VERTIGO : Symptoms, Cause, Treatment and Prevention

VERTIGO

What is Vertigo ?

Vertigo  is a sensation of feeling off balance. you might feel like you are spinning or that the world around you is spinning.

Vertigo is the sense of the world spinning, rotating, or rocking that is experienced even when a person is holding perfectly still.

Some patients use term vertigo interchangeably with dizziness  to describe a variety of symptoms, ranging from balance disorders and difficulty with walking to motion  sickness  or lightheadness . However, most health care professionals consider vertigo to be a specific complaint that involves the balance centers of the inner ear and the brain.

To understand vertigo, it's helpful to understand the ANATOMY OF EAR.

Sound waves travel through the outer ear canal until they reach the eardrum. 
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From there, sound turns into vibrations, which transmits in the middle ear via three small bones -- the incus, the malleus, and the stapes -- to the cochlea 
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and finally to the vestibular nerve, which carries the signal to our brain that interprets those nerve impulses as sound.

The inner ear is not involved with hearing.

This system provides instantaneous feedback to the brain, along with vision and proprioception receptors in the body, regarding our position in space.

Symptoms of Vertigo

Vertigo is often triggered by a change in the position of your head.

People with vertigo typically describe it as feeling like they are:

• Spinning
• Tilting
• Swaying
• Unbalanced
• Pulled to one direction

Other symptoms that may accompany vertigo include:

• Feeling nauseated
• Vomiting
• Abnormal or jerking eye movements (nystagmus)
• Headache
• Sweating 
• Ringing in the ears or hearing loss.

Symptoms can last a few minutes to a few hours or more and may come and go.

It is important for the medical professional to determine whether inner ear problems or the cerebellum (the balance centers of the brain) is the cause of the vertigo. 

The patient may be asked to perform coordination tasks to make certain that the brain performs normally. Some tests might include reaching out to touch the examiner's index fingertip, sliding a heel up and down the opposite shin, or walking (to look for balance problems).

What causes vertigo?

There are a number of different causes of vertigo. Vertigo can be defined based upon whether the cause is Peripheral or central. Central causes of vertigo arise in the brain or spinal cord, while peripheral vertigo is due to a problem within the inner ear.

Peripheral causes:

•  BPPV. These initials stand for Benign Paroxysmal Positional Vertigo.   BPPV occurs when tiny Calcium  particles (canaliths) clump up in canals of the   inner ear. The inner ear sends signals to the brain about head and body   movements relative to gravity. It helps you keep your balance.
• Infection of the vestibular nerve can cause dizziness, or vertigo. This is called vestibular neuritis, or labyrinthitis.
• Fluid buildup within the inner ear or the endolymphatic system causes Menierie  disease, vertigo that also includes hearing loss and tinnitus  (ringing in the ear) . The cause of this fluid accumulation is unknown.
• Acoustic neuromas, tumors of the vestibular nerve, may also present with these three symptoms.

Central causes:

• Concussion  or traumatic brain injury may be associated with vertigo.
• Strokes may cause vertigo and loss of coordination.
• Multiple sclerosis. 
• Tumors of the brain and spinal cord
• Some patients with a type of migraine headache  called vestibular migraine  may develop vertigo as a symptom

How medical proffesionls diagnose vertigo? 

During an evaluation for vertigo, the health care professional usually asks questions to take a history of the events and symptoms associated with vertigo. This includes medications taken , recent illnesses, and prior medical problems. Even seemingly unrelated problems may provide a clue as to the underlying cause of the vertigo.

After getting the person's medical history, a medical professional then performs a physical examination. This often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause. 

Some cases of vertigo may require MRI or CT Scan of the brain and inner ears to exclude a structural problem like stoke,  multiple sclerosis  or a non-malignamt tumor. 

Treatment for Vertigo And Role of Physiotherapy in Vertigo

Treatment for vertigo depends on what's causing it. In many cases, vertigo goes away without any treatment. This is because your brain is able to adapt, at least in part, to the inner ear changes, relying on other mechanisms to maintain balance.

For some, treatment is needed and may include:

Vestibular Rehabilitation.

This is a type of PHYSIOTHERAPY aimed at helping strengthen the vestibular system. The function of the vestibular system is to send signals to the brain about head and body movements relative to gravity.

Canalith repositioning maneuvers

Guidelines from the American Academy of Neurology recommend a series of specific head and body movements for BPPV. The movements are done to move the calcium deposits out of the canal into an inner ear chamber so they can be absorbed by the body. You will likely have vertigo symptoms during the procedure as the canaliths move.

A doctor or PHYSICAL THERAPIST  can guide you through the movements. The movements are safe and often effective.

Medicine - In some cases, medication may be given to relieve symptoms such as nausea or motion sickness associated with vertigo.

If vertigo is caused by an infection or inflammation, antibiotics  or steroids may reduce swelling and cure infection.

Surgery -  In a few cases, surgery may be needed for vertigo.

Is it possible to prevent vertigo?

Most cases of vertigo occur spontaneously, and it is difficult to predict who is at risk. Prevention  may not be possible. However, maintaining a healthy lifestyle will decrease the risks of experiencing this condition.

Vertigo vs. Dizziness

Dizziness can describe lightheadedness and vertigo. Dizziness is the sensation of feeling lightheaded as if you are weak and will pass out. Lightheadedness is often caused by a decrease in blood supply to the brain.

Vertigo is a feeling that you are dizzily turning around or that your surroundings are dizzily turning about you. Vertigo is medically distinct from dizziness, lightheadedness, and unsteadiness in that vertigo involves the sensation of movement. Vertigo may be caused by disturbances of the inner ear and the balance centers of the brain.

STAYING SAFE WHEN YOU HAVE VERTIGO

• Stay hydrated  - Dehydration can decrease vertigo symptoms.
• Sit down immediately  -  As soon as vertigo hits, find a safe place to sit.
• Sit up slowly from bed -  Always sit up slowly if you have been lying on you back.
• Use a cane or Walker - To avoid falls.
• Warn others around you - So they are prepared.
• Hold on tight - Find a steady support or ask for help.