Vertigo

Dizziness is a symptom which can describe many different sensations depending on the person experiencing it. Lightheadedness, imbalance, and a spinning sensation are all commonly referred to as dizziness but each can arise from completely different causes. Metabolic, neuromuscular, and cerebrovascular disorders as well as tumors or trauma are common causes for dizziness but each is experienced in a different way and has its own different method of treatment. When seeking help from a physician about dizziness, it is important to see someone who is able to discern between the different types of dizziness and identify the primary cause before treatment can be rendered.

A spinning sensation type of dizziness (vertigo) can be divided into two major types: central and peripheral. Central refers to conditions in the central nervous system (brain and spinal cord) which can cause vertigo. These include primarily strokes, tumors or trauma. Peripheral describes causes of vertigo which arise mainly from the ear or more specifically, from the balance nerves and balance organs in the inner ear. Peripheral vertigo is the most common type and can arise from tumors, trauma, infections, migraines, allergies, and inner ear fluid abnormalities. Click here for more on Peripheral Vertigo. Treatment is varied and often times includes combinations of lifestyle changes, medicines, surgery, or rehabilitation. Again, it is most important to determine the likely cause of the vertigo before treatment can be effectively prescribed.

At University of California-Irvine Medical Center, we have an ear team which includes a neurotologist, who is a physician that is specialty-trained in diagnosis and treatment of ear diseases both medically and surgically. The team also includes audiologists, neurologists, neurosurgeons, and physical rehabilitation specialists who function together in the diagnosis and treatment of the different types of dizziness and balance disorders. All aspects of the patient's care are done within the medical center and handled by professionals who deal with these types of disorders on a daily basis and progress is monitored regularly by the neurotologist.

Inner Ear/Balance Nerve Causes of Vertigo (Spinning Dizziness)

There are many disorders that cause vertigo (spinning dizziness). They are categorized as central (caused by problems in the brain or brainstem (back part of brain), or peripheral (inner ear or balance organ). Below are some of the diseases that cause vertigo. A brief description of each disorder is given. Please note that often, diagnosis of vertigo is complex and requires a careful history and physical examination, hearing and balance testing, as well as imaging studies.

Benign Positional Vertigo (BPV also known as BPPV)

Characteristics: Short lasting spinning dizziness caused by certain head movements.

What Brings on the Symptoms: The spinning dizziness in BPV comes on when patients turn their head one particular way (either left or right). It will most commonly occur when patients are lying in bed and turn.

Duration: The spinning dizziness lasts less than one minute.

Associated Symptoms: No associated hearing loss, tinnitus (ringing in the ears), etc.

What Causes It: The inner ear balance organ is filled with fluid. Certain areas of the inner ear balance organ contains microscopic crystals that for some reason (sometimes from trauma) can become loose and float in the fluids of the inner ear. When the head is turned in a particular direction, the crystals float in the fluid and cause a rippling effect (like a rock thrown in water). This movement of fluids causes stimulation of the inner ear, which causes a sensation of motion and thus dizziness. The spinning stops as the movement of the crystals and the fluid through the inner ear stops.

Treatment: BPV can usually be corrected by performing an office procedure called an "Epley maneuver".

Migraine Related Dizziness

Characteristics: Episodic vertigo or constant sense of dizziness. Associated with light or sound sensitivity. Sometimes, significant motion sensitivity may be present. Patients may have difficulty watching TV when there is too much movement, or have problems with looking at a computer monitor when scrolling up and down. The dizziness may be associated with fluctuating hearing loss, buzzing or ringing sound in the ear, and pressure in the ear. Many patients have a history of car sickness as a child.

What Brings on the Symptoms: Stress, certain foods (e.g., red wine, chocolate, canned/cured/processed meats, MSG, and/or cheeses in the diet. Change in sleep (too much, too little, or change in pattern), or skipping meals can cause it.

Associated Symptoms: Motion sensitivity, and in some, hearing loss, buzzing or ringing sound in the ear, and pressure in the ear.

Duration: The dizziness lasts at least anywhere from a few minutes and may last up to several weeks or months.

What Causes It: Genetic and environmental causes play a key role.

