Vertigo is the hallucination that either you or your surroundings are moving, when this is not the case. Mild vertigo or imbalance, such as on standing or during flu is common. However, symptoms that persist or are more severe may be an indication of underlying disease. Patients often find it difficult to explain their symptoms and often talk of a sensation that things are moving or spinning, loss of balance, nausea, vomiting and light-headedness.
Since balance relies on central processing of visual information, information from joint and muscle proprioceptors and the organ of balance in the ear, problems in any of these areas can give rise to vertigo. They are broadly categorised as being either "central" ie arising within the central nervous system, or peripheral. Peripheral problems are by far the commonest and include "labyrinthitis". The labyrinth is an inner ear structure which mediates balance functions and is susceptible to viral infections. This often starts suddenly and can be associated with a painful ear or high temperature, or can occur in the aftermath of a cold.
A viral infection of the inner ear affecting the vestibular nerve can give rise to vertigo, which can last for several hours or even days and slowly recovers.
This is caused by abnormal free particles in one of the semi-circular canals of the inner ear and is associated with turning the head, usually while lying in bed. There is a short latency followed by a short (usually seconds) of intense vertigo. This is usually self-limiting, but the condition can be rapidly settled by performing Epley's particle re-positioning manoeuvre which aims to re-position the calcium carbonate debris to a position where it will no longer cause symptoms.
Patients with Menierre's disease will have attacks of vertigo, which are often associated with tinnitus, a sense of aural (ear) fullness and hearing loss. Often one or two of the symptoms will predominate. Many patients are concerned that this will have a significant impact of their life, and while this may be true for a number of patients, it is important to realise that people are affected differently and some people may even suffer with Menierre's without realising it. Reducing salt and caffeine intake can be important, and medication (Serc) also has a role. A new device (Meniett device) has also been introduced which is promising in more severe case. In the most disabling of cases, which are fortunately extremely rare, surgery may have a role.
The causes of central vertigo include:
- acoustic neuromas (rare non-cancerous growth on the nerve of hearing)
- various neurological conditions such as multiple sclerosis
Treatment will depend upon your specific diagnosis. Vestibular sedatives such as prochlorperazine (Stemetil) and cinnarizine or cyclizine can be used on a short term basis to ease symptoms, but in the longer term can delay compensation and a return to normal. As a general principal an early return to normal activity is beneficial, but obviously it is important to guard against falls and clearly when the attacks of vertigo are unpredictable, use of machinery or driving should be avoided.
The most difficult cases of vertigo to diagnose are those where more than one condition applies. For example, a patient with arthritis and poor eyesight, who is elderly and frail, should be considered in the diagnosis. Clearly the history of your problem is vital to arriving at the diagnosis. Additional specific tests, such as the Hall-Pike Dix test for benign positional vertigo can be helpful, together with full otoneurological examination and additional tests, such as scans, hearing tests and balance tests may be required.