VERTIGO & DIZZINESS
What is Vertigo?
Vertigo is the false sensation of motion with mild or intense dizziness, loss of balance or spinning. A vertigo attack can feel like your body is not in your control and cause you to experience spatial disorientation.
What can cause Vertigo or Dizziness?
The sensation of vertigo could be caused by problems arising from parts of the brain to do with balance, or dysfunction of the equilibrium of the inner ear. The most common cause of vertigo is known as Benign Paroxysmal Positional Vertigo (BPPV).
Benign – it is not life-threatening
Paroxysmal – it comes in sudden, brief spellsl movement
Positional – it gets triggered by certain head positions or movements
Vertigo – a false sense of rotations
Moving your head or body too quickly in certain directions or motions can cause the feeling of dizziness due to BPPV. Activities that trigger the signs and symptoms of BPPV can vary from person to person but are almost always brought on by a sudden change in head position. For example, the shampooing, or hair washing position when at a hair salon with your head facing upwards. Some people may also feel out of balance when standing or walking. Head injuries or other disorders of balance organs may make someone more susceptible to vertigo as well.
How does Vertigo develop?
Our brains are constantly taking in sensory inputs such as vision and hearing. The balance organs in the inner ear are important in relaying information to the brain about where the body is, and how it is moving. Additional input comes from the eyes and muscles. This equilibrium system is what provides our sense of orientation, and controls balance and eye movements. Therefore, dysfunctions in the inner ear affect these systems and can cause vertigo.
Who is more likely to be affected by Vertigo?
Vertigo often resolves in an individual over a period of days or weeks. This is because the brain is able to compensate and adjust for impaired function. For example, if the balance organs in the right ear are impaired, over time, the body will learn to rely on the left ear system to compensate. This ability of the brain to adapt to new circumstances and form and modify connections between nerve cells is known as neuroplasticity.
As we age, neuroplasticity decreases, making it more difficult for vertigo to naturally resolve. Therefore, whilst vertigo can occur at any age, it is more frequent in the elderly and can be a sign of injury or age-related decline in cognitive function. Sensory inputs take longer to process the older we get, leading to feelings of imbalance or dizziness.
Signs and symptoms of Vertigo
Vertigo may itself be a symptom of other conditions you may have that cause attacks. Vertigo can also occur in conjunction with tinnitus as possible sign of hearing loss, or it could be a sign of Meniere’s disease as balance may be affected by conditions of the inner ear.
Acute vertigo attacks can often be accompanied by:
Feeling unsteady while standing or moving to sit down
A sense that you or your surroundings are spinning or moving
Nausea, or even vomiting
Involuntary eye movements, also known as nystagmus
When closing your eyes, vertigo may persist longer or get worse since your brain relies on vision to balance itself. Acute attacks can be potentially dangerous if one is driving or operating machinery.
Vertigo diagnosis and testing
Diagnosis is made based on the patient’s detailed medical history and an ENT examination, including a check of the hearing and balance systems. This involves checking the ears with an otoscope to exclude any other causes of the giddiness, such as an ear infection, tympanic perforations, cholesteatoma, etc.
The doctor may ask you to carry out various tasks and movements or to balance while closing your eyes to test which motions trigger your feeling of dizziness and where your balance is insecure. For example, the Dix Hallpike test for BPPV, securely lying the patient down while checking for any vertigo. The doctor may also test to see if any involuntary eye movements (nystagmus) are triggered when you are looking at a specific point or doing a specific motion.
Vertigo treatment options
Though many people are given medications for BPPV, there is no evidence to support its use in the treatment of this condition. Only in extremely rare circumstances are surgical options considered. However, in the vast majority of cases, BPPV can be treated mechanically. For example, by doing specific habituation exercises, you can retrain your body to be more confident with your sense of balance.
BPPV usually resolves on its own within a few weeks or months. But, to help relieve BPPV sooner, the doctor may recommend you learn a sequence of deliberate movements. This can consist of several simple manoeuvres for positioning your head and body. The goal is to hold each position for about 20 to 30 seconds at a time and repeat until vertigo symptoms or abnormal eye movements stop.
You will also be taught simple balance exercises you can do at home.These can include:
Simple movements in a chair, or in bed side to side to be comfortable in different positions
Training eye movements – e.g. moving your eyes left, right, up and down, or focusing on your thumb and moving it around while keeping your eye on it.
• Practicing different smaller movements- walking in place, stepping side to side, tilting head from side to side.
Regular practice of the exercises or habitation therapy can help to improve your confidence and balance.
Example of a habituation exercise that can help to reduce the symptoms of vertigo
If your vertigo is found to be related to sudden hearing loss, one procedure available for treatment is a Transtympanic Dexamethasone Injection to rescue hearing in the inner ear.