Vertigo – Head-Spinning Sensation

Vertigo is a specific kind of dizziness- a sense that we or our environment, is moving or spinning even though there is no movement. We can call it an Illusion of movement. People having Vertigo not only feel l that they are spinning but also feel that their surroundings are moving around them. The sensation of spinning worsens when the neck is moved suddenly or when any other movement involving the head is executed. People with Vertigo may actually find it difficult to balance while walking or when they stand up suddenly after resting for a long time. They may also find it difficult to focus their eyes on an object. They might experience ringing in their ears. This symptom may last for a few minutes or may persist for longer. Vertigo cannot be defined as fear of heights.

What causes Vertigo?

When we are standing or doing some work our brain sends constant signals to our sensory organs like our eyes, ear and skin about the position we are in which in turn helps us maintain our balance. It is the inner ear which performs the task of handling this balancing mechanism and makes us aware of our position in the surroundings. In the case of vertigo, these signals are not received correctly leading to instability, loss of balance and the feeling of spinning. All the Vertigo is not life-threatening; it can be disabling.

There are two types of vertigo- positional/peripheral Vertigo -one that is triggered by a problem in the inner ear

Central Vertigo – where the condition is triggered by a problem in the brain.

Symptoms -Vertigo is often triggered by a change in the position of your head. People with Vertigo typically describe it as feeling like they are spinning, tilting, swaying, unbalanced and pulled in one direction. Other symptoms that are accompanying Vertigo include feeling nauseated, jerky eye movements (nystagmus), headache, sweating, ringing in the ear or hearing loss.

Reasons and causes of vertigo:

1. Benign Paroxysmal positional vertigo (BPPV) – is a common cause of positional vertigo that is found in 20% of all patients with Vertigo. It is believed that when calcium particles in the inner ear get displaced it affects the ear function and causes BPPV. People with BPPV experience sudden Vertigo when they move their head. It lasts for a few seconds only.

2. Viral infection may cause inflammation in the inner ear which triggers Vertigo. Imbalance occurring during attacks of common cold usually will not persist after the cold subsides.

3. Head trauma or an injury to the head can cause Vertigo in a few cases

4. Migraine can also cause Vertigo along with headache, nausea and vomiting.

5. Drug induced toxicity that affects the nerve responsible for balance can lead to vertigo.

6. Meiners disease is a condition in which Vertigo is associated with dizziness, hearing loss and ringing in the ear(tinnitus)

7. Brain Tumour or tumour of the inner ear (acoustic neuroma) affects the nerve which is linked to the inner ear thereby leading to a feeling of loss in balance.

8. Stroke or diseases that affect the brain may also cause Vertigo.

9. Multiple sclerosis is a condition in which the nervous system is affected. This leads to faulty or incomplete nervous impulses being sent to the brain leading to a feeling of instability.

10. Medications for lowering blood pressure may cause faintness if they lower your blood pressure too much. Many other medications can cause non-specific feeling of dizziness that resolve when you stop the medications.

11. Anxiety disorders such as panic attacks and a fear of leaving home or being in large, ,open Spaces( agoraphobia) may cause of dizziness.

12. Low iron levels(anaemia) along with fatigue, weakness and pale skin.

13. Low blood sugar (hypoglycaemia). This condition generally occurs in people with diabetes who use insulin.

14. Ear infections- sometimes chronic ear infection can cause dizziness.

15. Dehydration

16. Chronic subjective dizziness. This is a specific clinical syndrome characterized by persistent non-specific dizziness that does not have an obvious medical cause. Chronic subjective dizziness is associated with hypersensitivity to one’s own motion. This type of dizziness is made worse by Complex visual environments, visual motion (such as movie), visual patterns and precision visual tasks.

Treatment:

Treatment for vertigo depends on what’s causing it. In many cases Vertigo goes away without any treatment. This is because our brain is able to adapt at least in part, to the inner ear changes, relying on other mechanism to maintain balance. In some cases Vertigo may also get resolved on its own.

1. Physical therapy: This therapy helps the brain to regain the loss of ear function. The aim of the therapy is to improve the brains balancing system. The most common type of therapy are

• A. Vestibular rehabilitation – Vestibular compensation is a process that allows the brain to regain balance control and minimise dizziness symptoms when there is damage to , or an imbalance between , the right and left vestibular organs (balance organs ) in the inner ear. Essentially, the brain copes with the disorientating signals coming from the inner ears by learning to rely more on alternative signals from eyes, ankles, legs and neck to maintain balance. This involves simple exercises such as movement of the eyes from side to side, changing the position of head while walking or climbing downstairs.

• B. Repositioning manoeuvre/ Epley’s manoeuvre – this treatment is used in BPPV where Vertigo is caused by displacement of calcium carbonate crystals in the inner ear. It involves a series of body turns to move the crystals to a part where they can stay still and be less dangerous.

2. Medications – medication does not treat the causes of vertigo. They are just used to reduce the intensity or suppress the symptoms of acute attack of vertigo to some extent

3. Surgery – surgical procedures for vertigo can either be corrective or destructive. Corrective surgery is performed to stabilize the inner ear where as a destructive surgery is performed to stop transmission of information from the inner ear to the brain.

Lifestyle changes to avoid Vertigo attack:

1. 1. 1. Avoid stressful physical activity and excessive neck movements that can trigger Vertigo.

      2. Exposure to loud sounds or bright light should be avoided.

      3. While sleeping use a pillow to keep your head slightly raised.

      4. When you are about to get out of bed make sure you get up slowly or sit at the edge of the bed for a minute before you stand up.

      5. Walk slowly while climbing up or down. Be careful while taking an escalator to avoid falls.

      6. Do not bend down with a jerk to pick up fallen things as this could worsen the symptoms.

      7. Move your head very carefully while performing daily activities. Essentially avoid extending your neck suddenly to look at things.

      8. Good way to reduce the symptoms of vertigo is to keep your blood pressure in check.

         
         Dr. Preeti Hajare
         Consulting ENT Surgeon
         KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi.