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DIZZINESS AND VERTIGO

Overview

Dizziness is a broad term and may be difficult to describe. Your description is critical for establishing the cause of the dizziness.

Descriptions include:

  • Spinning or tilting, or that you are about to fall or pass out.
  • Feeling lightheaded or giddy, or
  • Difficulty walking straight.

Vertigo is a type of dizziness.

Vertigo symptoms

The most common vertigo symptoms are:

  • Spinning (you or the room around you)
  • Tilting or swaying
  • Feeling off balance

These feelings come and go, and may last seconds, hours, or days. You may feel worse when you move your head, change positions (stand up, roll over), cough, or sneeze. Along with vertigo, you may:

  • Vomit or feel nauseous
  • Have a headache or be sensitive to light and noise
  • See double, have trouble speaking or swallowing, or feel weak
  • Feel short of breath or sweaty, have a racing heart beat

If you seek treatment for vertigo, you should mention how long these symptoms last, what triggers the symptoms, and any other associated problems. These clues can help point to the cause of vertigo.

Common causes of vertigo

  • Inner ear problems — Collections of calcium, inflammation, and certain infections can cause problems in the vestibular system
  • Benign paroxysmal positional vertigo (BPPV)—is a type of vertigo that develops due to collections of calcium in the inner ear. These collections are called canaliths. Moving the canaliths (called canalith repositioning) is a common treatment for BPPV. Vertigo is typically brief in people with BPPV, lasting seconds to minutes. Vertigo can be triggered by moving the head in certain way.
  • Meniere disease— Meniere disease is condition that causes repeated spells of vertigo, hearing loss, and ringing in the ears. Spells can last several minutes or hours. It is probably caused by a build-up of fluid in the inner ear.
  • Vestibular neuritis— Vestibular neuritis, also known as labyrinthitis, is probably caused by a virus that causes swelling around the balance nerve. People with vestibular neuritis develop sudden, severe vertigo, nausea, vomiting, and difficulty walking or standing up; these problems can last several days. Some people also develop difficulty hearing in one ear.
  • Head injury — Head injuries can affect the vestibular system in a variety of ways, and lead to vertigo.
  • Medications — Rarely, medications can actually damage the inner ear. Other medications can affect the function of the inner ear or brain and lead to vertigo.
  • Migraines — In a condition called vestibular migraine or migrainous vertigo, vertigo can be caused by a migraine. This type of vertigo usually happens along with a headache, although sometimes there is no headache.
  • Brain problems, such as a stroke or TIA (transient ischemic attack), bleeding in the brain, or multiple sclerosis can also cause vertigo. There are usually other symptoms, besides vertigo, that happen with these brain problems.

When to seek help

You should seek help immediately if you have dizziness or vertigo along with any of the following:

  • New or severe headache
  • Temperature greater than (38ºC)
  • Seeing double or having trouble seeing clearly
  • Trouble speaking or hearing
  • Weakness in an arm or leg
  • An inability to walk without assistance
  • Passing out
  • Numbness or tingling
  • Chest pain
  • Vomiting that will not stop

In addition, you should seek help immediately if you have vertigo that lasts for several minutes or more if you:

  • Are an older adult
  • Have had a stroke in the past
  • Have risk factors for stroke (high blood pressure, diabetes, smoking)

If you have dizziness or vertigo that comes and goes but you do not have any of the above problems, make an appointment with your ENT doctor. He or she will perform a physical exam, and may order further testing, depending on your exam and medical history.

Vertigo treatment

In most people, vertigo is bothersome but it is not caused by a serious problem. Treatment for vertigo aims to treat the underlying cause (if the cause is known), relieve the bothersome symptoms, and help with recovery. This section will discuss treatment for symptoms and treatments to help with recovery.

Treatment for symptoms

If you have spells of vertigo that are severe or last for hours or days, your ENT doctor may recommend a medication to relieve severe vertigo symptoms, like vomiting. Treatment with medication is not usually recommended if your vertigo lasts only second or minutes.

Possible medication treatments include:

  • An antihistamine, such as the prescription medicine meclizine,
  • Prescription anti-nausea medicines, such as promethazine, metoclopramide, or ondansetron.
  • Prescription sedative medicines, such as diazepam, lorazepam, or clonazepam.

Most of these medicines make you sleepy, and you should not take them before you work or drive. You should only take prescription medicines to treat severe vertigo symptoms, and you should stop the medicine when your symptoms improve.

Vertigo treatment

Canalith repositioning — Canalith repositioning is a treatment that may be recommended for people with benign paroxysmal positional vertigo (BPPV). The treatment will be done by the ENT doctor or audiologist in the office by moving your head into certain positions, sometimes called the Epley maneuver. You may be given instructions on how to perform similar movements at home, if needed.

These movements encourage the calcium collection to move into a part of the ear where it will be reabsorbed. You may begin to feel better immediately after this treatment or within a day or two.

Balance rehabilitation

Most patients with vertigo prefer to keep their head still. However, staying still and not moving your head can make it harder to cope with vertigo. Rehabilitation can help people with vertigo that is caused by injury to the vestibular system. The vestibular system includes parts of the inner ear and nervous system, which controls balance.

The rehabilitation works by helping your brain adjust its response to changes in the vestibular system. The therapy can also help train your eyes and other senses to “learn” how to compensate. This therapy is most helpful when it is started as soon as possible after you develop vertigo.

During rehabilitation, you will work with a therapist who will teach to you perform exercises at home. For example, you might start by focusing on an object with a blank background and move your head slowly to the right and left and up and down. You would perform this exercise for several minutes two to three times per day.

If you have trouble standing or walking because of vertigo, you are at risk for falling. In older adults, falls can lead to serious complications, such as a broken hip. Talk to your doctor, nurse, or therapist about your concerns. To reduce the risk of falls, get rid of hazards in your home, such as loose electrical cords and slippery rugs, and avoid walking in unfamiliar areas that are not lighted.

References

  1. Dommaraju S, Perera E. An approach to vertigo in general practice. Australian family physician. 2016 Apr;45(4):190.
  2. Shephard NT, Solomon D. Practical issues in the management of the dizzy and balance disorder patient. June 2000. The otolaryngological clinics of North America. Saunders.
  3. Approach to dizziness. 2013

Disclaimer

The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or condition.

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