VERTIGO

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Vertigo is a condition where a person has the sensation of moving or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. Many people use the term vertigo to describe a fear of heights, but this is not correct. It is not an illness but a symptom and many different conditions can cause vertigo. This may be associated with nausea, vomiting, sweating, or difficulties walking. It is typically worse when the head is moved.

CLASSIFICATION

Peripheral

Vertigo that is caused by problems with the inner ear or vestibular system, which is composed of the semicircular canals, the vestibule (utricle and saccule), and the vestibular nerve is called “peripheral”, “otologic”, or “vestibular” vertigo. The most common cause of peripheral vertigo is benign paroxysmal positional vertigo (BPPV), which accounts for 32% of all peripheral vertigo. Other causes include Ménière’s disease (12%), superior canal dehiscence syndrome, labyrinthitis, and visual vertigo. People with peripheral vertigo typically present with mild to moderate imbalance, nausea, vomiting, hearing loss, tinnitus, fullness, and pain in the ear.

Central

Vertigo that arises from injury to the balance centers of the central nervous system (CNS), often from a lesion in the brainstem or cerebellum, is called “central” vertigo and is generally associated with less prominent movement illusion and nausea than vertigo of peripheral origin. Central vertigo may have accompanying neurologic deficits(such as slurred speech and double vision), and pathologic nystagmus (which is pure vertical/torsional).

CAUSES

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder, it occurs in 0.6% of the population yearly with 10% having an attack during their lifetime. It occurs when loose calcium carbonate debris has broken off of the otoconial membrane and enters a semicircular canal thereby creating the sensation of motion. People with BPPV may experience brief periods of vertigo, usually under a minute, but nausea and other symptoms may also occur which occur with change in the position.

Labyrinthitis

This disorder can happen when an infection causes inflammation of the inner ear labyrinth. Within this area is the vestibulocochlear nerve. This nerve sends information to the brain about head motion, position, and sound. It presents with severe vertigo with associated nausea, vomiting, and generalized imbalance and is believed to be caused by a viral infection of the inner ear. Apart from dizziness with vertigo, a person with labyrinthitis may experience hearing loss, tinnitus, headaches, ear pain, and vision changes.

Vestibular neuritis

An infection causes vestibular neuritis, which is inflammation of the vestibular nerve. It is similar to labyrinthitis, but it does not affect a person’s hearing. Vestibular neuritis causes vertigo that may accompany blurred vision, severe nausea, or a feeling of being off balance.

Cholesteatoma

This noncancerous skin growth develops in the middle ear, usually due to repeated infection. As it grows behind the eardrum, it can damage the middle ear’s bony structures, leading to hearing loss and dizziness, thereby causing vertigo.

Ménière’s disease

It is an inner ear disorder of unknown origin, but is thought to be caused by an increase in the amount of endolymphatic fluid present in the inner ear (endolymphatic hydrops) which can lead to attacks of vertigo with ringing in the ears and hearing loss. It tends to be more common in people between the ages of 40 and 60 years. The National Institute on Deafness and Other Communication Disorders estimate that 615,000 people in the United States currently have a diagnosis of Ménière’s disease, with doctors diagnosing about 45,500 new cases each year.

Motion sickness

Motion sickness is common and is related to vestibular migraine. It is nausea and vomiting in response to motion and is typically worse if the journey is on a winding road or involves many stops and starts, or if the person is reading in a moving car. It is caused by a mismatch between visual input and vestibular sensation. For example, the person is reading a book that is stationary in relation to the body, but the vestibular system senses that the car, and thus the body, is moving

Vertigo can also occur as a result of the following;

Migraine headaches

Severe head injury

Ear surgery

Syphilis

Ataxia, which leads to muscle weakness

Cerebella or brain stem disease

Acoustic neuroma

Multiple sclerosis

Prolonged bed rest and the use of some medications can also lead to vertigo

SIGNS AND SYMPTOMS

Vertigo is commonly associated with the following;

Nausea or vomiting

Unsteadiness (postural instability)

Falls

Blurred vision

Difficulty in speaking

A lowered level of consciousness

Lightheadedness

Ringing in the ear, called tinnitus

A feeling of fullness in the ear

Headaches

Nystagmus, in which the eyes move uncontrollably, usually from side to side

MANAGEMENT

Definitive treatment depends on the underlying cause of vertigo. Below are some common drug treatment options;

Anticholinergics such as hyoscine hydrobromide (scopolamine)

Anticonvulsants such as topiramate or valproic acid for vestibular migraines

Antihistamines such as betahistine, dimenhydrinate, or meclizine, which may have antiemetic properties

Beta blockers such as metoprolol for vestibular migraine

Corticosteroids such as methylprednisolone for inflammatory conditions such as vestibular neuritis or dexamethasone as a second-line agent for Ménière’s disease

Lifestyle changes

Steps that can help reduce the effects of vertigo include:

Lying still in a quiet, dark room when the spinning is severe

Sitting down as soon as the feeling of dizziness appears

Taking extra time to perform movements that may trigger symptoms, such as getting up, looking upward, or turning the head

Squatting instead of bending over to pick something up

Sleeping with the head raised on two or more pillows

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