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Vertigo is not the fear of heights as commonly believed; it refers to a sensation of spinning or whirling

Woman experiencing vertigoVertigo, which is related to balance and equilibrium, is a severe form of dizziness. The word vertigo is derived from Latin words 'vertere' and 'igo', which together mean 'sensation of turning'.

What is vertigo?

In vertigo, a person suffers from a sensation of spinning or whirling, which makes it difficult for him/her to maintain balance while standing or sitting. Although vertigo and dizziness are often used interchangeably, they are not the same. While all vertigo is dizziness, all dizziness may not be vertigo. For example, a diabetic may feel dizzy when the blood sugar goes abnormally low, but this is not vertigo.

There is a lack of clarity on the exact symptoms of vertigo since the sensation is very vague and non-specific. Hence, broadly, when we say one has vertigo, it means s/he has:

    • Dizziness or light headedness
    • Spinning where everything goes round [true vertigo]
    • Sense of imbalance [unsteady on feet]
    • Black outs [where everything goes blank]

Fainting spells.

It can be experienced in three different ways.

  • You feel as if you are spinning in relation to the outside environment—subjective vertigo.
  • You feel as if your surroundings are whirling—objective vertigo.
  • It may seem as if the ground is suddenly rushing upwards, making you feel dizzy.

Causes

The inner ear, brain stem, cerebellum, nerve tracts or proprioceptive receptors and eye are the parts of the body, which maintain the body's equilibrium or balance. Hence, a disorder in any of these parts can cause vertigo.

Common causes include:

  • Motion sickness: It is the most common cause of vertigo, because the inner ear is sensitive to constant swaying motions. This occurs only when one is moving long distances. Taking the right care prior to travelling helps control this feeling.
  • Benign parozysmal positional vertigo [BPPV]: A condition in which the calcium particles in the semi-circular canals get dislodged due to sudden head/neck movements. This can be treated, but is recurrent.
  • Meniere's disease: This causes excessive fluid accumulation in the inner ear called hydrops. This fluid starts movement in the inner ear, which causes giddiness.
  • Infections [bacterial or viral]: These cause labyrinthitis or inflammation of the inner ear.
  • Tumours: Tumours of the VIII N like acoustic neuroma [a non-cancerous tumour that develops on the nerve that connects the ear to the brain].
  • Medications: Certain medications can damage the inner ear such as aminoglycocides, anti-malaria drugs, chemotherapeutic drugs, and diuretics.
  • Ear infections: Infection of the middle ear can erode into inner ear and cause giddiness due to the fistulas like cholesteatoma [a skin growth in the middle ear behind the eardrum].
  • Vertebro basilar insufficiency [VBI]: In this, the blood supply to the brain decreases. It is seen primarily in elderly patients.

Besides these, Herpes Zoster [viral disease] / Paget's Disease [a chronic bone condition] and numerous central and systemic conditions can also cause vertigo.

Symptoms

Usually the symptoms start suddenly and one may experience a spinning or moving feeling depending on the severity. This is accompanied by nausea or vomiting and may last from second to minutes, or sometimes even for hours or days.

Along with giddiness and vomiting, one may have noise or ringing sensation in the ear [tinnitus]. In some cases of Meniere's disease, there could be fullness of the ears or a decreased hearing.

Usually these symptoms occur as attacks. With each attack the hearing may decrease. These episodes can last several minutes to several hours and may recur everyday for few days. With each episode the hearing loss worsens.

Vertigo, due to central causes [disease from the central nervous system], will also be accompanied by slurring of speech.

  • Visual disturbances like diplopia [double vision]/blurring of vision
  • Headaches
  • Tingling numbness in limbs
  • Ataxia
  • Black outs.

Investigations usually required are audiological, audiogram, and hearing index. These help to differentiate between peripheral and central vertigo [When the disease that is causing the vertigo is in the central nervous system, it's called central vertigo; while if the vertigo arises from the inner ear, it is peripheral vertigo.]. An ophthalmologic check-up can also be done to check for visual disturbances and other eye-related problems.

Treatment

A thorough medical evaluation is a must so that once the cause is identified the appropriate treatment can be given.

However, during an acute attack complete bed rest with anti-vertiginous tablets should be administered.

Anti-emetics [effective against vomiting and nausea] and sedatives may also help. Once all investigations are concluded the maintenance therapy must be followed.

In cases of the inner ear, these attacks are usually recurrent. This can be handled by consulting your doctor and starting the treatment again.

Vestibular rehabilitation

This plays an important role in the management of vertigo. Here patients are given exercises to perform at home, which stabilises the inner ear and increases the blood flow and thereby oxygen to the brain and inner ear.

Lifestyle modifications

Here are a few suggestions to follow for a healthy lifestyle:

  • Avoid drug and alcohol abuse
  • Avoid OTC [over-the-counter] drugs like sedatives, anti-allergic, without proper consultation
  • Avoid drinking alcohol while taking medications, which can cause dizziness like anti-epileptics, anti-allergic, anti-depressants
  • Avoid jobs involving heights, driving or diving
  • Eat a healthy diet with limited use of salt and sugar
  • Keep blood pressure and blood sugar under control.

Vertigo is a benign condition, which can be treated. Even though it may recur, these can be minimised by correct medication, vestibular rehabilitation and healthy lifestyle.

Disturbed by dizziness

When vertigo is severe, it becomes impossible for the person to move from one place to the other because of severe dizzy spells. This restricts his/her social life. And since the attacks are unpredictable, they are afraid to venture out, which becomes frustrating.

The association between recurrent vertigo and emotional disturbance has also been extensively documented by numerous cross-sectional studies. Pratt and McKenzie [1958] recorded 12 instances of patients who developed various forms of psychological disturbance apparently as a direct consequence of a vestibular dysfunction; panic attacks, fear of travelling and depression were the most common sequelae. In 10 of the 12 patients, treatment and explanation of their medical condition resulted in recovery or significant improvement.

— Team CW

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