Vertigo

What is vertigo?

Vertigo is a sensation of motion making it difficult to maintain balance while standing or sitting. It is usually rotatory like spinning or whirling.or may be vertical, or just imbalance and falling to one side. The vertigo may be mild, or it may be severe enough to cause nausea and vomiting.

What are the causes?

Vertigo is frequently due to an inner ear problem, Benign Paroxysmal positional vertigo (BPPV) is an inner ear problem that causes vertigo. The vertigo caused by BPPV usually lasts for less than a minute and occurs on changing position of the head on lying down. BPPV occurs when debris collects in the fluid-filled canal system (semicircular canals) in the inner ear. The debris may collect in the inner ear as a result of aging, an injury (such as a blow to the head), or a viral infection. In most cases, no specific event can be identified as the cause of BPV. This usually subsides in a few days with or without medication and exercises.

Sudden severe vertigo may occur due to inflammation of the inner ear ( Labrynthitis) or the balance nerve ( Vestibular Neuronitis). This is accompanied by nausea and vomiting.It may be accompanied by sudden hearing loss.

Mennier’s syndrome is caused by changes in the pressure of the fluid in the inner ear. It is characterized by repeated episodes of vertigo, lasting a few days, often accompanied by reduced hearing and noises in the ear (Tinnitus) during the attacks. The frequency of such attacks and the hearing loss increases over the years.

Vertigo may also be due to neurological conditions of the cerebellum, or the brain stem. Vertigo may be a sign of stroke, multiple sclerosis, seizures or, rarely, a degenerative neurological disorder. In such conditions, other symptoms and signs usually accompany the vertigo. Age related reduced blood supply to the brain and brain stem often results in vertigo and imbalance.

Cervical spondylosis may also cause giddiness, but rarely is associated with severe vertigo.

Eye muscle imbalance may cause some unsteadiness, but never true vertigo.

High blood pressure may also lead to symptoms of lightheadiness and mild giddiness.

What are the symptoms?

The main symptom of vertigo is a sensation that the surroundings are spinning or whirling when they are actually not moving. Or the head may feel to be spinning.

In BPPV, the vertigo begins after making a certain head movement or putting the head in a certain position. There is often a brief period between the time the head is moved and the beginning of vertigo. This is referred to as latency. Vertigo usually lasts for less than a minute, and frequently it lasts only for a few seconds. The sensation may be mild, or it may be severe enough to cause nausea and vomiting. If the movement that causes the vertigo is repeated, the effect may be less noticeable each time. After 3 to 4 repetitions, the movement may no longer result in vertigo, and several hours may pass before the same movement again results in vertigo. Other symptoms are:

• Light-headedness
  
• Severe pain
  
• Headache
  
• Low blood pressure
  
• Heart beat too slow or too fast

In Labrynthitis/Vestibular Neuronitis, there Vertigo is severe, and lasts longer. It is only controlled by medication, and the patient feels better on lying don with the eyes closed. It is non positional.

In Menniers disease, there are recurrent such episodes, with reduced hearing in the affected side, and tinnitus.

In neurological conditions, there are often other signs. The sensation is more of head rotating. Nausea and vomiting are less pronounced. Imbalance and inability to stand with eyes closed  and walk in a straight line may be significant.

How is it diagnosed?

The most important part in Diagnosis is the History and examination.The physician can usually decide on the cause of Vertigo by the history. A full ENT examination is carried out. Specific Neuro-otological examination is carried out where the physician looks for signs of eye movement associated with vertigo ( Nystagmus).

Diagnostic tests that may be performed include:

• Blood pressure measurements and other blood tests
  
• ECG
  
• Hearing tests: Pure tone Audiogram & Impedance Audiometry. 
  
• Neurological tests
  
• Balance testing (ENG) may be required
  
• MRI (Magnetic Resonance Imaging): specially to exclude neurological causes, and detect them at an early treatable stage.

What is the treatment?

Vertigo often clears up on its own or becomes less intense after a few weeks even without any specific treatment. The brain's response to the abnormal signals may lessen over time. This process occurs most quickly if the person tries to continue normal movement of the head, even though doing so causes attacks of vertigo.

The doctor may give instructions to do specific exercises. Medications to control vertigo usually are only recommended if vertigo is associated with nausea and vomiting. Drug treatment does not cure benign positional vertigo (BPV). Medications may be used to control severe symptoms (whirling sensation, nausea, and vomiting) caused by BPV.

Apleys maneuver is a system of specific exercises carried out by the physician, to move the debris in the inner ear from an area where it is disturbing the nerve endings, to a non dangerous area where the debris can remain ill it dissolves.This usually results in a miraculous cure from symptoms. However this maneuver should only be carried out by the physician after proper assessment of the side and nature of vertigo. Otherwise it may lead to worsening of symptoms.

Medications that affect the inner ear to reduce the whirling sensation of vertigo are called vestibular suppressants. They include:

• Antihistamines
  
• Scopolamine
  
• Sedatives

Medications that calm the inner ear (vestibular suppressants) may slow how quickly the body adjusts to vertigo caused by BPV. In practice, these drugs are used to make the patient more comfortable.. They usually do not stop vertigo completely. Anti vertigo medication is often associated with significant vertigo.

Antiemetic medications may be used to control nausea and vomiting.

How is vertigo prevented?

In most cases, vertigo cannot be prevented. It may simply be a consequence of getting older. However, some cases of BPV may result from head injuries. Wearing a helmet when bicycling, motorcycling, playing baseball, or doing other sports activities can protect the head from a head injury that could cause BPV to develop.

It is more important to prevent a patient suffering from vertigo from getting injured. They should avoid climbing ladders or stools. Driving should be avoided when suffering from vertigo , or while on sedative antivertigo medication.

Long term low dose medication may reduce the frequency of vertigo in Menniers disease. Dietory modification like low salt diet, which keep thefluid pressure under control is also important, as is BP control.