Meaning of Vertigo / Dizziness
The word vertigo is derived from the Latin phrase verto, which means, “to revolve”. Vertigo is a false sense of motion, spinning or feeling of imbalance. Sufferers often call it dizziness, imbalance, light-headedness or “chakkar aana (vertigo meaning in hindi)”.
Often the imbalance is associated with nausea, vomiting or unsteadiness on walking. It may worsen when you move your head. Vertigo should not be mixed up with acrophobia, which is an extreme fear of heights.
Vertigo and dizziness are common complaints presented by patients to doctors of all specialties, and they affect all age groups. It is a fact that 20-40% people are affected by dizziness at some point in time in their life; 15% people have dizziness; 5% have vertigo in any given year; 2.5% of all primary care visitors report dizziness, and 2-3% of emergency visits in the developed world is for vertigo.
But it must be noted that vertigo is not a disease. It is only a symptom of a disorder. Therefore, suppressing the symptom is not the solution. Proper diagnosis of what is causing vertigo/dizziness is possible only when the doctor makes a systematic evaluation. A neuro-otological workup alone will help to find out if a vertigo patient is suffering from disorders like BPPV, Meniere’s Disease, Vestibular Neuritis, Labyrinthitis, Acoustic Neuroma, Otolith Dysfunction, Vestibular Migraine, Central Vestibulopathy or psychogenic disorders.
Different disorders causing vertigo have different presentations and require diverse treatment protocols. A correct diagnosis will enable the doctor to offer the right treatment, which is the only way to give the patient lasting benefit
Symptoms of Vertigo / Dizziness
Patients suffering from persistent or intermittent dizzy spells usually describe their symptoms as though they are
- Feeling unsteady or imbalanced
Vertigo patients may also complain of nausea, difficulty in focusing on moving objects, headaches, change in hearing or ringing in the ears, and difficulty in concentration. Their symptoms can come and go and can range from a few seconds to minutes, hours, even days.
Causes of Vertigo / Dizziness
- Ménière’s Disease
It is a disorder of the inner ear, which is characterised by episodes of hearing loss and fullness in one ear, tinnitus and vertigo. Meniere’s disease is caused by increased pressure of the inner ear fluid. If not treated timely, Meniere’s disease can lead to a progressive hearing loss. Meniere’s disease usually affects one ear, but it may be bilateral in 15% of cases.
- Vestibular Neuritis
Vestibular Neuritis is caused by a viral infection leading to inflammation of the vestibular nerve. The inflammation disturbs the balance function and causes dizziness.The dizziness symptom is accompanied by blurred vision, nausea, vomiting and difficulty in focusing during head movement. Vestibular Rehabilitation should be started at the earliest to help attain rapid recovery.
- Otolithic Disorders
Damage to otolith organs (utricle and saccule) cause disequilibrium of the body and affects visual stability. Until recently, there was no precise method to check the impairment of otolith organs. But now Otolith disorders can be diagnosed with the Subjective Visual Vertical test and VEMP. Otolith stimulation through vestibular rehabilitation therapy works well in treating the disorder.
- Vestibular Migraine
10% of the population is affected by a migraine, most of them are women. The most common presentation of a migraine is headaches. But in a vestibular migraine, the patient has dizziness which may be associated with headaches. A severe headache coupled with dizziness indicates a vestibular migraine. Along with the spinning sensation associated with headaches, motion sickness and hypersensitivity to light and sound prominently show up in the patient. A vestibular migraine is controlled with diet and lifestyle modifications. In cases of frequent dizzy spells, migraine prophylaxis is prescribed.
The unusual movements of carbonate crystals from their chamber into fluid-filled semicircular canals disturbs the way the balance nerve senses gravity and adjusts its movement. The result is vertigo or the sensation of spinning. BPPV is a common cause of vertigo. It is seen more frequently in old aged population after an ear infection, head injury, surgery or after prolonged rest. The canalith repositioning exercises are the best method to cure dizziness caused by BPPV in which the offending particles are repositioned according to the type of BPPV by maneuvers like Epley Maneuver, Semont Maneuver etc.
