Vertigo is a symptom of illusory movement. Almost everyone has experienced vertigo as the transient spinning dizziness immediately after turning around rapidly several times. Vertigo can also be a sense of swaying or tilting. Some perceive self-motion whereas others perceive the motion of the environment.
Vertigo is a symptom, not a diagnosis. It arises because of asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brain stem.
Vertigo is a troubling problem for many clinicians because it is symptomatic of a large range of diagnoses from benign to immediately life-threatening. However, in most cases, the clinical history, especially the tempo of the symptoms, with examination findings that distinguish between central and peripheral etiologies identify those patients that require urgent diagnostic evaluation. Vertigo is only one type of dizziness.
Other disorders that present with dizziness include presyncopal faintness, disequilibrium, and nonspecific or ill-defined light-headedness. The initial approach to the patient who complains of dizziness is to localize the cause of the symptom into one of these broad categories.
Dizziness is diagnosed mainly on history and physical but is also diagnosed with the use of equipment that specifically tests the inner ear and neural pathways through which sound is processed in the brain. This testing is conducted by trained audiologists here at the AEC. It is important to avoid medications and substances that either stimulate the central nervous system (like caffeine) or inhibit the central nervous system (like benadryl.) Other important procedures used to help in the diagnosis of vertigo include MRI, CT and MRA scans.
Benign Paroxysmal Positional Vertigo (BPPV)
There’s a certain type of vertigo which affects millions of people especially as they get older. It’s called Benign Paroxysmal Positional Vertigo or BPPV. The dizziness is generally thought to be due to debris collected in the inner ear. Think of it as ‘ear rocks’. The formal name is otoconia. Ear rocks are small crystals of calcium carbonate that come from the utricle in the inner ear. The otoconia are not able to migrate to the canal system so they essentially get stuck. Some dissolve. Others do not.
BPPV is a common cause of dizziness. In fact, it’s a cause in about 20% of all cases of dizziness or vertigo. It can occur in children, but the condition is more common in adults. The older you are, the more likely your dizziness is due to BPPV.
The most common cause of BPPV in people under 50 is head injury. The head injury doesn’t even need to be direct. Whiplash and migraines can also be associated with this type of vertigo. BPPV becomes more common as you age and the cause is usually degeneration of the vestibular system of the inner ear. Viruses affecting the ear are significant causes.
Sometimes, this type of vertigo follows surgery, including dental work, where the cause is a combination of prolonged supine positioning or ear trauma when the surgery is done on the inner ear. BPPV is also common in people who have been treated with ototoxic medications. However, in half of all cases, this type of vertigo is idiopathic. This means it occurs for no known reason.
For more information on vertigo or dizziness, contact Austin Ear Clinic today.
Dizziness and Vertigo Evaluation
Dizziness and vertigo can be extremely unsettling. They can lead to brain fog and fatigue and can range from a mild annoyance to debilitating. We take the evaluation and management of dizziness and vertigo very seriously and strive to make a diagnosis as quickly and definitively as possible.
In order to determine the cause of your dizziness and vertigo, a series of evaluations must be completed.
Medical history. Your doctor will ask you specific and pointed questions in order to try and determine the cause of your symptoms.
Physical Exam. This exam, while less informative than the medical history review, can be used to specifically pinpoint a cause, such as benign positional vertigo (BPV).
Audiogram. Normal or abnormal hearing are both clues to a cause of your dizziness. Within the inner ear is the cochlea (used for hearing) and the vestibular system (used for balance). Typically, if a problem with your vestibular system is causing your dizziness, there will also be an issue with your hearing.
Imaging. In order to determine the cause of your symptoms, your doctor may need an inside look of your brain and ears. Magnetic resonance imaging (MRI) will be used to look at your brain and a computed tomography (CT) scan will be used to get a detailed picture of your inner ear.
Inner Ear Testing. These functional tests are used to determine the relative strengths of the balance system, electrical function of the auditory nerve, the reflex between the eyes and the inner ear, and the pressure within the inner ear.
Treatment is directed towards the likely cause of your symptoms. This may require some trial and error, as there is usually more than one cause of your symptoms.
How you respond to the therapy, with either an improvement or no response, is also helpful in determining the specific cause. Therefore, follow-up visits are crucial.
Many patients with balance disorders have a weakened inner ear. While these patients usually recover normal balance and activity it is not uncommon for other illnesses to overpower the recovery and start producing symptoms of imbalance. Allergy and sinus problems, which are common in Austin, have been known to cause additional problems with imbalance. Working to improve these symptoms can help.
We may recommend input from other specialties, such as neurology, cardiology and ophthalmology, if our findings suggest non-vestibular causes.
We may recommend a second opinion if we feel it is needed and never discourage our patients from seeking other opinions on their own.