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Vertigo - A Guide

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Vertigo is the sensation that you or the environment around you is moving or spinning. It is commonly caused by a problem with the balance mechanisms within the inner ear.

Introduction
Symptoms of vertigo
Causes of vertigo
Diagnosing vertigo
Treating vertigo
Preventing attacks of vertigo

 

Introduction

Vertigo is not a fear of heights

Vertigo is often confused with a fear of heights. However, the dizzy feeling that is often experienced when looking down from a high place is not the same as vertigo, which can occur at any time and may last for many months or even years.

Mild vertigo is very common, and the symptoms are not usually serious. However, vertigo that reoccurs or persists may be caused by an underlying health condition, such as Ménière's disease (a rare disorder that affects the inner ear).

Therefore, if you have recurrent or persistent vertigo, see your GP. They will be able to confirm or rule out a more serious cause, and recommend appropriate treatment.

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Symptoms of vertigo

If you have vertigo, your surroundings will appear to be moving vertically or horizontally, or you may feel that you are spinning.

The effect of vertigo may be slight and barely noticeable, or it may be so severe that you find it difficult to keep your balance and perform everyday tasks.

Attacks of vertigo can develop suddenly and last for a few minutes, or they may last much longer. If you have severe vertigo, your symptoms may be constant and last for several days, making normal life very difficult.

The symptoms of vertigo can vary in severity andmay include:

  • the sensation that your surroundings are moving or spinning,
  • loss of balance,
  • nausea,
  • vomiting,
  • light-headedness,
  • difficulty standing, and
  • difficulty walking.

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Causes of vertigo


Vertigo is most commonly caused by a problem with the balance mechanisms of the inner ear. However, it can also occur as a result of a problem with the brain, or a problem with the nerves that connect the brain to the middle ear.

Vertigo is more severe than dizziness, which is often experienced as a feeling of light-headedness when standing up. Vertigo can make it difficult to move around because the sensation of spinning often affects your balance.

Labyrinthitis

The inner ear includes a complex system of fluid-filled channels that send signals of sound and balance to the brain. This system is known as the vestibular labyrinth, and it is located behind the eardrum.

Sometimes, viral infections such as a common cold or flu can spread to the labyrinth. This is known as labyrinthitis. Less commonly, labyrinthitis is caused by a bacterial infection of the inner ear (otitis media).

Vertigo that is caused by an ear infection usually starts suddenly, and may be accompanied by a painful ear and high temperature.

See Useful linksfor further information about labyrinthitis.

Vestibular neuritis

Vestibular neuritis is an inner ear condition that causes nerve pain and inflammation. It can also cause attacks of vertigo that canlast for several hours or days.

A viral infection can sometimes lead to vestibular neuritis. If your vertigo attacks are a result of vestibular neuritis, they will often be followed by a feeling of discomfort and unbalance. You will not usually have tinnitus (ringing in the ears) or hearing problems.

Benign paroxysmal positional vertigo

Short, intense, recurrent attacks of vertigo (usually lasting 10-20 seconds) are often the result of benign paroxysmal positional vertigo (BPPV).

BPPV occurs when a person turns their head suddenly, or rolls over in bed. It is often accompanied by nausea and vomiting. You will not usually have tinnitus, and your hearing will not be affected.

BPPV is thought to be caused by small fragments of debris which, for unknown reasons, break off from the lining of the labyrinth. The fragments, known as otoconia, are made of calcium carbonate crystals, and do not usually cause a problem unless they get into one of the ear’s fluid-filled canals.

When your head is still, the otoconia sit at the bottom of the canal. However, certain head movements cause the fragments to be swept along the fluid-filled canal, where they brush against the sensitive hairs that line the canal. This sends extra, confusing, messages to the brain, which responds by causing vertigo.

BPPV usually affects older people. Most cases occurr in people over 40. However, it can affect younger people, and may develop after an ear infection, or after a head injury that causes damage or inflammation to the inner ear.

Attacks of BPPV usually clear up within a few days. The condition usually clears up within a few weeks or months but it can sometimes reoccur at a later date.

Ménière's disease

If you have severe vertigo, it may be caused by an underlying problem with the balancing mechanisms of your inner ear. This conditionis known as Ménière's disease.

As well as vertigo, the symptoms of Ménière's disease include hearing loss and tinnitus, which arecaused by pressure within the affected ear.

If you have Ménière’s disease, you may experience attacks of vertigo that last one to 24 hours. The attacks often cause nausea and vomiting, and are sometimes followed by a feeling of discomfort and unbalance.

The tinnitus associated with Ménière’s disease often gets worse over time. Initially, the hearing loss is experienced intermittently (it comes and goes), but it may eventually become permanent.

See Useful links for more information about Ménière’s disease, tinnitus and hearing impairment.

Head injury

Vertigo can sometimes develop after a head injury. If you have symptoms, such as dizziness or vertigo following a head injury, go to your GP as soon as possible.

Other causes of vertigo

Vertigo can sometimes be caused by a number of other conditions or factors. These are listed below.

  • Migraines (severe headache).
  • Chronic otitis media: long-term, or recurring, infection of the inner ear.
  • Acoustic neuroma: a rare, non-cancerous (benign) brain tumour, which grows on the acoustic nerve and may sometimes cause mild vertigo.
  • Medicationthat contains substances such as salicylates (ibuprofen and some types of antiinflammatories), quinine and aminoglycosides.
  • Other conditions,such as Eustachian tube dysfunction (the tube that links the inner ear with the nose), nasopharyngeal carcinoma (cancer of the canal located behind the nose).
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Diagnosing vertigo

Dizziness is a common symptom that is associated with several conditions. In order to rule out a number of possible causes of your symptoms, your GP will ask you to describe your symptoms in detail.

