Vertigo Overview
Vertigo is a sensation of spinning and dizziness. It may cause balance problems and nausea. Vertigo stems from a problem with the inner ear, brain, or sensory nerve pathway. Possible causes include labyrinthitis, pregnancy, and stroke.
Dizziness, including vertigo, can happen at any age, but it is common in people aged 65 years or over.
People may experience vertigo temporarily or long term. It can occur during pregnancy or as a symptom of an ear infection. People with an inner ear disorder, such as Ménière’s disease, sometimes also experience vertigo.
Vertigo can last for varying amounts of time, from just a few seconds to several days, depending on the underlying cause. Most often, it lasts a couple of seconds or minutes.
What is Vertigo?
Vertigo is a common sensation of spinning dizziness. A person may feel as though the room or surrounding environment is spinning in circles around them.
Many people use the term to describe a fear of heights, but this is inaccurate.
Vertigo can happen when a person looks down from a great height, but the actual term vertigo usually refers to any temporary or ongoing spells of dizziness due to problems in the inner ear or brain.
People with vertigo feel as though they are actually spinning or moving, or that the world is spinning around them.
Vertigo is not an illness but a symptom of an underlying condition. Many different conditions can cause vertigo.
Symptoms of Vertigo
A person with vertigo feels as though their head or the space around them is moving or spinning.
Vertigo is a symptom, but it can also lead to or occur alongside other symptoms.
These may include:
- A sense of motion sickness
- Balance problems
- A feeling of fullness in the ear
- Headaches
- Lightheadedness
- Nausea and vomiting
- Ringing in the ear, called tinnitus
- Nystagmus, where the eyes move uncontrollably, usually from side to side
Causes of Vertigo
Various conditions can lead to vertigo, which usually involves either an imbalance in the inner ear or a problem with the central nervous system (CNS).
Conditions that can lead to vertigo include the following.
Labyrinthitis
This disorder can happen when an infection causes inflammation of the inner ear labyrinth. Within this area is the vestibulocochlear nerve.
This nerve sends information to the brain about head motion, position, and sound.
Apart from dizziness with vertigo, a person with labyrinthitis may experience hearing loss, tinnitus, headaches, ear pain, and vision changes.
Vestibular Neuritis
An infection causes vestibular neuritis, which is inflammation of the vestibular nerve. It is similar to labyrinthitis but does not affect a person’s hearing. Vestibular neuritis causes vertigo that may accompany blurred vision, severe nausea, or a feeling of being off-balance.
Cholesteatoma
This noncancerous skin growth develops in the middle ear, usually due to repeated infection. As it grows behind the eardrum, it can damage the middle ear’s bony structures, leading to hearing loss and dizziness.
Ménière’s disease
This disease causes a buildup of fluid in the inner ear, which can lead to attacks of vertigo with ringing in the ears and hearing loss. It tends to be more common in people between 40–60 years old.
The National Institute on Deafness and Other Communication Disorders estimates that 615,000 people in the United States currently have a diagnosis of Ménière’s disease, with doctors diagnosing about 45,500 new cases annually.
The exact cause is unclear, but it may stem from blood vessel constriction, a viral infection, or an autoimmune reaction. There may also be a genetic component, meaning that it runs in some families.
Benign Paroxysmal Positional Vertigo (BPPV)
The otolith organs are structures within the inner ear that contain fluid and particles of calcium carbonate crystals.
In BPPV, these crystals become dislodged and fall into the semicircular canals. There, each fallen crystal touches sensory hair cells during movement.
As a result, the brain receives inaccurate information about a person’s position, and spinning dizziness occurs. People typically experience periods of vertigo that last less than 60 seconds, but nausea and other symptoms may also arise.
Other factors
Vertigo can also occur with:
- A head injury
- Cerebellar or brain stem disease
- Ear surgery
- Migraine headaches
- Multiple sclerosis (MS)
- Acoustic neuroma, which is a benign growth that develops in the inner ear
- Perilymphatic fistula
- Shingles in or around the ear
- Otosclerosis
- Syphilis
- Ataxia, which is the result of muscle weakness
- Stroke
Vertigo in Pregnancy
Nausea and dizziness are usual problems during pregnancy. Hormonal changes appear to play a role, as they affect the characteristics of the fluid in the body and cause blood vessels to relax and widen.
