoms, or
- Vestibular suppressant drugs can be useful in the short term
- Meniere’s disease may respond to a diuretic or a very low salt diet.
- Vestibular migraine should be treated with antimigraine drugs
- Infection control by the use of antibiotics.
- Inflammation reduction with the use of Steroids
- Vestibular rehabilitation: If vertigo results from an inner ear problem, this physical therapy may help reduce your symptoms. Vestibular rehabilitation helps strengthen your other senses so they can compensate for vertigo episodes.
- Canalith repositioning procedure (CRP): If you have BPPV, Canalith repositioning maneuvers help move calcium deposits into an inner ear chamber where your body will absorb them.
- Surgery: When vertigo is due to a serious underlying issue, such as a brain tumour or neck injury, surgery may be necessary.
