What is Vertigo? What can cause it?

Feeling dizzy is a very common complaint in medicine. Dizziness can be described in several ways, including being lightheaded, unsteady, or woozy. On some occasions, patients will experience a specific type of dizziness called vertigo. Vertigo is the sensation of whirling, often described as a “room spinning ” feeling. Unlike most types of dizziness, vertigo is typically caused by disorders of the inner ear (labyrinth). Three of the most common causes of vertigo include BPPV, Meniere’s Disease, and Labyrinthitis.

BPPV, or benign paroxysmal positional vertigo, is characterized by acute vertigo lasting approximately 30 seconds. Episodes are triggered by positional changes of the head, such as rolling over in bed, looking up, or stooping over. BPPV is thought to be caused by loose particles (otoliths) in the inner ear. It can be identified by an easy in-office test called the Dix-Hallpike test. In most cases, the patient’s dizziness improves when keeping the head steady. If the dizziness persists, at-home exercises called the Brandt-Daroff exercises can be performed which often improves the condition. Sometimes a patient will require a repositioning maneuver known as an Epley procedure to help resolve the positional vertigo.

Labyrinthitis is another common cause of acute vertigo. Unlike BPPV, patients with labyrinthitis experience constant vertigo, lasting several hours, sometimes days. Associated symptoms may include nausea, vomiting, headaches, hearing loss, and ringing in the ears. Symptoms begin acutely and gradually improve. Sometimes patients will experience residual symptoms lasting up to a month before completely resolving. Labyrinthitis is caused by inflammation of the vestibular nerve, thought to be caused by a viral infection. It is not uncommon for patients to experience labyrinthitis in the setting of an upper respiratory tract infection or cold. Although there are no definitive cures for labyrinthitis, certain medications such as Meclizine can be provided that help calm the vestibular system of the inner ear. If symptoms persist after an extended period of time, physical therapy can also be performed.

Patients with Meniere’s Disease experience episodic vertigo – lasting minutes to hours, ringing in the ears, and fluctuating hearing loss. Although the cause of Meniere’s Disease is not well understood, it is thought to be related to a fluid imbalance in the inner ear(endolymph) . Meniere’s Disease can sometimes become a chronic condition , and may affect a patient for many years after onset. Coping with Meniere’s can be challenging, as attacks are unpredictable. In many cases, first line treatments such as a low-salt diet and a diuretic can be helpful to control or eliminate symptoms.

If you are experiencing symptoms of vertigo, it is helpful to be seen by an Ear Nose and Throat specialist (Otolaryngologist) to rule out inner ear disorders. During the visit, your physician may recommend obtaining a comprehensive audiogram (hearing test). Many conditions associated with vertigo are also associated with hearing loss. In certain circumstances, your physician may also recommend obtaining a specialized balance test called an electronystagmography (ENG). ENGs can be performed in the office and measure the normal eye movement and involuntary eye movement (nystagmus) following exposure to various stimuli. The test can be helpful for identifying the potential cause of a patient’s vertigo/dizziness.

If you or family members have concerns regarding dizziness, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to set up an appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.