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What is Vertigo?

Vertigo is a sensation in which the environment around you appears to spin in circles. It can make you feel dizzy and off-balance. Vertigo is a symptom of many health conditions rather than a disease itself, but it can occur alongside other symptoms.

Other symptoms you might experience when you have vertigo include:

  • Nausea and vomiting
  • Dizziness
  • Balance issues
  • Hearing loss in one or both ears
  • Tinnitus (ringing in your ears)
  • Headaches
  • Motion sickness
  • A feeling of fullness in your ear

Nystagmus (a condition causing your eyes to move rapidly and uncontrollably).

What are the symptoms of Vertigo?

The major symptom is the false perception of motion when there isn’t. But besides this, there are several supplementary symptoms such as:

  • Nausea and Vomiting:

The mismatch of signals from the inner ear and eye, in many cases, leads to vomiting and nausea.

  • Balance Issues:

Affected people may find it difficult to stand and walk, and may stumble. Hence, it is advised to have a companion always by your side while walking, or climbing stairs, etc. They may even find it hard to maintain a straight posture.

  • Nystagmus:

 Eyes find it difficult to look for a stable point, thus resulting in flickering of the eyes. You can’t even control it; the flickering stops on its own.

  • Tinnitus:

People suffering from Meniere’s disease might experience a buzzing or ringing sensation in their ears.

  • Autonomic Reaction:

Headache, sweating, or a sudden increase in pulse rate may be experienced during an intense trigger.

  • Hearing Loss:

Accumulation and pressure of fluids in the ear can result in temporary hearing loss.

How to diagnose Vertigo?

Analyzing the reason for vertigo is the main aim in the diagnosis. Doctors want to know whether it is a result of issues in the inner ear (peripheral) or related to nerves or the brain.

The doctor analyzes the patient’s entire medical history and assigns a few tests to gauge the situation of the nervous system and the eyes.

Dix-Hallpike Maneuver:

Here, the doctor suddenly tilts the person’s position from sitting to lying down, with the head at a specific angle.

If a certain eye movement occurs, doctors confirm Benign Paroxysmal Positional Vertigo (BPPV).

Vestibular Testing:

To check the functioning of the inner ear in different circumstances, tests like ENG (electronystagmography) or VNG (video nystagmography) are prescribed.

Imaging:

 If doctors have opinions of heart issues, stroke, or sclerosis as the primary reason, then a CT scan or an MRI is recommended to get a visual structure of the brain.

Audiometry:

Hearing tests are used to check whether the auditory nerve is related to it, hinting towards Meniere’s or even an acoustic neuroma.

Diagnosis Summary Table

Test What It Looks For
Dix-Hallpike Loose calcium crystals in the inner ear (BPPV)
VNG/ENG Involuntary eye movements and inner ear sensitivity
Audiogram Hearing loss patterns linked to Meniere’s or infections
MRI Structural issues in the brain or central nervous system
Tilt Table Test Fainting or dizziness related to blood pressure (not true vertigo)

What is the treatment of Vertigo?

Physical Maneuvers (For BPPV)

If the cause is Benign Paroxysmal Positional Vertigo (BPPV), where tiny calcium crystals have moved into the wrong part of the inner ear, the most effective treatment is a repositioning maneuver.

  • Epley Maneuver: A series of specific head movements performed by a doctor or therapist to shift the crystals back into the correct chamber. This often provides immediate relief in 80% to 90% of cases.

  • Semont-Toupet Maneuver: An alternative rapid-movement sequence used for specific types of BPPV.

  • Brandt-Daroff Exercises: Simple head-tilt exercises that patients can perform at home to habituate the brain to the vertigo triggers.

Medication

Medication is typically used for short-term symptom relief during acute attacks or for specific chronic conditions like Meniere’s disease.

  • Vestibular Suppressants: Drugs like meclizine or benzodiazepines can reduce the sensation of spinning and calm the balance system.

  • Antiemetics: Medications to control severe nausea and vomiting (e.g., ondansetron).

  • Diuretics: Often prescribed for Meniere’s disease to reduce fluid pressure in the inner ear.

  • Steroids: If the vertigo is caused by inflammation (like vestibular neuritis or labyrinthitis), oral or injected steroids can speed up recovery.

Vestibular Rehabilitation Therapy (VRT)

Vestibular Rehabilitation Training (VRT) is a kind of therapy where specific exercises help strengthen the nervous system.

The brain is trained to get accustomed to inner ear defects and analyze balance and equilibrium more efficiently.

Surgery

Surgery is considered a last resort when all other treatments fail, and the vertigo is disabling.

  • Labyrinthectomy: Removing the balance sense organ in the affected ear (only if hearing is already lost).

  • Vestibular Nerve Section: Cutting the nerve that sends balance signals to the brain.

  • Endolymphatic Sac Procedure: Decompressing the fluid-filled sac in the inner ear to alleviate pressure.

What are the limitations of the treatment?

Well, most of the vertigo patients find relief immediately, but still, there are some limitations that must be addressed.

Symptoms Suppression:

Certain medications cause immediate relief but do not address the primary reason. This leads to symptoms returning.

Prolonged application of these medications can negatively impact the brain’s efficiency to receive signals from the inner ear.

Recurrence:

In situations such as Meniere’s disease or BBPV, even after proper procedures, the fluid pressure might again destabilize. It requires multiple and continued monitoring.

Diagnostic Ambiguity:

Vertigo is a result of multiple triggers and is also one of the symptoms of other disorders. Thus, many patients waste a lot of time in a hit-and-miss trial of medications. It is advised to get diagnosed by a doctor instantly.

Physical Limitations:

Treatment of vestibular regions needs time, patience, and continuous monitoring. Elderly patients might get impatient, especially patients with nervous disorders, who fail to consistently follow the medication or exercise.

Hence, vertigo neither has a simple cause nor a simple solution. It requires a multidimensional approach for a better solution.

When to See a Specialist

While a primary care physician can often diagnose common types of vertigo, like BPPV, persistent or complex cases are usually referred to:

  • Otolaryngologist (ENT): For inner ear and hearing-related balance issues.

  • Neurologist: For brain-based or nervous system causes.

  • Vestibular Rehabilitation Therapist: For functional recovery and balance training.

When to see a doctor

See your healthcare professional if you have dizziness or vertigo that is sudden, intense, lasts a long time, or keeps coming back.

Seek emergency care

In most cases, BPPV does not signal a serious illness. If you experience dizziness or vertigo with any of the following, see your healthcare professional right away:

  • Bad headache
  • A fever
  • Seeing double or not being able to see well
  • Hearing loss
  • Trouble talking
  • Weakness in the leg or arm
  • Passing out
  • Falling or trouble walking
  • Numbness or tingling