Vertigo is a condition in which you feel off-balance and dizzy, as if you or your surroundings are moving, spinning, or swaying. It can lead to nausea and disability. Vertigo is most common in elderly people, but it can affect both sexes at any age. It may be a temporary or permanent condition. Vertigo is especially problematic when symptoms occur during a task such as driving or operating machinery.
The organ of balance is the vestibular system in the ear, a tiny grid of fluid-filled tubes and sacs. There are two identical vestibular systems, located in the labyrinth of each inner ear. As you move, the liquid in the tubes also moves about, and its levels are read by nerve cells. The information is sent to the brain, which uses it to calculate which way is down and what should be the horizontal level.
Any problems with balance originate in the vestibular system, so people who suffer from frequent vertigo are said to have a vestibular disorder. Balance problems may be associated with a ringing in the ears or loss of hearing. Vertigo can also be caused by changes in the parts of the brain (cerebellum and brain stem) that are also involved in controlling balance.
Major causes of vertigo include the following:
- benign paroxysmal positional vertigo: This is a common form of vertigo, usually brought on by specific head positions or movements. It is caused by calcium deposits in the inner ear balance organ that periodically become dislodged and cause symptoms.
- head trauma: People who have received a violent blow on the head can suffer temporary or permanent damage to the inner ear, causing balance problems.
- vestibular neuritis: This is also known as vestibular neuronitis and labyrinthitis, and is believed to be caused by a viral infection. It affects the nerves of the vestibular system and not the cochlea (the organ for hearing). However, neuritis can also be caused by a blood clot lodged in the tiny blood vessels that feed the inner ear.
- Ménière’s disease: This was once called watchmaker’s disease because it tends to strike people who do precise, intricate work that requires concentration and careful control of the hands for long periods. Nobody knows what causes Ménière’s disease.
Some antibiotics can damage the vestibular system in high doses or with prolonged use. Acetylsalicylic acid* (ASA), caffeine, alcohol, nicotine, sedatives, tranquilizers, and several illegal drugs can cause temporary dizziness but do no permanent damage to the balance organs once they are stopped.
Symptoms and Complications
Vertigo is the primary symptom of any balance disorder. If you close your eyes during an episode of vertigo, you’ll feel as if you’re spinning or falling. Severe vertigo can cause vomiting and stop you from walking.
Because the vestibular system is linked to the brain’s movement centre and to the eyes, some people with vestibular disorders find their vision is affected, or their muscles are poorly coordinated or don’t go where they’re supposed to. The muscles may ache, particularly in the neck and back.
Some people complain of other symptoms during attacks of vertigo, like memory problems or difficulty reading. Most people find the struggle against vertigo physically exhausting. Symptoms can last from a few minutes to hours.
The symptoms of bacterial labyrinthitis are unmistakable. Typically, an ear infection will be followed over days or weeks by a serious deterioration of hearing and extreme vertigo. Viral labyrinthitis may appear weeks or months after a bout of flu or some other viral illness. The vertigo is milder and you may not lose any hearing, though you’ll probably have tinnitus, a ringing in the ear.
Ménière’s disease brings periodic attacks of vertigo and tinnitus, ranging in frequency from once a year to once a day. Hearing may come and go, but it tends to get worse over the long run. About 10% to 15% of people with Ménière’s disease have it in both ears.
Neuritis due to a blood clot causes sudden loss of balance that may leave you unable to walk for weeks. Your hearing may be unchanged.
See your doctor right away if your vertigo symptoms occur with head or neck pain, fainting, or are severe and continue for over an hour.
Making the Diagnosis
Many diseases can cause dizziness, especially diseases that involve poor circulation and low blood pressure. The first step of a diagnosis is a complete medical checkup, including testing oxygen and blood sugar levels.
Audiometry is a thorough test of various hearing abilities. A device that measures eye movements in various situations, an electronystagmograph, provides clues about the nature of the problem. In platform posturography, you stand on a movable platform and your responses to movement are recorded.
Treatment and Prevention
Many cases of vertigo, even severe vertigo, such as in labyrinthitis, clear up on their own, but it usually takes time. Depending on the cause of the vertigo, a doctor may recommend any number of treatments, ranging from antibiotics, antihistamines, and other medications to surgery. Your doctor may also prescribe a medication to help with nausea and vomiting. The doctor may also suggest some exercises that help to build tolerance to vertigo, making episodes less intense and shorter.
For benign paroxysmal positional vertigo , there is an effective treatment called the particle repositioning maneuver. Your doctor or therapist may perform this series of head movements on you during an acute attack, then teach you how to do the movements yourself should the attack recur. There are several commercially available aids to help you do this maneuver correctly.
If vertigo is due to motion sickness or a certain type of movement, it can be prevented by avoiding the trigger or by using a technique called visual fixation, where you can help prevent vertigo by fixing the eyes on a specific point on the horizon.
Rehabilitation programs can also help people with vestibular damage to recover their balance and coordination and overcome vision problems.
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