Vertigo and balance disorder

Vertigo is a sensation of dizziness or spinning that can occur when there is a problem with the balance systems of the inner ear, brain, or sensory pathways. It's a symptom rather than a disease in itself and is typically associated with disorders of the vestibular system, which controls balance.

Causes of Vertigo

1. Benign Paroxysmal Positional Vertigo (BPPV):

   • The most common cause of vertigo.
   • Occurs when tiny calcium crystals in the inner ear (otoconia) become dislodged and move into the semicircular canals, causing brief, intense episodes of dizziness triggered by changes in head position.

2. Meniere's Disease:

   • A disorder of the inner ear characterized by episodes of vertigo, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the ear. It is thought to be due to abnormal fluid buildup in the inner ear.

3. Vestibular Neuritis or Labyrinthitis:

   • Inflammation of the vestibular nerve or inner ear, typically caused by a viral infection, leading to severe vertigo, nausea, and imbalance.

4. Migrainous Vertigo:

   • Vertigo associated with migraines, often linked to changes in blood flow in the brain or vestibular pathways. This can occur with or without a headache.

5. Vestibular Schwannoma (Acoustic Neuroma):

   • A benign tumor on the vestibulocochlear nerve can lead to vertigo, hearing loss, and tinnitus, though it’s less common.

6. Stroke or TIA (Transient Ischemic Attack):

   • A stroke affecting the brainstem or cerebellum can result in vertigo. A sudden onset of vertigo, especially if associated with other neurological symptoms (e.g., numbness, slurred speech, double vision), requires immediate medical attention.

7. Other Causes:

   • Conditions like head trauma, ear infections, or certain medications (e.g., ototoxic drugs) can also contribute to vertigo.

Symptoms of Vertigo

• Spinning sensation: Feeling like you or your surroundings are moving or spinning.
• Nausea and vomiting: Often associated with the intense dizziness.
• Balance problems: Difficulty maintaining balance, especially when standing or walking.
• Hearing loss, tinnitus, or fullness in the ear: Common in conditions like Meniere's disease.
• Nystagmus: Involuntary eye movements, often seen during episodes of vertigo.

Diagnosis

A comprehensive diagnosis involves a detailed medical history, physical examination, and possibly:

1. Dix-Hallpike test: A maneuver to diagnose BPPV.
2. Electronystagmography (ENG): Measures involuntary eye movements to assess inner ear function.
3. MRI or CT scans: Used to rule out structural causes such as tumors or strokes.
4. Audiometry: Hearing tests if a hearing-related cause (e.g., Meniere’s disease) is suspected.
5. Blood tests: To rule out infections or metabolic disorders.

Treatment Options for Vertigo

1. Vestibular Rehabilitation Therapy (VRT):

   • A specialized form of physical therapy designed to help the brain adapt to the altered signals from the inner ear, improving balance and reducing dizziness.

2. Epley Maneuver:

   • A series of head movements performed by a healthcare provider to move dislodged otoconia back into their proper location in the semicircular canals (used for BPPV).

3. Medications:

   • Antihistamines (e.g., meclizine, dimenhydrinate): Used to reduce dizziness and nausea during an episode of vertigo.
   • Benzodiazepines (e.g., diazepam): Sometimes prescribed for short-term relief, though they are generally not recommended for long-term use.
   • Anticholinergics: Medications like scopolamine may be used for nausea and vomiting.
   • Corticosteroids: Can be used for vestibular neuritis or labyrinthitis to reduce inflammation.
   • Diuretics: In cases of Meniere's disease to reduce fluid buildup in the inner ear.
   • Migraine medications: For vertigo related to migraines, preventive or abortive medications may be used.

4. Surgery:

   • In cases where other treatments fail or in the presence of structural problems (e.g., vestibular schwannoma), surgery may be considered. Surgical options include:
     • Labyrinthectomy or vestibular nerve section for intractable vertigo.
     • Endolymphatic sac decompression in Meniere's disease.

5. Lifestyle Modifications:

   • Dietary changes: In Meniere’s disease, reducing salt intake may help control fluid balance in the ear.
   • Avoiding triggers: For migraine-associated vertigo, identifying and avoiding migraine triggers (e.g., stress, certain foods) can help.
   • Hydration and physical activity: Staying well-hydrated and engaging in regular exercise to help manage vertigo.

When to Seek Medical Attention

• Sudden, severe vertigo with associated neurological symptoms (e.g., weakness, slurred speech, vision changes).
• New or unexplained vertigo, especially if persistent or worsening.
• Vertigo episodes that do not resolve with home treatments or worsen over time.

Prognosis

• BPPV: Often resolves with treatment (e.g., Epley maneuver) and has a good prognosis.
• Meniere’s Disease: Can be managed with medications and lifestyle changes, though episodes may persist.
• Vestibular Neuritis/Labyrinthitis: Most people recover within weeks to months, although some may experience residual imbalance.
• Migraine-associated vertigo: Often improves with migraine management.