Vertigo

Vertigo

Vertigo is often thought of as a sensation of spinning or turning and this is a very common type, but vertigo can actually be any false sensation of movement. Amongst many other things this may include a feeling of being pushed or a sensation that the body continues to move after it has stopped.

It is common for people to think that vertigo is a disease, particularly if they have been told that they have had vertigo. But it is actually a symptom. It may be caused by cardiovascular or neurological problems, but many cases of vertigo stem from a problem with the vestibular system – the part of the inner ear responsible for balance.

There are a range of inner ear disorders that can cause vertigo and some of them are described below.

Benign paroxysmal positional vertigo (BPPV)

BPPV is a condition where calcium carbonate crystals are dislodged from the otolith organs of the inner ear and become free-floating in the semicircular canals – where they don’t belong. This makes sufferers experience brief episodes of vertigo following particular changes in head position. For more information on BPPV see the BPPV fact sheet on the Audiology Australia website.

Vestibular neuritis or labyrinthitis

These conditions occur when there is a sudden insult on the inner ear – often attributed to a virus. The sudden insult causes a quick loss of vestibular function in one ear and an imbalance of information that the brain receives from the left and right vestibular systems. This imbalance gives a very strong sensation of vertigo which can last for several days.

If the vestibular system alone is affected then vertigo will be the only symptom and the condition is called vestibular neuritis. If the cochlea – the part of the inner ear responsible for hearing – is also involved then there may also be symptoms such as hearing loss, tinnitus and a sensation of fullness in the affected ear. When both the cochlea and the vestibular system are involved then the condition is called labyrinthitis.

Following an attack of vestibular neuritis or labyrinthitis there may be some spontaneous recovery, but there may also be permanent damage to the vestibular system. The brain is able to learn to account for this damage via a process called central compensation. For compensation to occur the brain must be stimulated with movement. This can often be hard as movement can make people feel worse when they are recovering. It is important to try to stay active though and exercises from an audiologist or physiotherapist who is trained in vestibular rehabilitation can help.

In the case of permanent hearing loss caused by labyrinthitis a hearing aid or other assistive listening device may also be helpful.

Vestibular Migraine (VM)

This is a form of migraine that may or may not include a headache! Some people with VM experience vertigo for a few minutes and others for a few hours. It can leave you feeling foggy, tired, off-kilter and nauseas (vomiting). During the migraine attack, rest is best with reduced stimulation from people, foods or lights. Between migraines, many people report being asymptomatic and can return to daily activities.  Preventative measures can be taken to help boost health and wellbeing. Some people find changes to diet, sleep, exercise and workload can help reduce migraines. A neurologist can discuss medication options with you. Vestibular rehabilitation can help to recover balance function if you are feeling a bit unsteady following a vertigo attack.

Meniere’s disease

Meniere’s disease is caused by an imbalance in a type of fluid that occurs in the inner ear – called endolymph. Meniere’s disease occurs as recurrent attacks when the fluid builds up and then returns to normal levels.

There are four typical symptoms of Meniere’s disease: vertigo, roaring tinnitus, low frequency hearing loss and a full sensation in the ear. People with Meniere’s disease may have all or some of these symptoms.

Meniere’s disease is notoriously difficult to diagnose. It is a diagnosis of exclusion meaning that all other possible causes for the symptoms must first be ruled out. For this reason the diagnosis is usually made by an ENT specialist, although an audiologist will often perform the vestibular function tests.

There are a range of treatment options for Meniere’s and these are best discussed with an ENT specialist. The hearing loss component of Meniere’s disease is usually treated with a hearing aid in the affected ear.

For more information on Meniere’s disease contact your local audiologist or Meniere’s Australia.

Semicircular canal dehiscence (SCD)

SCD occurs when there is a thinning of the bone surrounding the vestibular system. This makes the vestibular system sensitive to changes in pressure.

Sufferers of SCD experience two types of symptoms – vertiginous and auditory. Vertiginous symptoms include a brief sensation of vertigo, dizziness or imbalance in response to pressure changes. Pressure changes that cause vertiginous symptoms may include loud noise, straining to lift or nose-blowing amongst others.

Auditory symptoms usually involve hearing own body sounds loudly. This may include footsteps being very loud, increased awareness of heart beat and even hearing your eyeballs moving. 

People with SCD may experience vertiginous symptoms, auditory symptoms or both.

SCD is diagnosed with a combination of vestibular testing performed by an audiologist as well as a CT scan.

Once they understand their condition many people with SCD find they are able to manage it with lifestyle alterations. For those people who have a higher level of disturbance from their symptoms surgical intervention may be an option.