As vertigo and symptoms of dizziness are one of the top 5 reasons individuals seek medical attention, I feel it is necessary to understand both the symptoms themselves, and what is likely causing them. These frightening and often debilitating symptoms have many potential causes, and proper assessment and diagnosis is essential to treating them effectively.
First we must understand the symptoms. Vertigo is derived from the Latin “vertere”, meaning to turn. Vertigo is always associated with a sensation of turning or spinning, whether it is the individual spinning, or the environment spinning around the individual. Most cases involve the environment spinning around the individual, which is most often a less complicated presentation.
Dizziness is often described as “lightheadedness” or feeling as if one is going to faint. Spinning is typically not associated with dizziness.
Disequilibrium is a loss or alteration in our sense of balance, often associated with feelings of being “on a boat” or the effects of alcohol on the way we walk and perceive ourselves relative to the environment around us (“drunken gait”).
Nausea and/or vomiting often accompany vertigo and may, although less often, be associated with dizziness and disequilibrium. Dizziness and disequilibrium typically do not lead to vertigo, but untreated vertigo will often lead to complications with these two symptoms due to compensatory changes within the nervous system.
There are many possible causes of vertigo, but, by far, the leading cause is related to debris (otoconia) made up of calcium carbonate crystals that dislodge from their proper place within the inner ear canal system. This condition, called Benign Paroxysmal Positional Vertigo (BPPV), is due to the disruption of signals transmitted to the brain regarding angular acceleration of the head from this debris in the affected ear canal. Fortunately this condition is treated with great success via head positioning maneuvers designed to relocate the debris to its proper location, followed by rehabilitation for the inner ear vestibular (balance) organs. Aging and head trauma are the two main predisposing factors for BPPV. The one major drawback is that this condition is often not assessed appropriately, therefore leading to an incorrect diagnosis.
Other causes of vertigo include Vestibular Neuritis/Neuronitis, which, as its name implies, involves inflammation of the inner ear. Although treated with anti-inflammatory agents, symptoms often persist and require rehabilitation of inner ear vestibular organs. Meniere’s Disease, which consists of a triad of symptoms including vertigo, tinnitus (ringing in the ears) and progressive hearing loss, is caused by an increase in a certain type of fluid within the inner ear causing pressure on balance and hearing centers. Considered a more ominous and poorly understood condition, certain types of therapeutic interventions can be effective, especially with regard to the vertigo component. Perilymph Fistula is a defect in the membrane, or window, between the middle and inner ear causing pressure changes affecting the inner ear. A certain class of antibiotic medications (aminoglycosides) can cause damage to the eighth cranial nerve leading to vertigo and hearing loss.
As with vertigo there are many causes of dizziness, a list too exhaustive to explore here, but many are related to medication side effects (it is one of, if not the most common medication side effects across all classes of medications) and changes in heart rate and blood pressure (Postural Hypotension and Vasovagal Syncope). Anxiety disorders and panic attacks may lead to dizziness as well.
Disequilibrium is often related to alteration or disturbance in central (brain) feedback from any of the major systems related to balance including visual, muscle and joint (proprioceptive), and inner ear vestibular systems. The number of metabolic, physical and functional conditions that may affect these systems is quite lengthy as you could imagine! Alcohol, recreational and therapeutic drugs, and environmental exposures, among many other triggering agents, can play a large role in disruption of equilibrium. As noted, untreated vertigo will likely lead to symptoms of both dizziness and disequilibrium.
Treatment for all disorders is wide ranging and the effectiveness of any given treatment is dependent upon the accurate diagnosis of the condition creating the symptoms. The bottom line is that all conditions affecting balance will likely benefit from active rehabilitation of the involved systems once the causative factor has been established. Although to the individual experiencing these symptoms it appears that the prognosis is hopeless, long term outcomes are favorable for the vast majority of conditions outlined! Diagnostic and treatment interventions will be discussed in greater detail in future articles.
Dr. Michael S. Trayford is a Board Certified Chiropractic Neurologist who has undergone extensive training in diagnosis and management of vestibular/balance disorders and fall prevention therapies.