Vertigo

What is Vertigo?

Vertigo is a type of dizziness. It is described as a ‘spinning’ sensation in the head and is usually brought on by sudden changes in position. Some people say it feels like standing still in a spinning room. You may feel like you are going to fall over. While there are some serious causes of vertigo, in most cases it is not a serious condition and usually gets better with time. Vertigo can be temporary or long-term

What are the causes of Vertigo?

The most common cause of vertigo is called Benign Positional Paroxysmal Vertigo or BPPV. BPPV happens when tiny particles in the balance centre of the inner ear are disturbed, usually by sudden movement. This causes the spinning sensation. It is a common problem that can affect people of all ages.

• Meniere’s disease is an inner ear disorder that affects balance and hearing.
• Acute peripheral vestibulopathy (APV) is inflammation of the inner ear, which causes a sudden onset of vertigo.

Rarely, peripheral vertigo is caused by:

• Perilymphatic fistula, or abnormal communication between the middle ear and the inner ear.
• Cholesteatoma erosion, or erosion caused by a cyst in the inner ear.
• Otosclerosis, or abnormal bone growth in the middle ear.

There are other causes of vertigo, including head injuries (such as a knock to the head), stroke, circulation problems, for some people the cause may not be found.

Symptoms

A person with vertigo will have a sense that their head, or their surrounding environment, is moving or spinning. Vertigo can be a symptom of other conditions, and it can also have its own set of related symptoms.

These include:

• Balance problems and lightheadedness.
• A sense of motion sickness.
• Nausea and vomiting.
• Tinnitus.
• A feeling of fullness in the ear.
• Headache.

Types of Vertigo

• Peripheral vertigo usually occurs when there is a disturbance in the balance organs of the inner ear.
• Central vertigo occurs as the result of a disturbance in one or more parts of the brain, known as sensory nerve pathways.

What is a vertigo assessment?

In order to assess the cause of the symptoms, the doctor will conduct a vertigo assessment. This begins with a thorough history and examination investigating the nature, onset, duration and precipitating factors of the vertigo. A hearing test will be conducted as part of the evaluation. Depending on the doctor’s assessment, further vestibular tests or a MRI may be deemed necessary.

• Videonystagmography (VNG) refers to the same test battery run using goggles with video cameras to monitor the eyes. It measures eye movements to evaluate signs of vestibular dysfunction or neurological problems.
• Video Head Impulse Testing (VHIT) also evaluates how well the eyes and inner ears work together. vHIT test uses very small and quick movements of the head to evaluate reflex function, as opposed to the slow or moderate speeds used in rotation testing.
• Vestibulo Evoked Myogenic Potential (VEMP) testing is used to evaluate whether certain vestibular organs and associated nerves are intact and functioning normally.
• Electrocochleography (ECOG) measures a response to sound from the nervous system. This test is performed to rule out Meniere’s disease.
• Rotary chair test is used to help determine whether the symptoms are due to a disorder of your inner ear or a disorder of the brain.

Treatment option for Vestibular disorders:

Treatment option for vestibular disorders varies with etiology, onset and severity of the problem.

• Pharmacological treatments
• Liberatory and repositioning maneuver for BPPV treatment (specific maneuvers according to the location(s) of the otoconial debris; Epley and Semont maneuvers are common examples for repositioning debris located in the posterior semicircular canal);
• Vestibular rehabilitation (e.g. exercises for eye and head stabilization, proprioceptive training or habituation exercises);
• Psychotherapeutic measures (particularly important in psychogenic vertigo);
• Surgical treatments - in less frequent lesions such as semicircular canal dehiscence, where there is a lack of bone covering one or more semicircular canals and ear tumors (e.g. vestibular schwannoma).

Team Members involved in vestibular assessment and treatment: ENT Specialist, Audiologist, Neurophysiologist.