What is vertigo?
Dizziness is a broad, non-specific term used to describe a wide range of sensations such as feeling faint, light headed, or woozy. These sensations are often due to medical conditions such as heart disease, low blood pressure or low blood sugar rather than a problem in the balance system. Medication side effects can also make you feel dizzy.
Dizziness that makes you feel that you or your surroundings are spinning or moving is called vertigo. It is a false sense of movement.
Vertigo is usually due to a dysfunction in the balance system of the body, most commonly in the balance part of the inner ear or the balance nerve.
Abnormalities of these peripheral parts of the balance system cannot cause a loss of consciousness.
Central lesions involve the brainstem or cerebellum or higher levels of the brain.
What is the cause of vertigo?
Vertigo has many possible causes. The duration of vertigo can help in determining its cause.
Vertigo lasting seconds to minutes is commonly due to Benign Paroxysmal Positional Vertigo or BPPV. In this condition, particles or crystals in the fluids of the inner ear cause abnormal fluid movement sending a false signal to the brain resulting in vertigo. BPPV is usually triggered by certain movements of the head such as looking upwards and backwards or rolling over in bed.
Vertigo lasting minutes to hours may be due to Meniere’s syndrome. This condition occurs due to a build-up of fluid in the inner ear. This results in episodic attacks of vertigo, tinnitus, fluctuating hearing loss and aural fullness or pressure in the ear.
Vertigo lasting hours to days may be due to vestibular migraine, vestibular neuritis or labyrinthitis.
Vestibular migraine is an atypical migraine that affects the inner ear. It causes vertigo but is not always associated with a headache or light sensitivity.
Vestibular neuritis is thought to occur either due to a viral infection involving the balance nerve or an abnormality involving the small blood vessels supplying the balance part of the inner ear. It results in vertigo but hearing is generally unaffected.
Acute labyrinthitis results from inflammation of the lining of both the hearing and balance parts of the inner ear causing both vertigo and hearing loss.
How is vertigo treated?
A priority is to make sure you don’t have a serious, potentially life-threatening cause for your vertigo such as a brainstem or cerebellar stroke or brain tumour. Your GP will assess you and arrange urgent referral to a hospital if a central cause is suspected.
Treatment for peripheral vestibular lesions depends on the cause of your vertigo. Vertigo often gets better with time as the brain adapts to the dysfunction in your balance system.
Repositioning manoeuvres to move the crystals or particles in BPPV are often effective. Medications and balance exercises can make your vertigo more manageable.
A balance exercise program, also known as vestibular rehabilitation, is a program of exercises to help your brain compensate for the mismatch of information from your balance system. This is often coordinated by a physiotherapist with a special interest in balance rehabilitation.
Your WestsideENT specialist will carry out a comprehensive clinical assessment and arrange for you to have an audiogram and other tests such as balance tests, a CT scan or MRI scan, if indicated.