Vertigo

Vertigo is a sensation of spinning, dizziness, or feeling off-balance, often described as the feeling that you or the environment around you is moving or spinning. It is not a condition itself but a symptom of various underlying disorders, particularly those related to the inner ear or brain.

Causes of Vertigo

  1. Benign Paroxysmal Positional Vertigo (BPPV)

    • Overview: The most common cause of vertigo, BPPV occurs when tiny calcium crystals (otoconia) in the inner ear become dislodged and move into the semicircular canals, leading to brief episodes of dizziness triggered by changes in head position.
    • Symptoms: Sudden onset of vertigo with head movement, lasting seconds to minutes.
    • Treatment: Epley maneuver (a series of specific head movements to reposition the crystals), and vestibular rehabilitation.

  2. Meniere’s Disease

    • Overview: A disorder of the inner ear that causes episodes of vertigo, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the ear. It is believed to be related to fluid buildup in the inner ear.
    • Symptoms: Severe vertigo lasting 20 minutes to several hours, fluctuating hearing loss, and tinnitus.
    • Treatment: Dietary changes (low sodium diet), medications (diuretics, anti-nausea drugs), and in severe cases, surgery.

  3. Vestibular Neuritis

    • Overview: Inflammation of the vestibular nerve, usually caused by a viral infection, leading to sudden, severe vertigo without hearing loss.
    • Symptoms: Intense vertigo lasting days, imbalance, and nausea, with gradual recovery over weeks.
    • Treatment: Corticosteroids, vestibular suppressants, and vestibular rehabilitation exercises.

  4. Labyrinthitis

    • Overview: Inflammation of both the vestibular nerve and the inner ear, typically due to viral or bacterial infection, causing vertigo along with hearing loss.
    • Symptoms: Vertigo, hearing loss, and tinnitus.
    • Treatment: Similar to vestibular neuritis, including medications to treat infection if bacterial.

  5. Migrainous Vertigo (Vestibular Migraine)

    • Overview: Vertigo associated with migraines, where the dizziness may occur before, during, or after a headache, or even without a headache.
    • Symptoms: Vertigo episodes lasting minutes to hours, sensitivity to light and sound, and sometimes headache.
    • Treatment: Migraine medications, lifestyle modifications, and vestibular therapy.

  6. Cholesteatoma

    • Overview: An abnormal, non-cancerous skin growth in the middle ear that can lead to vertigo by damaging the structures of the inner ear.
    • Symptoms: Persistent vertigo, hearing loss, and discharge from the ear.
    • Treatment: Surgical removal of the cholesteatoma.

  7. Central Causes of Vertigo

    • Overview: Vertigo can also result from conditions affecting the brain, such as stroke, multiple sclerosis, or brain tumors.
    • Symptoms: Often accompanied by other neurological symptoms like double vision, difficulty speaking, or weakness.
    • Treatment: Depends on the underlying cause, ranging from medication to surgery.

Diagnosis of Vertigo

Diagnosing the cause of vertigo involves a comprehensive evaluation, including:

  • Medical History: Assessment of symptoms, duration, triggers, and associated conditions like hearing loss or headaches.
  • Physical Examination: Includes a neurological exam and specific tests like the Dix-Hallpike maneuver to diagnose BPPV.
  • Imaging: MRI or CT scans may be used if a central cause is suspected.
  • Hearing Tests: Audiometry may be performed if hearing loss is present.

Treatment of Vertigo

Treatment varies depending on the underlying cause but generally includes:

  1. Medications:

    • Vestibular Suppressants: Such as meclizine or diazepam to reduce dizziness.
    • Antiemetics: To control nausea and vomiting associated with vertigo.
    • Corticosteroids: For conditions like vestibular neuritis or labyrinthitis.

  2. Physical Therapy:

    • Vestibular Rehabilitation Therapy (VRT): Exercises designed to improve balance and reduce dizziness by retraining the brain to compensate for inner ear issues.

  3. Lifestyle Modifications:

    • Dietary Changes: Especially in Meniere’s disease, reducing sodium intake can help manage symptoms.
    • Stress Management: Since stress can exacerbate vertigo, relaxation techniques may be helpful.

  4. Surgical Options:

    • In severe or refractory cases, surgery may be needed to correct structural problems in the inner ear.

Living with Vertigo

Managing vertigo often requires a combination of medical treatment, lifestyle changes, and coping strategies. People with chronic vertigo may benefit from:

  • Home Safety Measures: To prevent falls during episodes of dizziness.
  • Regular Follow-Up: With healthcare providers to monitor and adjust treatment plans.
  • Support Groups: For those living with chronic vertigo to share experiences and coping strategies.

 

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