Vertigo
Vertigo is characterized by a false sensation of spinning or movement, often experienced when a person is still. It typically arises from disorders affecting the inner ear or the central nervous system. Common causes include conditions like benign positional vertigo, Ménière's disease, vestibular neuritis, and various central nervous system disorders such as migraines and strokes. Symptoms often accompany vertigo, including tinnitus, nausea, imbalance, and issues with coordination.
The duration and intensity of vertigo can vary widely depending on the underlying cause, and treatment approaches are tailored accordingly. Options may include physical therapy, medications, dietary changes, or surgical interventions. Diagnosis usually involves a thorough examination and specialized tests to identify the root cause of the symptoms. While vertigo can be disorienting and distressing, it is generally not a sign of a serious condition, and many individuals can manage or alleviate their symptoms with appropriate care.
Vertigo
ANATOMY OR SYSTEM AFFECTED: Brain, ears, nervous system
DEFINITION: A sensation of motion or spinning when not moving
CAUSES: Inner ear or central nervous system disorders
SYMPTOMS: Sensation of movement or spinning, sometimes accompanied by tinnitus, nausea, disequilibrium, clumsiness, ataxia
DURATION: Varies depending on cause; may be episodic
TREATMENT: Depends on cause; may include otolith repositioning, inner ear surgery, low-salt diet, medications, vestibular rehabilitation therapy, treatment of underlying diseases
Causes and Symptoms
Vertigo is a sensation of spinning or movement. Dizziness and disequilibrium are broader terms that include vertigo in some cases.
Vertigo results from disorders of the inner ear or central nervous system. Inner-ear causes include injury, labyrinthitis, vestibular neuritis, acute or recurrent vestibulopathy, benign positional vertigo, Ménière’s disease, perilymphatic fistula, and vestibular toxicity from drugs. Labyrinthitis or vestibular nerve can result from trauma, cancer (acoustic neuroma), benign tumor, infection, disorders, autoimmune disorder, otosclerosis, or middle-ear infection. Central causes of vertigo include stem stroke, cervical vertigo, tumors adjacent to the brain stem, migraines, multiple sclerosis, cranial nerve injury or degeneration, seizure disorders, hereditary familial ataxia, and inflammatory paraneoplastic syndromes. Problems with peripheral nerves and vision can contribute to vertigo.
Three systems work together to provide balance. The first is the inner-ear system of tiny canals filled with a called and tiny called otoliths. These canals contain tiny cells that sense endolymph movement. Information from the is conveyed to the brain through the eighth cranial nerve (auditory nerve) as well as branches of the seventh cranial nerve (facial nerve). The second system, vision, provides information to the brain via the optic nerve. The third system is proprioception, the ability to orient the body in space using input from the system and from peripheral nerves. Specialized areas of the brain process information from these three systems to provide balance and maintain the vestibular ocular reflex and the vestibular spinal reflex. Adaptation to variations in input from these systems allows for activities such as figure skaters being able to tolerate high-speed spins. Balance is also possible with just two of three balance systems, allowing normal individuals to stand with eyes closed and not lose balance.
Disruption of one or more balance systems causes vertigo. Additional symptoms may include tinnitus, disequilibrium, hearing loss, to sound, nausea, blurred vision, oscillopsia, nystagmus, ataxia, clumsiness, or headaches. Symptoms of underlying disease may be present.
Onset and additional symptoms; examination of the ear, nose, and throat; and a general neurological examination will help in diagnosis. Specialized techniques include the Hallpike maneuver (tilting the head over the edge of the examination table) and the test, done by plugging one ear. Testing may include complete eye examination, computed tomography (CT) scan, magnetic resonance imaging (MRI), electronystagmography, hearing test, and rotational chair testing. Diagnosis of the underlying disorder is necessary for treatment.
Treatment and Therapy
Treatment of vertigo depends on the cause. and other inner-ear conditions such as vestibular neuronitis may be treated with a salt-restricted diet, diuretics, medication, antinausea medication, steroid injections, lifestyle modification including stress reduction, or inner-ear surgery. Otolith repositioning involves specialized physical therapy maneuvers that may be helpful for benign positional vertigo. Perilymphatic fistula may respond to bed rest. Middle-ear infections are treated with antibiotics.
Vertigo requires treatment aimed at correcting the underlying disorder. For example, acoustic neuromas may be treated with surgery and radiation. Symptoms from multiple sclerosis may respond to oral or intravenous steroids.
Diagnosis and treatment of vertigo will require a team of specialists, including a family physician, otorhinolaryngologist, neurologist, audiologist, internist, physical therapist, and occupational therapist.
Vestibular treats vertigo and other balance and problems through adaptation. Because vision is an important part of the balance system, significant vision impairment might limit rehabilitation effectiveness. Exercises prescribed by a physical or occupational therapist target activities that are problematic and may be done at home, in a rehabilitation center, or both. Exercises include targeted movements such as bending over, walking with one foot in front of the other, or walking with the head turned. Rehabilitation can take several weeks to several months.
Perspective and Prospects
Vertigo and dizziness are common symptoms. Because of the variety of causes, some otolaryngologists and neurologists focus solely on the diagnosis and treatment of vertigo and dizziness.
Ménière’s disease is the best-known cause of vertigo, first presented by Prospère Ménière to the French Academy of Medicine in 1861. Other inner-ear problems cause similar symptoms, but Ménière’s disease specifically affects the endolymph fluid, causing vertigo and tinnitus. With modern diagnosis, Ménière’s disease is now known to be less common than once thought.
Several famous people may have suffered from Ménière’s disease or other forms of vertigo. Julius Caesar was said to have “falling disease” attributed to Ménière’s disease or epilepsy. Other famous sufferers include artist Vincent Van Gogh, poet Emily Dickinson, and film star Marilyn Monroe.
Fortunately, vertigo does not usually indicate serious or life-threatening disease; however, it can take time and numerous tests to pinpoint the cause. With patience and persistence, most people can find a treatment or combination of treatments to reduce or eliminate their symptoms.
Bibliography
"Dizziness and Vertigo." MedlinePlus, US National Library of Medicine, 14 Feb. 2017, medlineplus.gov/dizzinessandvertigo.html. Accessed 8 Apr. 2024.
Fauci, Anthony, et al. Harrison’s Principles of Internal Medicine. 18th ed., McGraw-Hill.
Jasmin, Luc, et al. "Vertigo-Associated Disorders." MedlinePlus, US National Library of Medicine, 7 Feb. 2017, medlineplus.gov/ency/article/001432.htm. Accessed 9 Apr. 2024.
"Overview of Vertigo." BMJ Best Practices, 9 July 2023, bestpractice.bmj.com/topics/en-us/965. Accessed 8 Apr. 2024.
Poe, Dennis. The Consumer Handbook on Dizziness and Vertigo. Auricle Ink, 2005.
"Vertigo." Cleveland Clinic, 9 May 2023, my.clevelandclinic.org/health/diseases/21769-vertigo. Accessed 8 Apr. 2024.
West, John. Best and Taylor’s Physiological Basis of Medical Practice. 12th ed., Williams & Wilkins, 1991.