Vertigo and its treatment
In vertigo, there is a feeling that either a person or the surroundings is moving or spinning. When there is a perception that the person moving, it is called subjective vertigo. When there is a perception that the surroundings are moving is called objective vertigo.
Causes of vertigo-The following are its important causes –
- Benign paroxysmal positional vertigo- This is a most common form, in which there is a sensation of motion initiated by sudden head movement in a certain direction. This type of vertigo can be treated easily.
- Meniere’s disease- In this type, there are episodes of vertigo, ringing in the ears (tinnitus) and loss of hearing. It has an abrupt onset. There are symptoms free periods.
- Vertigo due to labrynthitis- Labrynthitis is the inflammation or infection within the inner ear due to a bacteria or virus. This type has sudden onset and associated hearing loss.
- Vertigo due to acoustic neuroma- Acoutic neuroma is the tumor of the nerve tissue, which can cause vertigo. There is vertigo with one sided ringing in the ear and hearing loss.
- Vertigo due to decreased blood flow to brain- Bleeding in the back of the brain (cerebellar hemorrhage) gives rise to vertigo, headache and difficulty in walking. There is a disability to look towards the side of bleed and the person’s eyes gaze away from the side with the problem.
- Vertigo due to multiple sclerosis- The onset is usually abrupt. The eyes show inability to move past the midline toward the nose.
- Vertigo due to head and neck injury- This normally goes away when the injury heals.
- Vertigo due to migraine- The headache is followed by vertigo which can be easily treated.
- Diabetes and atherosclerosis- It is a complication of diabetes and atherosclerosis which can lead to lowered blood flow to the brain.
Symptoms- The symptoms include sensation of disorientation or motion. In addition, an individual may also have nausea or vomiting, sweating and or abnormal aye movements. The duration of symptoms is variable. The onset may occur due to movement or change in position. The person may have hearing loss and a ringing sensation in the ears. There might be visual disturbances, difficulty in speaking, difficulty in walking and low level of consciousness.
Diagnosis- It is mainly diagnosed by history and physical examination. A neurological examination will determine if the cause of vertigo is peripheral and due to inner ear issues rather than the problems in the brain. Tests for balance and co-ordination should be done. Examination of the ears and the hearing tests should be done to find out if there is underlying middle ear, cochlear or auditory nerve cause. CT or MRI imaging should be performed if there is a concern that there is central brain problem.
Treatment- Some cases are self-limiting or may be treated with medications. BPPV and vertigo due to labrinthitis is often treated with physical therapy. By using Epley maneuvers, the debris (crystals) from the semicircular canals of the ear is removed to reduce the inflammation caused by the debris.
Drugs like diazepam and meclizine are used to decrease inflammation from the vestibular system. Soft neck collars are required in selected cases to restrict the movement of the neck till verigo gradually subsides.
Anti-viral drugs like acyclovir or valacyclovir are needed in the viral infections. The patients of acoustic neuroma may require surgery.
Vertigo prevention- The following precautions may be taken by the persons having vertigo –
- The persons having vertigo should take precautions to prevent injuries from falls.
- The persons with Meniere’s disease should limit salt in their diet.
- The persons having risk factors for stroke should control their high blood pressure and high cholesterol. They should also quit smoking.