Vertigo & Dizziness

Patients frequently complain of dizziness for which there are many possible causes which may have nothing to do with the balance organ in the inner ear. Fainting attacks, heart problems, thyroid problems and brain problems can all give rise to feelings of “light-headedness”, “giddiness” and general imbalance.

One form of dizziness is “vertigo” which is the specific complaint of either the environment moving in relation to the patient or the patient moving in relation to the environment. It is usually a spinning or rotatory sensation. Vertigo is usually linked to problems with the inner ear. Ninety-nine percent of people who suffer from vertigo due to inner ear problems will recover with time, without any treatment. Balance and the ability to remain upright is dependent upon three systems, the eyes, joints and the inner ear, all of which give information to the brain.

Anyone suffering from persistent recurrence of vertigo should consult their doctor to find the cause and to arrange effective treatment.

Inner ear disease and vertigo symptoms

Many different factors can affect the inner ear and cause vertigo. One way to distinguish them is by the duration of the dizziness.

Short-lived episodes of dizziness:(few seconds to minutes). An extremely common type of vertigo is “benign paroxysmal positional vertigo” which lasts for only a few seconds or minutes, but which comes on very suddenly. It is often started off by the person suddenly looking upwards or sideways, and some people get it when they turn over in bed. Sometimes it starts after a whiplash injury or other head injury, but often there appears to be no reason that they should have started.

Medium length episodes of dizziness:(half-hour to several hours) These types of vertigo are rarer. Menière’s disease or endolymphatic hydrops result in episodes of severe vertigo with hearing loss and tinnitus that can last up to several hours. The hearing recovers once the vertigo has settled but may gradually deteriorate with time.

Longer episodes of dizziness:(days to weeks). An infection of the inner ear (labyrinthitis) or an inflammation of the balance nerve (vestibular neuronitis) can give rise to severe rotatory dizziness for up to two to three weeks, with a slow return to normal balance which can take a further few weeks. Again, the initial episode is often associated with vomiting, and the patient can be bed-bound because the dizziness is so severe.

Investigations

Specialist investigations can help with the diagnosis, and will generally include hearing tests, tests of balance, blood tests (rarely), and an MRI scan or CT scan.

Treatment

In general, the treatment of vertigo is “symptomatic” with treatment given to control the symptoms without regard to the specific cause of the vertigo.

Rehabilitation

There are specifically targeted exercises to speed up the brain’s natural compensation after inner ear disease. Recovery can be hastened by these exercises.

Vestibular sedatives

The inner ear may be “suppressed” (or made sleepy) by the use of drugs such as prochlorperazine or cinnarizine. They are not a long term solution and should be used for as short a time as possible because they prolong the time taken for the body to readjust after the vertigo.

Surgery

If medical treatment proves ineffective, surgical options range from insertion of a grommet to operations which completely destroy the inner ear or divide the nerves leading from the inner ear to the brain.

New treatments

Drugs can be delivered directly into the ear through the ear drum and can selectively destroy the inner ear balance mechanisms without affecting hearing though there is always a risk of damage to the hearing.