Vertigo

Vertigo: Overview

Vertigo is closely related to dizziness but also involves the perception of actually seeing the room spin about you, similar to what happens when you spin around rapidly and then stop.  Vertigo is frequently accompanied by nausea and a loss of balance; it may pass quickly, or it may last for hours or even days.  It can be a disturbing condition which increases the risk of injury from falling and may, depending on severity, duration and frequency, prevent a person from performing their normal duties.  It is usually self-limiting, but may intermittently reappear over weeks or months. Among the most common causes of the condition called vertigo is Benign Paroxysmal Positional Vertigo (BPPV).  Thousands of people, mainly elderly, are going untreated for BPPV because doctors are unaware of how to diagnose and treat it – despite a quick, simple diagnostic test and speedy treatment being available.  Treatment shows almost immediate results.

Labyrinthitis, in the most general terms, is a condition which causes irritation of tiny hair cells which project into fluid-filled canals (labyrinths) within the balance center in the inner ear.  Normal balance is, to a degree, controlled by movement of the fluid, in response to changes in body position.  Labyrinthitis is a condition where the hair cells become irritated or inflamed and discharge randomly, tricking the brain into thinking you are moving or spinning.

Causes and Development; Contributing Risk Factors

Vertigo may result from other vestibular (inner ear – balance center) disorders such as Meniere's disease or vestibular neuritis, or may be a symptom of a more serious illness such as a stroke or tumor.  Anyone with vertigo should be seen immediately by a doctor and avoid hazardous activities (such as driving, operating heavy machinery and climbing, etc.) until one week after symptoms disappear.

BPPV is caused by calcium carbonate crystals (octonia) moving out of position into the semicircular canals in the inner ear.  As they float around, certain types of head movement will induce vertigo.  The misplaced crystals can easily be moved back into position, even by patients themselves.

Risk factors for labyrinthitis include recent viral illness, respiratory or ear infection, use of prescription or nonprescription drugs (especially aspirin), stress, fatigue, or a history of allergy, smoking or alcohol consumption.  The prompt treatment of respiratory infections and ear infections may help prevent labyrinthitis.

Signs and Symptoms

Symptoms of labyrinthitis can include dizziness, nausea and vomiting, loss of balance (especially falling toward the affected side), hearing loss in the affected ear (especially with bacterial labyrinthitis), ringing or other noises in the ears (tinnitus) and involuntary eye movements.

Diagnosis and Tests

The diagnosis of BPPV is determined by a clinical history, with a typical complaint of vertigo whenever the patient leans forward, arises from a supine (lying-down) position, or rolls over in bed.

The diagnosis is confirmed by a positive response on the Dix-Hallpike maneuver.  This maneuver is conducted while sitting on an examining table and begins with the patient's head being turned either to the right or to the left by about 45 degrees.  The patient is then moved rapidly from a sitting position onto their back with the head hanging off of the back of the examining table while the head continues to be in the same 45-degree position.  The patient is instructed to keep his or her eyes open so that the examiner can see eye movement during the entire procedure.  If BPPV is present, vertigo will begin after a period of 5 to 10 seconds and usually will last from 30 seconds to a minute.  Eye movements will occur and the patient will complain of dizziness.  After the signs and symptoms subside, the patient is returned to the sitting position.  The eye movement (nystagmus) may reverse in direction and the patient may again experience vertigo.  If a positive response occurs, the same maneuver is repeated.  The opposite ear is then tested in a similar fashion.  The offending ear is the one that is toward the floor when BPPV occurs during this maneuver.

Treatment and Prevention

The treatment for BPPV is called the Epley Maneuver or Canal Repositioning Maneuver.

Although labyrinthitis usually runs its course over a few weeks, symptoms may need treatment.  Recovery is usually spontaneous and hearing usually returns to normal.  The spread of inflammation to other ear areas or to the brain are rare.

Signs, symptoms & indicators of Vertigo:

Symptoms - General

Counter-indicators

Risk factors for Vertigo:

Autoimmune

Multiple Sclerosis often increases risk of Vertigo Multiple Sclerosis

Vertigo is a fairly common symptom of multiple sclerosis, occurring in about 20% of sufferers at some point.  It is an acute, uncomfortable sensation, making those who are already a little unsteady feel even more nervous about moving around.  It is not a permanent symptom, but may indicate a new lesion or inflammation.

This vertigo can be caused by lesions in the cerebellum, or it can be a result of damage to the nerves that control the vestibular functions of the ear in the brain stem.  Vertigo is, however, not always a direct result of the MS disease process.

Diet

Environment / Toxicity

Metabolic

Nervous System

Neuritis/Neuropathy may increase risk of Vertigo Neuritis/Neuropathy

When the vestibular nerve (connecting the inner ear to the brain) is affected, dizziness or vertigo can result.

Recommendations for Vertigo:

Botanical

Ginkgo Biloba often helps with Vertigo Ginkgo Biloba

A double-blind placebo-controlled study of 67 people with vertigo found that 160mg of Ginkgo biloba extract per day significantly reduced symptoms compared to placebo.  At the end of the 3-month study, 47% of the ginkgo group had completely recovered, as compared to only 18% of the placebo group.[ Presse Med.  1986;15: pp.1569-72]

Diet

Drug

Conventional Drug Use may help with Vertigo Conventional Drug Use

Medications that may reduce symptoms of labyrinthitis include antihistamines, anticholinergics, sedative/hypnotics, antinausea medications and diazepam (valium).  The antihistamine meclizine (Antivert) is commonly used.

Physical Medicine

Rest is highly recommended for Vertigo Rest

To prevent worsening of symptoms during episodes of labyrinthitis, keep still and rest during attacks, gradually resuming activity.  Avoid sudden position changes, do not try to read during attacks and avoid bright lights.

Manipulation may help with Vertigo Manipulation

In cases of BPPV (calcium carbonate crystals moving into the inner ear), Dr. Peter West, consultant audiological physician at the Queen Alexandra Hospital in Portsmouth, England, has stated that using a simple technique to manipulate the head and return the loose crystals to their correct position is for many a permanent cure.  "It is just like maneuvering marbles round a tray in a child's toy." Others who suffer continued episodes of BPPV can have repeat treatments.

Psychological

Hypnosis may help with Vertigo Hypnosis

Hypnosis has been used for vertigo that is a result of head trauma, with some apparent success.  [Int J Clin Exp Hypn.  1976;24: pp.195-201]

KEY

Weak or unproven link: may increase risk of
Weak or unproven link:
may increase risk of
Strong or generally accepted link: often increases risk of
Strong or generally accepted link:
often increases risk of
Definite or direct link: is a sign or symptom of; increases risk of
Definite or direct link:
is a sign or symptom of; increases risk of
Definitely or absolutely counter-indicates: strongly contraindicates
Definitely or absolutely counter-indicates:
strongly contraindicates
May be useful: may help with
May be useful:
may help with
Moderately useful: often helps with
Moderately useful:
often helps with
Very useful: is highly recommended for
Very useful:
is highly recommended for