To make an accurate diagnosis of vertigo, they will want to know:

  • what symptoms you have,
  • how often they occur, and
  • how long they usually last for.

Hallpike’s manoeuvre

Hallpike’s manoeuvre is a test that brings on the symptoms of vertigo, and is often used to confirm cases of benign paroxysmal positional vertigo (BPPV).

The test involves moving quickly from a sitting to lying position, with your head below the horizontal line (of the surface you are lying on). As you lie back, you will be asked to rotate your head towards the person testing you, keeping your eyes open.

In cases of BPPV, after about 10 seconds, the symptoms of vertigo appear for several seconds before disappearing.

Other tests

Another simple test used for vertigo involves standing still and closing your eyes. If your balance is affected, it may indicate that there is a problem with your middle ear.

If you have tinnitus, your GP may refer you to an ear, nose and throat (ENT) specialist. You may be given a number of tests including:

  • an ear X-ray,
  • hearing tests, and
  • balance tests.

A computerised tomography (CT) or magnetic resonance imaging (MRI) scan may also be recommended to rule out an acoustic neuroma (benign brain tumour).

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Treating vertigo

If you have vertigo, the treatment that you will receive will depend on the cause and severity of your symptoms.

During a vertigo attack, lying still in a quiet, darkened room may help to ease any symptoms of nausea that you have, and reduce the sensation of spinning. Avoid stressful situations, because anxiety can make the symptoms of vertigo worse.

Labyrinthitis

Labyrinthitis often clears up on its own without treatment. Antibiotics may be prescribed in rare cases where labyrinthitis is caused by a bacterial infection of theinner ear (otitis media).

Surgery may be an option in very severe cases of labyrinthitis. A labyrinthectomy is a surgical procedure that involves completely removing the vestibular labyrinth, which isthe system of tiny, fluid-filled channels in the ear that send out signals of sound and balance to the brain.

However, a labyrinthectomy can only be carried out if one ear is affected and you have severe hearing loss. This is because after the procedure, you will not be able to hear from the affected ear again, and your other ear will take over your hearing and balance.

Benign paroxysmal positional vertigo

As with labyrinthitis, benign paroxysmal positional vertigo (BPPV) often clears without treatment after several weeks or months.

It is thought that the otoconia (small fragments of debris in the ear canal that cause vertigo) either dissolve or become lodged in a place where they do not cause symptoms.

The Epley manoeuvre

The Epley manoeuvre is often very effective in resolving the symptoms of vertigo. It is carried out under the supervision of a healthcare professional, and itinvolves performing four separate head movements to move the otoconia fragments to a place where they cannot cause symptoms. Each head position is held for about 30 seconds.

In order to allow the otoconia to settle in their new position after you have had the Epley manoeuvre, you may be advised:

  • not to lie flat for 48 hours (you will need to sleep sitting in an upright position),
  • to avoid lying on the affected side for a week, and
  • to avoid bending over for a week.

After a single treatment, the Epley manoeuvre has been shown to cure approximately 80% of BPPV cases. However, if the Epley manoeuvre is not effectivethefirst time, it is possible that a second treatment may prove successful.

Surgery for BPPV

Most cases of BPPV improve on their own without treatment, or they are cured following the Epley manoeuvre. However, in rare cases, the symptoms of vertigo can last for many months or years. In such cases, surgery to remove the fluid-filled canal may be possible. An ear, nose and throat (ENT) specialist will be able to advise you about this.

Ménière’s disease

If your vertigo is caused by Ménière’s disease, you may be prescribed medication such as prochlorperazine, or antihistamine. These are described in more detail below.

Prochlorperazine

Prochlorperazine can be used on a short-term basis to help ease symptoms of nausea and vomiting. However, prochlorperazine can make some people feel sleepy, and it is not suitable for everyone. You should see your GP if you are taking prochlorperazine and you develop a high temperature (fever) of 38ºC (100ºF) or above.

Antihistamines

Antihistamines, such as cinnarizine or cyclizine can be used on a short-term basis to help ease the symptoms of nausea and vomiting. Antihistamines all have slightly different cautions and possible side effects, so the dosage instructions must be followedcarefully. Seek advice from your GP or pharmacist if you are unsure.

Surgery

Surgery may be offered as a last resort option to help reduce severe attacks of vertigo which are caused by Ménière’s disease. A procedure called a endolymphatic sac decompression reduces swelling in the labyrinth by removing some of the bones surrounding your inner ear.

A labyrinthectomy involves removing the whole of the vestibular labyrinth, and may be recommended in cases where the symptoms of vertigo are persistent and severe. The section about labyrinthitis (above) has furtherdetails about the labyrinthectomy procedure.



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Preventing attacks of vertigo


Betahistine

Betahistine is a medicine that helps to increase blood flow around the inner ear, and it can help to prevent vertigo. If taken for up to a year, it may reduce the number and severity of vertigo attacks, although there is no firm evidence that it is effective.

Physiotherapy

A physiotherapist can improve your balance by teaching you a number of different exercise techniques. These exercises help by teaching you how to cope with the abnormal and disorientating signals coming from your inner ear. They teach you how to use alternative signals from your eyes, ankles, legs and neck to keep you balanced.

Self-help advice

The self-help advice listed below may help to relieve or prevent the symptoms of vertigo.

  • Sleep with your head slightly elevated (raised) on two or more pillows.
  • When getting out of bed, get up slowly and sit on the edge of the bed for a minute or so before standing.
  • Avoid bending down to pick up items.
  • Avoid extending your neck. For example, while reaching up to a high shelf.
  • Move your head carefully and slowly during daily activities, or when your neck is extended, or when your head is positioned horizontally, such as when you are lying flat.

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