Vertigo - About

Vertigo is the feeling of a sense that your environment is spinning. It is a form of dizziness. It differs from dizziness in that vertigo involves the perception that either you or the things around you are moving - often described as a spinning sensation. When you feel as if you yourself are moving, it's called subjective vertigo; the perception that your surroundings are moving is called objective vertigo. In addition, the individual may also experience nausea or vomiting, sweating, and/or abnormal eye movements. You may have trouble walking or standing, and you may lose your balance and fall.

Unlike nonspecific lightheadedness or dizziness, vertigo has relatively few causes.

Vertigo can be caused by problems in the brain or central nervous system (central vertigo) or the inner ear (peripheral vertigo).

Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is a brief sensation of motion lasting 15 seconds to a few minutes and is sometimes followed by a period of imbalance which can last hours or longer.. It may be initiated by sudden head movements or moving the head in a certain direction, such as rolling over in bed. The initial episode can be severe - but subsequent episodes usually decrease in intensity. This type of vertigo is rarely serious and can sometimes resolves by itself or can be treated.

Vertigo may also be caused by inflammation within the inner ear (labyrinthitis or vestibular neuritis), which is characterized by the sudden onset of vertigo and may be associated with hearing loss. The most common cause of labyrinthitis is a viral or bacterial inner ear infection. The duration of symptoms can last for days until the inflammation subsides. Viruses that may cause labyrinthitis or vestibular neuritis include herpes viruses, influenza, measles, rubella, mumps, polio, hepatitis, and Epstein-Barr virus (EBV).

Meniere's disease is a triad of symptoms including episodes of vertigo, ringing in the ears (tinnitus), and hearing loss. People with this condition have the abrupt onset of severe vertigo and fluctuating hearing loss as well as periods in which they are symptom-free. The cause of Meniere's disease is not fully understood but is thought to be due to viral infections of the inner ear, head injury, a hereditary factors, or allergies.

Acoustic neuroma is an uncommon cause of vertigo related to a type of tumor of the nerve tissue of the inner ear that can cause vertigo.

Vertigo - Diagnosis

There are many possible causes of dizziness, vertigo and disequilibrium. It is also quite possible that a person may have a combination of problems.

Your doctor will carry out a physical examination, ask about your symptoms and conduct some simple tests. Your doctor will ask questions such as whether you felt lightheaded or if your surroundings were spinning and if you also experience other symptoms – such as hearing loss, tinnitus (ringing in the ears), nausea, vomiting or fullness in the ear. The physical exam may involve a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central (involving the central nervous system) or peripheral cause (involving the inner ear). New symptoms of vertigo should be looked at to rule out stroke as the primary cause. History, physical exam, and imaging as needed are critical to insure any life-threatening conditions are ruled out. Signs of nystagmus (abnormal eye movements) or incoordination can help pinpoint the underlying problem. If indicated, some cases of vertigo may require an MRI or CT scan of the brain or inner ears to exclude a structural problem like stroke or acoustic neuroma (a non-cancerous brain tumor).

If hearing loss is suspected, an ear, nose and throat (ENT) specialist may carry out some hearing tests for tinnitus (ringing in your ears) or hearing loss.

You may also need balance tests such as:
Eye movement testing to look at how your eyes move when you track a moving object. And you may be given an eye motion test in which cold and warm water or air are placed in your ear canal. Head movement testing. If your doctor suspects your vertigo is caused by BPPV (benign paroxysmal positional vertigo), he or she may do a simple head movement test to verify the diagnosis. Your physician may order other types of balance tests to help an accurate diagnosis of what is causing the problem.

Vertigo - Treatment

Treatment for vertigo depends on what's causing it. In many cases, vertigo goes away without any treatment. This is because your brain is able to adapt, at least in part, to the inner ear changes, relying on other mechanisms to maintain balance.

For some people, treatment is needed.

Canalith repositioning maneuvers. Some of the most effective treatments for peripheral vertigo include particle(canalith) repositioning movements. During this treatment, specific head movements can reposition the loose crystals (canaliths) within the inner ear. By repositioning these crystals, they cause less irritation to the inner ear and symptoms can resolve. The movements are safe and often effective but because these movements can initially lead to worsening of the vertigo, they should be done by an experienced health care professional.

Vestibular rehabilitation (balance therapy). This is a type of physical therapy aimed at helping strengthen the vestibular system. The function of the vestibular system is to send signals to the brain about head and body movements relative to gravity. Balance therapy should be taught by an appropriately certified physical therapist.

Vestibular rehab may be recommended if you have recurrent bouts of vertigo. It includes a series of eye and head movements which lead to decreased sensitivity of the nerves within the inner ear and subsequent improvement of vertigo. These simple movements need to be practiced by the patient on a regular basis for best results. The exercises are designed to retrain the brain to compensate for, and adapt to, loss of function in the vestibular system.

Medicine. In some cases, medication may be given to relieve symptoms such as nausea or motion sickness associated with vertigo but are not recommended for long-term use and are not considered "cures" for vertigo.

If vertigo is caused by an infection or inflammation, antibiotics or steroids may reduce swelling and cure infection.

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