What is vertigo?

 

The word vertigo derives from the Latin word 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”.

Often the imbalance is associated with nausea, vomiting, sweating, 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 specialities and they affect all age groups. It is a fact that 20-40% people are affected by dizziness at some point of 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 are 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 if the doctor makes a systematic evaluation. And only a neuro-otological workup 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 different treatment protocols. A correct diagnosis will enable the doctor to offer the correct treatment which is the only way to give the patient lasting benefit.

 

Symptoms of vertigo

Patients usually describe their symptoms as though they are

  • Getting chakkar or spinning
  • Swaying
  • Tilting
  • Feeling unsteady or imbalanced
  • Falling
  • Experiencing dizziness.
 

Vertigo patients also sometimes complain of nausea, difficulty in focusing on moving objects, headaches, change in hearing or ringing in the ears, and inability to focus their thoughts. Their symptoms can come and go, and can range from a few seconds to minutes, hours, even days.

 

Causes, diagnosis & treatment

 

Meniere’s disease

It is a disorder of the inner ear which is characterized by episodes of hearing loss and fullness in one ear, tinnitus and vertigo. This is caused by increased pressure of the inner ear fluid. If not treated timely, Meniere’s disease can lead to progressive hearing loss. Meniere’s disease usually affects one ear but it may be bilateral in 15% of cases. Treatment involves dietary restrictions and medical management, and in intractable cases, intratympanic gentanycin injections or surgery may be required.

 

Vestibular neuritis

This is a viral infection of the balance nerve leading to severe vertigo with nausea and vomiting. Vertigo typically lasts for several hours to days. A timely diagnosis and proper treatment along with vestibular rehabilitation aids in faster recovery of nerve function.

 

Labyrinthitis

This is a bacterial infection of the eighth cranial nerve (which transmits sound and balance information from the inner ear to the brain) characterized by intense vertigo with sudden hearing loss in one ear. Diagnosis is through audiovestibular evaluation that gives a clear picture of the extent of damage to the cochlea and labyrinth. An early diagnosis and treatment may prevent the hearing loss from becoming permanent. Vestibular rehabilitation aids early recovery of balance function.

 

Vestibular migraine

Vestibular migraine is one of the common causes of vertigo. Headaches and dizziness are very common symptoms presenting across all age groups. It is important to determine whether the two symptoms are associated or independent of each other or due to migraine. These patients generally do not suffer from any hearing problems. They often have intolerance to loud sounds or bright lights (sensory amplification). The treatment involves lifestyle modifications, dietary restrictions along with medical management and usually lasts several months.

 

Otolithic disorders

This is characterized by a sensation of rocking, chronic dizziness or feeling of difficulty in standing straight. This dysfunction is recognised by subjective visual vertical test and VEMP. Its treatment involves a specialized rehabilitation programme for otolith disorders along with medication to decrease the sensitivity of the nervous system to the rocking feeling.