Vertigo & Dizziness

Vertigo is usually associated with a problem in the inner ear balance mechanisms (vestibular system), in the syndrome and Meniere’s disease. Vertigo-like symptoms may also appear as paraneoplastic syndrome (PNS) in the form of opsoclonus myoclonus syndrome, a multi-faceted neurological disorder associated with many forms of incipient cancer lesions or viruses. Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway.

These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings. Vertigo can also occur after long flights or boat journeys where the mind gets used to turbulence, resulting in a person’s feeling as if he is moving up and down. This usually subsides after a few days. Vertigo can also occur when exposed to high levels of sound pressure rattling the inner ear in which throwing off ones balance and others. Vertigo is the sudden sensation that you are unsteady or that your surroundings are moving. You may feel like you’re spinning around on a merry-go-round or that your head is spinning inside. Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that can cause vertigo.

Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness associated with specific changes in the position of your head. It most commonly occurs when you move your head in a certain direction, lie down from an upright position, turn over in bed or sit up in the morning. Moving your head to look up or look down also can bring about symptoms of benign paroxysmal positional vertigo. You may also feel out of balance when standing or walking. Although benign paroxysmal positional vertigo can be a bothersome problem, it’s rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor’s office visit.

Dizziness is a feeling of unsteadiness. There are two main types of vertigo. In the first type the sufferer feels that his or her body or the environment is spinning. It is commonly caused by motion sickness or a viral infection of the organs of balance. The second type of vertigo is characterized by weakness, and is commonly caused by low blood sugar or low blood pressure. As long as low blood pressure is not the result of shock or blood loss, a sufferer of the second type of vertigo may benefit from physical activity. Anyone prone to vertigo should take great care when taking part in sports where a fall may be dangerous.

Causes of Vertigo

• Otitis media – inflammation of the middle ear, or middle ear infection. Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube. Labyrinthitis is an inflammation of the inner ear that is often a complication of otitis media. It is caused by the spread of bacterial or viral infections from the head or respiratory tract into the inner ear.
• Eustachian tube dysfunction (ETD) – occurs when the tube fails to open during swallowing or yawning. This results in a difference between the air pressure inside and outside the middle ear. It causes discomfort in the ear and temporary hearing problems.
• Labyrinthitis – can also be caused by toxic drugs. The primary symptoms of labyrinthitis are vertigo (dizziness), accompanied by hearing loss and a sensation of ringing in the ears called tinnitus.
• Head injury – refers to trauma to the head. This may or may not include injury to the brain (traumatic brain injury). However, the terms traumatic brain injury and head injury are often used interchangeably in the medical literature. Common causes of head injury are traffic accidents, home and occupational accidents, falls, and assaults. Bicycle accidents are also a common cause of head injury-related death and disability, especially among children.

Diseases that may cause vertigo and deafness

• Ménière’s disease – is a disorder of the inner ear that can affect hearing and balance. It is characterized by episodes of dizziness and tinnitus and progressive hearing loss, usually in one ear. It is caused by an increase in volume and pressure of the endolymph of the inner ear.
• Positioning Vertigo – Benign Paroxysmal Positional Vertigo, BPPV (sometimes also referred to as BPV) is the most common cause of bouts of vertigo in the general population. The hallmark of BPPV is vertigo, i.e. an abnormal sensation of motion (usually spinning), that lasts for a few seconds or up to a minute. Vertebrobasilar insufficiency (VBI), or vertebral basilar ischemia, refers to a temporary set of symptoms due to decreased blood flow in the posterior circulation of the brain. The posterior circulation supplies blood to the medulla, cerebellum, pons, midbrain, thalamus, and occipital cortex (responsible for vision).
• CNS Degenerative Change Degenerative diseases of the central nervous system (CNS) – Alzheimer’s, Parkinson’s, senile dementia, and the like
• Vestibular neuronitis – acute, sustained dysfunction of the peripheral vestibular system with secondary nausea, vomiting, and vertigo. As this condition is not clearly inflammatory in nature, neurologists often refer to it as vestibular neuropathy.
• Vestibular schwannoma – a vestibular schwannoma (also known as acoustic neuroma, acoustic neurinoma, or acoustic neurilemoma) is a benign, usually slow-growing tumor that develops from the balance and hearing nerves supplying the inner ear. The tumor comes from an overproduction of Schwann cells–the cells that normally wrap around nerve fibers like onion skin to help support and insulate nerves. As the vestibular schwannoma grows, it presses against the hearing and balance nerves, usually causing unilateral (one-sided) or asymmetric hearing loss, tinnitus (ringing in the ear), and dizziness/loss of balance.
• Other brain or CNS dysfunctional syndromes such as physical disease, DM, high blood pressure, infectious disease, kidney disease, heart disease, dysfunctional thyroid.

Diagnosis Methods

1. Patient’s History of having Vertigo

Vertigo is usually associated with a problem in the inner ear balance mechanisms (vestibular system), in the syndrome and Meniere’s disease. Vertigo-like symptoms may also appear as paraneoplastic syndrome (PNS) in the form of opsoclonus myoclonus syndrome, a multi-faceted neurological disorder associated with many forms of incipient cancer lesions or viruses. It can be caused by inflammation of the inner ear due to the common cold, influenza, and bacterial infections. Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway. These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings. It can also occur after long flights or boat journeys where the mind gets used to turbulence, resulting in a person’s feeling as if he is moving up and down. This usually subsides after a few days. It can also occur when exposed to high levels of sound pressure rattling the inner ear in which throwing off ones balance and others. Consumption of alcohol can also cause vertigo.

2. Physical Examination

During patient’s history interview, staff must carefully observe patient reaction.  Elderly patients usually have problem with Blood Circulation System, thus physical examination must include ear, nose, throat, and other organs examination for initial diagnosis because these may be the cause of vertigo.

Special Diagnosis Methods

• Bekesy
• Posturography
• Caloric test
• Positioning test
• VNG
• Brainstem Electrical Response Audiometer (BERA)

Summary

Vertigo is the sudden sensation that you are unsteady or that your surroundings are moving. You may feel like you’re spinning around on a merry-go-round or that your head is spinning inside. Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that can cause vertigo. Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness associated with specific changes in the position of your head. It most commonly occurs when you move your head in a certain direction, lie down from an upright position, turn over in bed or sit up in the morning. Moving your head to look up or look down also can bring about symptoms of benign paroxysmal positional vertigo. You may also feel out of balance when standing or walking. Although benign paroxysmal positional vertigo can be a bothersome problem, it’s rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor’s office visit.