Vertigo

Dr. Terry Murphy

ED Medical Director

Samaritan Hospital

Vertigo is the feeling that either you or your environment is moving when no movement is occurring.  It is a specific symptom complex that is distinguishable from dizziness or light headedness.  While as a child, spinning around until you had vertigo was great fun; it can be incapacitating when the symptoms are severe or persistent.

While dizziness is one of the most common complaints of older adults, and to a great degree is a fact of aging, especially when associated with chronic illnesses and multiple medications; vertigo is a specific symptom of a balance disturbance.  The sense of motion involves a very complex interplay, coordination and interpretation of signals from the eyes, the sensory nerves, the inner ear, the nerve from the inner ear and the brain.  A breakdown of sensory input at any of these levels can cause vertigo.

The inner ear has 3 semicircular canals connected to a vestibule.  These organs are filled with fluid and lined with hair like sensory nerve fibers.  This organ functions in part like a carpenter’s level – that is, as the head changes position (side to side, front to back, forward, backward, sideways, up or down) this fluid also moves, touching different sensory nerve fibers as it moves.  The sensory nerves “interpret” the change in position and send that information to the vestibular organ that acts like a computer receiving and coordinating the data, and then sending it via the acoustic nerve to the brain.

In addition to the information the brain receives from the inner ear; it receives input from the eyes and the joints, skin and bones of the body that send their information through nerves to the spinal cord and onto the brain.

Regardless of where the information flow “breaks down,” people who have vertigo have an inappropriate sense of motion.  This is often worse with actual movement, is frequently associated with profound nausea and vomiting, may have an associated constant ringing in the ear, and usually has some component of an unsteady gait, falling and/or blurred vision.

Specific causes of vertigo include:

Benign paroxysonal positional vertigo (BPPV) which is usually sudden, intense exacerbation that often make any position other than holding onto the mattress is in prone position impossible.  This inner ear caused problem, is thought to be secondary to displacement of crystals (stones) into the wrong part of a semicircular canal causing fluid flow disruption.

Labrynthritis also has a sudden onset with intense symptoms. It may be indistinguishable from BPPV though it frequently is associated with other recent viral infection symptoms.  It is thought to be secondary to the viral infection.

Meniere’s disease is a chronic form of vertigo associated with ringing in the ear (tinnitus) and hearing loss.  It can affect adults of any age and patients have recurrent bouts of vertigo with the other symptoms constant.  Its cause is unknown.

Acoustic neuroma is a benign tumor of the acoustic nerve. The nerve that transmits signals from the vestibular organ to the brain.

Vestibular migraine is one of several unusual presentations of a migraine headache.  The cause of vestibular migraines is the same as with other migraine headaches (brain blood vessel dilatation and inflammation of the meninges, the brain’s lining tissue).

Other medical problems such as too low or too high blood pressure, a stroke, an abnormal heart rhythm, infections of the middle ear (otitis), and many medications can also cause vertigo.

Anyone with new onset of vertigo or change in vertigo symptoms should undergo a thorough evaluation by their health care provider.  Because of the multiple potential causes of vertigo, the evaluation should be comprehensive including a thorough history, complete physical exam, a hearing exam, blood tests, EKG and often a head CT.

Once the specific cause of the vertiginous symptoms have been determined, treatment options can be tailored to the specific cause, as well as treatment of symptoms:

BPPV generally responds to a procedure called canalith repositioning.  This involves maneuvering the head into different positions to move obstructing stone into a position where they no longer produce symptoms and can be reabsorbed.  Success rates as high as 90 percent have been reported with this procedure.

Labrynthitis symptoms generally resolve as the body heals from the viral infection but a physical or occupational therapist can instruct and help with balance retraining exercises.

Meniere’s disease is treated by salt intake reduction and diuretic medication.

Acoustic neuroma that is too symptomatic to manage with medications alone can be treated with either surgery or radiation therapy known as gamma radiosurgery.

Vestibular migraines are managed in the manner of a migraine headache with the combination of Triptan medications and nonsteriodal anti-inflammatory medications.

Other causes should also be tailored to the specific cause such as medications to lower blood pressure, treat heart rhythm irregularities, treat a middle ear infection, etc.

Lastly, a commonly prescribed antihistamine medication, meclizine (Antivert) is very efficacious for most patients for the treatment the motion sensation and motion sickness symptoms of vertigo.

This article is intended to provide useful information, not medical advice. This information cannot, and is not meant to, replace consultation with your physician regarding your individual circumstances.