These changes increase the blood flow to the developing baby, but they also mean a slow return of blood in the veins to the rest of the body. As a result, an individual’s blood pressure is lower than usual, which reduces blood flow to the brain. This can cause temporary dizziness.
Hormonal Changes
Changes in fluid characteristics in the inner ear can lead to symptoms such as:
- A feeling of fullness in the ear
- Instability with loss of balance
- Tinnitus and hearing difficulties
- Vertigo
Low Blood Sugar
Low blood sugar in pregnancy can also lead to dizziness. People who are anemic may be more prone to dizziness than others.
During pregnancy, hormonal changes bring about alterations in the inner ear. These can cause issues with balance and symptoms of nausea and dizziness. Changes in body weight and posture during pregnancy may also contribute to balance problems.
In a 2017 review involving four case studies, the authors suggest that hormonal changes may lead to BPPV during pregnancy. Estrogen, specifically, may also play a role.
Is Vertigo Hereditary?
Vertigo itself is not necessarily hereditary. However, it could be a symptom of various hereditary conditions and syndromes. Therefore, a doctor may ask a person with vertigo about their family medical history.
Scientists have recently discovered six gene variants they associate with vertigo. These genes play a role in inner ear development, maintenance, and problems.
Examples of conditions that can trigger vertigo and appear to involve genetic factors include:
- Bilateral vestibular hypofunction
- Familial episodic ataxia
- Migrainous vertigo
- familial Ménière’s disease
Treatment of Vertigo
Some types of vertigo resolve on their own, but a person may need treatment for an underlying issue.
A doctor may, for example, prescribe antibiotics for a bacterial infection or antiviral drugs for shingles.
Medications are available that can relieve some symptoms. These drugs include antihistamines and antiemetics to reduce motion sickness and nausea.
An individual may need surgery if other treatments do not help. If someone has BPPV or acoustic neuroma, doctors may recommend surgery.
Treating Ménière’s disease
A doctor may prescribe medication for people with Ménière’s disease. These may include meclizine, glycopyrrolate, or lorazepam, which can help relieve dizziness due to this condition.
Other options include:
- Avoiding caffeine, chocolate, and alcohol and not smoking tobacco
- Having a doctor inject antibiotics or corticosteroids into the middle ear
- Limiting sodium intake and using diuretic therapy to reduce fluid levels
- Trying pressure pulse treatment, which involves fitting a device to the ear
Types of Vertigo
There are two different types of vertigo, which vary in their cause.
Peripheral Vertigo
This type of vertigo accounts for about 80% of cases. Peripheral vertigo usually results from problems in the inner ear.
Tiny organs in the inner ear respond to gravity and the person’s position by sending messages via nerve signals to the brain. This process enables people to keep their balance when they stand up.
Changes to this system can produce vertigo. BPPV and inflammation are common causes. Other causes include Ménière’s disease and acoustic neuroma, among others.
Central Vertigo
Central vertigo relates to problems with the CNS. It usually stems from a problem in a part of the brain stem or cerebellum. Approximately 20% of cases are of this type.
Possible causes include vestibular migraine, demyelination, and tumors involving the affected CNS region or regions.
Diagnosis of Vertigo
A doctor needs to determine the underlying cause of the dizziness. Therefore, they may carry out a physical examination, ask the person how their dizziness makes them feel, and take their medical history.
The doctor may also carry out some simple tests, including:
- Romberg’s test: The doctor asks the person to stand with their arms by their sides and feet together, then to close their eyes. If the person then becomes unsteady, this could signal a CNS problem.
- Fukuda-Unterberger’s test: The doctor asks the person to march on the spot for 30 seconds with their eyes closed. If they rotate to one side, this may indicate a lesion in the inner ear labyrinth, which could cause peripheral vertigo.
Depending on the results of these and other tests, the doctor may recommend a head CT or MRI scan to obtain more details.
Summary
Vertigo is a feeling of spinning dizziness, but it may also mean someone feels lightheaded, sick, or has ear problems. It is a symptom of various conditions where someone has a problem with the inner ear, brain, or sensory nerve pathway.
Conditions that may cause vertigo include labyrinthitis, vestibular neuritis, Ménière’s disease, and benign paroxysmal positional vertigo (BPPV). Some individuals experience vertigo when they are pregnant.
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