Vertigo is a form of dizziness, in which a sense of rotation or spinning is experienced, whereas the body in fact doesn’t make those movements. Vertigo is often accompanied by nausea, vomiting and balance disorder. This condition is an important symptom of BPPV (benign paroxysmal positional vertigo), vestibular neuritis (labyrinthis) and Ménière’s disease.
Cause
Vertigo is caused by a disturbance of the vestibular system. This is a small vulnerable organ inside the ear. If it doesn’t function properly, the brains receive wrong information. Then a person sees everything turning or has the sensation of moving, falling or turning.
People can have vertigo in the following cases:
- The vestibular system is infected.
- The tubes of the vestibular system are clogged.
- There is too much fluid in the tubes.
- The blood supply to the vestibular system is disrupted.
Very occasionally, the cause is not in the vestibular system, but in the brains, such as in case of multiple sclerosis. Vertigo may occur in divers, caused by oxygen poisoning, when dived with a gas mixture of enriched oxygen.
Symptoms
The signs and symptoms of vertigo may vary by condition:
- In case of BPPV, vertigo comes in attacks as a person moves the head. An attack of BPPV takes only a few minutes.
- In case of vestibular neuritis, a person suffers, apart from the vertigo, from pallor, nausea and vomiting. During an attack, one can't do anything else than lying in bed with closed eyes.
- In case of Ménière’s disease, a person has attacks of severe, very troublesome vertigo which lasts several hours. During the attack, the patient can hear less well and suffers from tinnitus or a feeling of fullness in the ears. One can also be nauseous and vomit. After one to two hours, the attack is at its peak. After the attack, the patient can still have milder symptoms for a few days.
Diagnosis
Making the diagnosis of vertigo needs specialized examination. With the so-called Dix-Hallpike test, in which the head and upper body are suddenly tumbled backwards from a seated position, the dizziness can be induced. Usually, a typical eye movement can be seen, which can be recorded with a video camera during the balance test.
Treatment
Since vertigo is often the manifestation of an underlying cause, it isn’t necessary to treat the dizziness itself. Little can be done against dizziness. There is no medication that can reduce or stop it. One should therefore look for the underlying cause and remedy the situation. If there is a presumption that the inner ear is causing the problem, a hearing test will be done. Hearing will be tested with the aid of a headphone. In addition, a balance test can be carried out too, in which can be studied how the patient responds to certain stimuli and thus can be tried to figure out where the problem is located. Sometimes, an MRI can be made in order to exclude other underlying causes. If it's presumed that the dizziness is based on a vascular problem, an ultrasound and Doppler test will be done in many cases, in which the vessel wall is examined and the flow of blood is studied.
Prognosis
When the symptoms disappear, depends on the cause. The vertigo in BPPV usually passes on its own within four weeks. In case of vestibular neuritis, the symptoms usually disappear within a week. In case of Ménière’s disease, the attacks of vertigo can keep coming back. But it can take longer than a year before there will be another attack.
Considerations
If a person suffers from vertigo for the first time, the initial advice is: just try to continue what you are doing. Further advice will depend on the cause:
- In case of BPPV, the patient can do exercises, which seems to make the dizziness disappear sooner. Sit with the eyes closed on the middle of the edge of the bed. Then go lying on the side. Get up as the dizziness is over and then go lying on the other side. Repeat this until the dizziness disappears. Do this exercise five times a day. These exercises stimulate dizziness. Thus, they are difficult to hold on in the beginning.
- The dizziness in case of vestibular neuritis and Ménière’s disease is often so intense that bed rest is initially the only option. Once the dizziness decreases, attempt can be made to resume daily activities.
Some adjustments in daily activities can ensure that a person has less problems with vertigo. This can be done by:
- Use two or more pillows when resting or sleeping.
- Prevent sleeping on the ‘affected’ side (if the condition exists in one ear).
- Get easily out of bed. Before stepping out of bed, remain seated on the edge of the bed for at least one minute.
- Avoid bending forward to grab something.
- Don’t bend the head backwards too far.