The infection causes labyrinthitis in the labyrinth of the inner ear leading to vertigo, hearing loss and tinnitus. The difference between labyrinthitis and vestibular neuritis is; in labyrinthitis both vestibular and cochlear nerves are affected and cause dizziness, ringing in the ear and hearing loss. While in Vestibular neuritis only vestibular nerve is affected leading to vertigo but the hearing ability is not affected. Labyrinthitis causes severe dizziness bouts that may last for days! Vestibular suppressants may be prescribed by the doctors to treat dizziness and its associated symptoms, for a very short duration of 3 to 5 days. Vestibular rehabilitation should be started at the earliest to ensure rapid recovery
- Perilymph Fistula
Dizziness, fullness in the ear, vertigo spells are the symptoms of a perilymph fistula. A small tear in the fluid-filled inner ear causes fluid to leak into the middle ear. This leakage disturbs the equilibrium and leads to vertigo spells especially when the patient does straining activities or coughs vigorously. This condition may also lead to tinnitus and hearing loss. Videonystagmography (VNG) and vestibular examination help diagnose the presence of the perilymph fistula.
- Vestibular Paroxysmia
The compression of the vestibular nerve due to an inflamed blood vessel, radiation, surgery, or vestibular neuritis may cause vestibular paroxysmia. Microvascular compression is the most common reason for vestibular paroxysmia. The patient may have frequent short spells of vertigo episodes recurring throughout the day. VNG/ ENG and MRI scanning are recommended to diagnose Vestibular paroxysmia .
A rare condition of SSCD may occur as a result of thinning, or damage to the bony part of the labyrinth. It affects the patient’s hearing ability too. A natural coughing or sneezing can trigger dizziness in this condition. These patients have an extreme sensitivity to loud sound. VNG guided Valsalva manoeuvre, VEMP and CT scan of the temporal bone confirm SSCD. The treatment for SSCD is to avoid actions which aggravate dizziness. Surgical repair of the bony dehiscence is advocated for lasting results.
The patient experiences a continuous rocking or sense of motion as a result of long travel, either by ship or aeroplane. Some individuals may develop MdDs even without exposure to long travel.A thorough vestibular evaluation and studying the history of the patient can diagnose MdDS. Antidepressant medication is prescribed to treat the swaying sensation. Vestibular rehabilitation treatment is the best technique to treat MdDS. Virtual reality training is also advised for these patients.
- Acoustic Neuroma/ Vestibular Nchwannoma
Acoustic neuroma is a noncancerous growth on the balance nerve which causes unsteadiness, dizziness, facial numbness or tingling sensation, change in taste etc. A tumour grows slowly, and hence the patient often does not notice the symptoms. However, it may prove life-threatening if a tumour grows big enough to press on the brain stem. Surgery and radiation are widely used methods to treat acoustic neuroma.
- Multiple Sclerosis
Multiple sclerosis is an autoimmune disorder which attacks the protective shield of the nerve cells and hampers the signal transmission to the brain. Loss of focus, visual problem, vertigo spells are some of the symptoms of multiple sclerosis. Under this condition, the CNS is affected Spinal tap, VNG and MRI brain are advised in the evaluation to confirm multiple sclerosis .
Differential Diagnosis of the Causes
Vertigo is not a disease in itself. Once the cause of vertigo is diagnosed & treated, the person can reclaim balance and return to healthy living.
There are various tests to diagnose vertigo and its cause.
In the OPD, the doctor will look for any abnormal eye movements and ascertain that ability to follow objects is normal.The doctor evaluates the involuntary eye-movements (nystagmus) of the patient. The rapid eye movements induced due to head manoeuvres by the doctor may suggest in which ear the problem lies.
NeuroEquilibrium is the leader in using cutting-edge technology in India to conduct proper diagnosis of vertigo and its cause. Advanced Vertigo and Balance Clinics across India use ultra-modern differential dizziness diagnosing devices to evaluate symptoms and severity of dizzy spells in real-time on an innovative assessment platform.
Tests are done on diagnostic devices such as, Videonystagmography (VNG), Electronystagmography (ENG), Craniocorpography (CCG), Subjective Visual Vertical (SVV), computerised Dynamic Visual Acuity (DVA) and VEMP to identify the cause of the balance disorder in the patient.
