What Is Dizziness & Vertigo?

Dizziness and vertigo symptoms can range from the merely uncomfortable to the incapacitating. Severe vertigo can limit life activities and cause nausea, headaches, abnormal eye movements, and imbalance. The condition is most common among adults but can occur in younger patients as well.

Symptoms of Vertigo

Vertigo is typically described as a feeling of spinning, tilting, being off balance, or being pulled in one direction. The symptoms can be triggered when the head changes position or can occur spontaneously. The symptoms occur because the vestibular system, which controls our sense of balance and position, sends conflicting messages to the brain.

Causes of Dizziness and Vertigo

Types of vertigo

There are two main types of vertigo: peripheral and central.

1 Peripheral vertigo is the most common type. It happens when there’s an issue with your inner ear or vestibular nerve. (Both help with your sense of balance.)

2 Central vertigo is less common. It occurs when you have a condition affecting your brain, like an infection, stroke or traumatic brain injury. People with central vertigo usually have more severe symptoms like severe instability or difficulty walking.

Peripheral causes of vertigo

Many cases of vertigo are the result of an inner ear problem. The most common ear problems associated with vertigo include:

• Benign Paroxysmal positional vertigo – A condition that causes vertigo lasting less than a minute when the head is placed in particular positions. It is caused by microscopic crystals of the inner ear getting displaced into the balance canals

• Ménière’s disease - A condition of fluid imbalance in the inner ear that can lead to vertigo, tinnitus, hearing loss and other issues. This is thought to occur due to the accumulation of endolymphatic fluid in the cochlea and the vestibular organ. In most cases, it is slowly progressive and significantly impacts the social functioning of the individual affected. 

• Labyrinthitis - An inner ear infection caused by a virus that can cause extreme dizziness and balance problems with hearing loss lasting several weeks

• Vestibular neuronitis - A viral infection of the vestibular nerve in the inner ear with no hearing loss. The vertigo lasts 2-3 weeks.

What is vestibular testing?

Vestibular testing includes several tests that check how the balance system within your inner ear (vestibular system) is working. These tests are sometimes called a vestibular test battery. Your healthcare provider may order vestibular testing if you have symptoms of dizziness, vertigo or if you’re feeling off balance.

Your vestibular system helps you position and move your body so that you feel a sense of balance within your environment. It includes three semicircular canals (head rotation sensors), two otolith organs (gravity sensors) and the vestibular nerve.

Vestibular testing allows a healthcare provider to evaluate how these parts of your vestibular system work to help you coordinate movements and stay balanced.

When is vestibular testing performed?

Vestibular testing can show if your symptoms relate to an inner ear or a related neurological (brain) issue. Vestibular tests can help your provider diagnose conditions, such as:

Benign paroxysmal positional vertigo (BPPV).

Labyrinthitis.

Ménière’s disease.

Vestibular neuritis.

Others.

How do vestibular tests work?

For vestibular testing, an audiologist guides you through various simple tasks while asking questions. Audiologists specialize in hearing and balance disorders.

These tests measure how your body’s sensory systems that control balance work together. To feel balanced, your brain requires input from three systems working together:

Vision (sight). Proprioception (touch). Vestibular system (inner ear balance system). An important reflex within your vestibular system keeps your vision in focus while your head and body move. It’s called the vestibulo-ocular reflex, or VOR. The audiologist will monitor your eye movements to assess your VOR. For example, they may look for involuntary eye movements (nystagmus). Your eyes provide essential visual evidence of how your vestibular system is working.

How do I prepare for vestibular testing?

Follow your audiologist’s instructions on how to prepare. Instructions may include the following:

Plan to have someone drive you home after the test. You may feel dizzy or unsteady after testing. To be safe, it’s a good idea to have someone drive you home. Follow your provider’s guidance about what medications to take. Some medicines may interfere with your test results. Follow your provider’s instructions on which medicines you should take and which ones you should avoid. Follow your provider’s guidance about what foods to eat or drink. Your provider may recommend eating only a small meal or avoiding eating before the test. They may ask you to avoid alcohol. Don’t wear eye makeup. It’s important that your provider can see all eye movements so they can evaluate your VOR. Eyeliner, mascara and dark eye shadow can make this difficult.

Treatments for Vertigo

The best treatment for vertigo depends on the exact cause. Some of the most common therapies include:

• Canalith repositioning (Epley) maneuver, which are a specific set of head and body movements designed to force the calcium deposits which are abnormally displaced in the inner ear canals and into the inner ear chamber where they can be reabsorbed by the body.

• Medications may be used to relieve the motion sickness and nausea associated with vertigo. If the vertigo is due to labyrinthitis, steroids, and intratympanic injections (behind the ear drum) are performed to reduce the hearing loss.

• Migraine preventative medications are used to treat vestibular migraine and Meniere’s disease. In one of our studies, 92% of patients had significant improvement of their symptoms with this treatment. Sometimes, injections in the ear are needed to control the symptoms of Meniere’s disease and vestibular migraine.

• Balance rehabilitation, which is a specialized exercise-based program designed to teach patients how to compensate for their faulty vestibular system in order to reduce gaze instability, imbalance, and falls.

• Rarely, surgery is used to treat patients with incapacitating vertigo.

Anyone experiencing vertigo accompanied by a sudden change in speech or vision should seek immediate medical help. This could indicate a more serious problem, such as a transient ischemic attack or stroke.