Vertigo

Vertigo (from the Latin vertō “a whirling or spinning movement”) is a type of dizziness, where there is a feeling of motion when one is stationary. If you ever wondered what it feels like to have vertigo try spinning about yourself about 20 times. The sensation as if you are still turning is called vertigo. These symptoms may occur without intentional spinning due to a dysfunction of the vestibular system located in the inner ear. It is often associated with nausea and vomiting as well as difficulties standing or walking straight.

The most common causes are benign paroxysmal positional vertigo, vestibular migraine while less common causes include Ménière’s disease and vestibular neuronitis. Excessive consumption of alcohol or alcoholic beverages can also cause notorious symptoms of vertigo. Other causes of vertigo may include stroke or other abnormalities within the brain case. Repetitive spinning as previously described and as in familiar childhood games, can induce short-lived vertigo by disrupting the inertia of the fluid presented within the center of balance also called the vestibular system.

Vertigo is a condition that should be evaluated by an Ear Nose and Throat (ENT) physician to determine the cause and treatment.

What to expect during your ENT visit?
The doctor will first ask you a series of questions regarding your symptoms that can help to pinpoint the cause. Some of the questions you may expect include questions about the vertigo like:

  • Timing of symptoms — duration, onset, frequency, severity.
  • Aggravating factors (such as movement of the head).
  • Effect on daily activities (such as walking).
  • The doctor may ask about associated symptoms such as:

    • Ear related – hearing loss, ear discharge, a feeling of fullness in the ear, or tinnitus (unilateral or bilateral).
    • Neurological — such as headache, double vision or any visual disturbance, difficulty speaking or articulating words or difficulty swallowing, numbness, muscle weakness, or unsteadiness.
    • miscellaneous — nausea and vomiting, sweating, or abnormal slow, fast or irregular heartbeat.
    • Migraine aura — visual or smell related symptoms.

    The doctor may be interested in asking about your general health relative to the vertigo such as:

    • Recent upper respiratory tract infection or ear infection — suggestive of vestibular neuronitis or labyrinthitis.
    • History of migraine headaches— increases the likelihood of the vertigo being caused by migraines.
    • Head trauma — suggests benign paroxysmal positional vertigo especially if the episodes are short lasting relating to head movement.
    • Direct trauma to the ear — the doctor may suspect a perilymph fistula.
    • Anxiety or depression — can exacerbate dizziness or vertigo. Rarely, anxiety or depression may manifest as dizziness or vertigo, especially if the person hyperventilates.
    • Heart disease risk factors (such as previous angina or heart attack, diabetes, high blood pressure, smoking, irregular heart rhythm) — increases the likelihood of stroke as the cause of vertigo.
    • Drugs (such as gentamycin, lasix, antidepressants, antipsychotics, anticonvulsants [carbamazepine and phenytoin]) — may cause vertigo as a side effect.
    • Acute intoxication with alcohol — may frequently cause vertigo.
    • Family history of migraine or Meniere’s disease — may increase the likelihood of these conditions.

    The doctor will then perform a physical examination that may be limite depending on the severity of your symptoms.

    Physical examination is helpful in confirming the presence of nystagmus, the abnormal eye motion that the body uses to try to compensate for the abnormal balance signals coming to the brain. A full neurologic exam may be done to make certain that the cause of vertigo is peripheral and due to inner ear issues rather than central problems with the brain. Testing for balance and coordination may help decide if the cerebellum (the part of the brain that controls the fine movement of muscles) is working properly.

    Hearing tests may be appropriate to make certain that the middle ear, the cochlea, and the auditory nerve are functioning properly and it is only the labyrinth that is the cause of vertigo.

    The Dix-Hallpike test can be performed by the health care practitioner and help with the diagnosis. By moving the head in different directions, eye movements can be assessed and see whether they correlate with the vertigo symptoms.

    You may be sent for an electronystagmography (ENG or VNG study), a specialized study of the function of the center of balance and equilibrium located in the inner ear and the reflexes that connect between it and the movement of the eye.

    If there is concern that there is a central brain problem may be the cause of vertigo, CT or MRI imaging of the brain may be considered. Screening blood tests may also be done.

    Physical therapists specially trained in vestibular rehabilitation may be helpful, not only in making the diagnosis, but also in treating peripheral causes like benign paroxysmal positional vertigo or labyrinthitis.