The frequency and severity along with the associated symptoms need to be considered for appropriate treatment of each patient.
Treatment for Vertigo / Dizziness
Most people do not believe that their condition of imbalance can be cured. But, here’s a good word- Vertigo is curable.
It is essential to get timely treatment for vertigo, to get back to a healthy life as soon as possible.
Vertigo is only a symptom. Diagnosis of the underlying cause using various diagnostic tests like VNG etc. is essential for correct treatment.
- Medications are prescribed as the first line of treatment to control the severity of dizziness and the discomfort that accompanies it, such as nausea, fatigue, anxiety, vomiting, difficulty in focusing, visual disturbance etc. Often patients with Vertigo are given medicines like Vertin, Stugeron, Meclizine Hydrochloride, Stemetil etc which suppress the symptoms. Taking these medications for the prolonged duration is dangerous. They should not be given for more than 5 days.
- Surgery is advised for rare cases of vestibular disorders as inner ear surgeries are quite complex.
- Vestibular Rehabilitation exercises and Canalith Repositioning manoeuvres are prescribed for appropriate Vestibular problems. Vestibular rehabilitation exercises are very useful in gaining balance, normalising visual disturbance and reducing dizziness in a short span of time. Canalith Repositioning maneuvers are done for patients suffering from BPPV. The type and side of BPPV are diagnosed, and then the recommended repositioning maneuver like Epley manoeuvre, Semont manoeuvre, Barbeque maneuver etc. is performed.
At NeuroEquilibrium’s speciality clinics, we use virtual reality to make the vestibular rehabilitation therapy more effective and provide long-lasting relief. Currently, we are the only one in India to do so. The exercises are designed to cater to various needs of vertigo patients, physically, physiologically and psychologically.
Every patient is put on a customised Vestibular rehabilitation Therapy, keeping his condition, severity and other associated problems and medical conditions in view.
Our methods in providing personalised vertigo treatment enable us to map the patient’s improvements efficiently and alter the line of treatment if required. Such regular review of treatment and response is necessary to provide quick and long-lasting relief to vertigo patients.
Exercises & Home Remedies to Stop Vertigo
Lifestyle modifications and some simple measures may help in reducing your dizziness or vertigo. Always consult your doctor before trying these measures. Read more about vertigo exercises and home remedies here.
Some tips to avoid dizziness include:
- Avoid sleeping on the side of problem ear
- Elevate your head with a pillow while sleeping
- Try to sleep on time
- Reduce salt and caffeine in your diet
- Avoid food with preservatives
- Avoid alcohol and carbonated drinks
- Do not skip meals/fast
- Reduce screen time: cell phone, TV and Computer
Watch the video below to learn more about disequilibrium & its solutions.
Watch the below video to learn how ear problems can be the cause of your imbalance.
Author: Dr. Anita Bhandari
Dr.Anita Bhandari is MS(ENT) and a consultant Neurotologist practicing in Jaipur, India. She has done a fellowship in Otology and Neurotology from Singapore. She has set up a state-of-art Vertigo and Ear Clinic in Jaipur (www.vertigoandearclinic.com) which is amongst the most advanced vertigo clinics in India.
Dr. Bhandari is actively involved in development of diagnostic equipment in the field of diagnosis and rehabilitation of vertigo and balance disorders. She has contributed to the development of Computerized Dynamic Visual Acuity , Cranio-Coprpography , Subjective Visual Vertical , Video Nystagmography and
Posturography diagnostic equipment and has two patents in this field . She has also been involved in development of Virtual reality for vestibular rehabilitation . She is Scientific advisor to NeuroEquilibrium, a unique project to set up 500 super-specialized vertigo and dizziness clinics in India , Asia & Africa leveraging cloud technology.
She has authored chapters on ‘Vestibular Physiology’, ‘Dynamic Visual Acuity’, ‘Surgical treatment of vertigo’, ‘Difficult cases in vertigo’ in various Neurotology textbooks. She is an invited speaker in various Vertigo & Neurotology conferences across the world.