Vertigo: Frequently asked questions

Vertigo is a subjective sensation. Nobody other than the patient can experience what that person is experiencing. Many people with this disorder are inadequately evaluated.

Since most forms of vertigo are readily treated, we recommend anyone with this condition to seek further attention despite the fact that prior visits to one's physician may not have resulted in alleviation of this condition.

What is vertigo?

The precise definition of vertigo is an illusion of motion. But it also refers not just to illusions of motions, but chronic or intermittent sensation of loss of balance.

What are common causes of vertigo?

There are a large number of causes of vertigo, but the three most common causes are:

• Cold viruses
• Head trauma
• Meniere's disease

How are causes of vertigo related?

These are all conditions that affect the inner ear. The inner ear is responsible for our sense of balance and also our sense of position in space. When the inner ear dysfunctions, we lose our sense of balance and frequently suffer symptoms such as vertigo, nausea, vomiting, and loss of balance.

Can vertigo be treated?

Most causes of vertigo are readily treatable with physical therapy, medication, surgery, and time. By time, I mean, waiting because many causes of vertigo resolve spontaneously. Because of the many causes of vertigo, the critical issue in choosing a physician is their experience with vertigo.

Who should I see for vertigo treatment?

There are two types of physicians whose specialties include dizziness:

• Neurologists, who would deal in treating chronic forms of vertigo.
• Otolaryngologists, who are neurologists that specialize in ear disease.

Since many types of vertigo go away without treatment, initial evaluation by a general practitioner or family doctor is appropriate early on, reserving specialty care for chronic cases.

At what age is vertigo most common?

It is extremely rare, but not impossible, for young children to have vertigo. It becomes more common in the early 20s and affects all ages commonly after that. Its consequences however become more substantial as you get older because loss of balance in the elderly commonly leads to major fractures.

Can someone get vertigo from playing a video game that simulates movement?

Three-dimensional video games can cause a brief sensation of vertigo, but it would not persist.

Can stress cause vertigo?

Mental stress can make many forms of vertigo worse, but will not, by itself, produce vertigo.

What is positional vertigo?

Positional vertigo refers to a variety of conditions where a change in the position of your head produces a sense of vertigo.

Benign paroxysmal positional vertigo (BPPV)

The most common form is a condition called benign paroxysmal positional vertigo or BPPV for short. In BPPV when one lies down with the affected ear toward the floor, one gets a brief but very intense feeling of the world spinning around.

Is ataxia related to vertigo?

Ataxia refers to clumsiness. Disease of the inner ear does not produce ataxia per se but can be confused with ataxia. Ataxia is produced by disease of the cerebellum, a part of the brain that works with the inner ears to help maintain balance and also fine motor control.

Can the symptoms of vertigo be confused with the symptoms of other diseases or conditions?

Yes, this is a common occurrence. Usually they are mistaken because of use of the word dizziness. Dizziness can refer to lightheadedness, which is not vertigo and is commonly produced by vascular problems. Dizziness also can mean vertigo, and there are very few causes of vertigo that do not come from the inner ear. Occasionally, rare types of strokes can cause vertigo, but these are usually associated with other neurological symptoms as well.

Are there any surgical procedures to correct vertigo?

There are surgical procedures to correct certain types of vertigo. If the vertigo is caused by a disease such as Meniere's disease, where the function of the involved ear changes over time, and these changes do not respond to medical therapy, then surgical intervention may eliminate the vertigo.

How does physical therapy help vertigo?

In forms of vertigo, where the inner ear has suffered damage and the function of that ear is fixed, not changing over time, physical therapy can be quite helpful. When the inner ear is damaged, people commonly experience severe spinning for several days. If after several weeks the person still has a loss of balance, then physical therapy can help restore this balance. The reason physical therapy is helpful is that it helps train the brain to compensate for the loss of function in the ear. Just as you can make a muscle stronger by exercising it, you can make the balance system in the brain work better by exercising it.

What kind of physical therapy works to reduce vertigo?

It's called vestibular rehabilitation, and it is a relatively new form of physical therapy. Not all physical therapists are trained in the practice. Typically the exercises consist of movements that initially make the vertigo worse and balance tasks that are quite difficult. By doing these repetitively, the balance system in the brain learns to function better. Common exercises include moving the eyes from side to side, rotating the head from side to side, rotating the head from side to side while walking down a corridor, and things like this.

Can vertigo be associated with the onset of a menstrual period?

Some women with Meniere's disease have worse symptoms during their menstrual period. This is not an uncommon symptom because Meniere's disease is exacerbated by salt retention, and menstrual periods are associated with salt retention.

Is anxiety associated with vertigo?

Yes, vertigo causes extreme anxiety in most people. Anxiety, by itself, does not produce vertigo. However, in association with conditions that do produce vertigo, anxiety can make the vertigo much worse. People with certain anxiety disorders such as panic attacks can sometimes also experience vertigo.

What is particle repositioning maneuver?

Particle positioning maneuvers are a treatment for benign paroxysmal positional vertigo (BPPV).

What causes BPPV?

BPPV is caused by loose otoconia within the inner ear. Otoconia are small calcium carbonate crystals that are part of the balance mechanism. In BPPV, these crystals break loose from their normal attachments and are free to tumble around the inner ear. When the involved ear is suddenly put in a downward position, the otoconia stimulate part of the inner ear abnormally. This results in a brief but intense whirling vertigo.

Eliminating symptoms of BPPV

Particle position maneuvers are a series of body turns that maneuver the otoconia into a different part of the inner ear where they will not cause symptoms. It is a very effective maneuver that takes just a few minutes to perform.

How does vertigo relate to labrynthitis?

Labyrinthitis or vestibular neuronitis is a presumed viral infection of the vestibular nerve. It causes sudden loss of function in the balance system of one ear. The brain normally compares the two ears. When you turn in any direction, the output of one ear to the brain goes up and the output of the other goes down. The brain looks at the difference between the two ears and says "I'm turning." When one ear develops labyrinthitis, its output suddenly drops. The brain sees a difference between the two ears, and that produces the feeling of spinning. This is commonly associated with nausea and vomiting and the worst part of it usually lasts for about three days. For several weeks afterward, it is common to feel a little bit off balance. Typically, after three to four weeks the balance returns to normal.