What is Vertigo?
Vertigo, which is derived from the Latin word vertere, that is ‘to turn’, is the illusion of rotation and the feeling that the environment is moving or spinning. Vertigo is a sensation caused by an imbalance in signals from the body’s sensory balance organs, including the eyes and inner ears, or abnormality in the way the brain interprets such signals.
Dizziness and vertigo are among the most common symptoms causing patients to visit a physician or the Emergency Department (ED); between 5-10% of people report symptoms of dizziness, vertigo, and imbalance at some time, and it may be as high as 40% in patients older than 40 years. It is estimated that about 4 million patients visit the ED for dizziness and vertigo. Significant dizziness has been reported by 17% to 30% of adult community populations. Falling can be a direct consequence of dizziness, and the risk is even greater in elderly people with other neurologic deficits and chronic medical problems.
Causes of vertigo fall into two main categories. The first is central vertigo, which caused by a problem in the central nervous system, and may include a growth on cranial nerves called vestibular schwannoma, commonly referred to as an “acoustic neuroma”. The second is peripheral vertigo, probably caused by problems in the inner ear or middle ear. Differentiating the causes of vertigo can be helpful for providers to determine what possible treatments exist for each type.
Symptoms patients often experience with peripheral vertigo include the spinning, hearing loss, nausea, and tinnitus (ringing in the ears). In contrast, central vertigo often appears with migraines. A condition called vestibular migraine is one of the most common causes of central vertigo.
The most common types of peripheral vertigo include Ménière’s disease, vestibular neuronitis, and Benign Paroxysmal Positional Vertigo (BPPV) .
Ménière’s disease is an inner ear disorder that is characterized by unpredictable, recurrent events and it is associated with vertigo that lasts for hours, decreased hearing or hearing loss for some period, and ringing in the ears (tinnitus). Cold sweats, nausea, and vomiting with a sense of weakness are also symptoms associated with Meniere’s disease. Patients with Ménière’s disease live in constant fear of attacks of disabling vertigo and may require family support and counseling. Many patients can manage their symptoms with diet and lifestyle modifications as well as pharmacological treatment prescribed by their physician.
Vestibular neuronitis is due to infections, causing vertigo attacks that may last for days. Patients suffering from this condition usually do not experience hearing loss. However, there are manifestations in which a bacterial infection that affects the inner ear may destroy both equilibrium and hearing functions of the affected ear, a condition known as labyrinthitis.
Chronic migraine sufferers may also experience vertigo attacks with symptoms like Ménière’s disease. This condition is called vestibular migraine and headaches may or may not manifest during a vertigo crisis.
Patients with BPPV often describe a feeling of intense spinning sensation (positional) that lasts only a few minutes (benign) and often comes and goes without any specific reason or cause (paroxysmal). A complex system of semicircular canals filled with fluid, called the labyrinth, is responsible for maintaining body balance. In patients with BPPV, the formation or dislocation of small crystals in the fluid stimulates the nerves associated with these canals and creates the sensation of spinning and nausea. Patient also have involuntary eye movements, called nystagmus, which can help doctors diagnose this condition. Treatment mainly consists of physical maneuvers by specialists with the aim of re-positioning the crystals. In a small proportion of patients with persistent vertigo after the re-positioning maneuvers, pharmacological treatment with sedatives or anti-vertiginous drugs may be necessary.
For any type of vertigo, we recommend seeking the advice of a medical professional. The accurate diagnosis and effective treatment of vertigo can be very challenging and this is an area of continuous research.
- Saber Tehrani AS, Coughlan D, Hsieh YH, et al. Rising annual costs of dizziness presentations to U.S. emergency departments. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2013;20(7):689-96 doi: 10.1111/acem.12168[published Online First: Epub Date]|.
- Murdin L, Schilder AG. Epidemiology of balance symptoms and disorders in the community: a systematic review. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2015;36(3):387-92