Treatment: Migraines are generally best managed by stress reduction, good sleep regimen, not skipping meals, and diet modifications. Medications can be given to help the symptoms. The class of medication used depends on a variety of factors.

Meniere's Disease (For More on Meniere's Disease, click here)

Characteristics: Episodic vertigo associated with fluctuating hearing loss, buzzing or ringing sound in the ear, and pressure in the ear.

What Brings on the Symptoms: Stress, high salt, caffeine, or alcohol in the diet.

Associated Symptoms: Hearing loss, buzzing or ringing sound in the ear, and pressure in the ear.

Duration: The spinning lasts at least 30 minutes and may last up to 24 hours.

What Causes It: Unknown, but genetic and environmental causes play a key role.

Treatment: Meniere's disease can often be controlled with a strict diet of low sodium (less than 1500mg per day), elimination of caffeine and alcohol, and stress reduction (daily exercise and meditation). In more severe cases medications and surgeries may be needed. The latest treatment for Meniere's disease that has been found to be very effective has been steroid injections through the ear drum. This has been shown to help approximately 90% of patients from Meniere's without the major side effects of gentamicin or other surgical procedures.

Acoustic Neuroma 

Characteristics: The dizziness in acoustic neuromas can present like any other disease and has no particular characteristic. Patients with acoustic neuromas most commonly present with one sided hearing loss (total or partial), one sided ringing in the ears, or sudden hearing loss. 

What Brings on the Symptoms: No particular trigger is known for symptoms of Acoustic neuromas. The symptoms can come on suddenly or gradually.

Associated Symptoms: hearing loss, buzzing or ringing sound in the ear, and rarely numbness of the face.

Duration: The duration of the dizziness is variable, it can be short like BPV or long like other diseases.

What Causes It: No known cause exists. Genetics are thought to play a role. Recently, loud noise exposure over a long period of time was found to increase the likelihood of getting an acoustic neuroma.

Treatment: The treatment depends on the size of the tumor, the age and medical status of the patient. Click here for more information on acoustic neuroma treatment.

Labyrinthitis

Characteristics: Severe spinning dizziness and imbalance that comes on suddenly and lasts 2-3 weeks and is associated with hearing loss. 

What Brings on the Symptoms: Any movement or even sitting still can make you feel dizzy. 

Associated symptoms: Intense dizziness associated with nausea and vomiting, hearing loss, and ringing in one ear.

Duration: The dizziness lasts about 2-3 weeks. It takes some time after that to get your balance fully back.

What Causes It: It is thought that a virus infection of the inner ear causes labyrinthitis. 

Treatment: Treatment consists of medications to reduce the dizziness and nausea. Since it is caused by a virus, no good treatment is known. Cortisone (anti-inflammatory steroid) medications are given to reduce the symptoms. Injections of steroids into the space behind the ear drum (intratympanic steroids) can help reduce the long-term hearing loss of labyrinthitis. The injections must be done in the first 14 days after the onset of symptoms.

Vestibular Neuronitis

Characteristics: Severe spinning dizziness and imbalance that comes on suddenly and lasts 2-3 weeks and is NOT associated with hearing loss. 

What Brings on the Symptoms: Any movement or even sitting still can make you feel dizzy. 

Associated symptoms: Intense dizziness associated with nausea and vomiting.

Duration: The dizziness lasts about 2-3 weeks. It takes some time after that to get your balance fully back.

What Causes It: It is thought that a virus infection of the balance nerve causes vestibular neuronitis. 

Treatment: Since it is caused by a virus (much like labyrinthitis), no good treatment is known. Cortisone (anti-inflammatory steroid) medications are given to reduce the symptoms.

Perilymph Fistula

Characteristics: Episodic vertigo lasting a few seconds to a few minutes, associated with fluctuating hearing loss.

What Brings on the Symptoms: Loud sounds, pressure changes (such as in an airplane, elevator, or SCUBA diving). Also, blowing one's nose, coughing, lifting heavy objects, or straining can cause the vertigo.

Duration: The dizziness lasts a few seconds to a few minutes.

What Causes It: Trauma to the head, or a sudden pressure change (such as in SCUBA diving or in a plane) can cause a leakage of fluid from the inner ear. The intermittent leakage of inner ear fluid causes dizziness and hearing loss.

Treatment: Treatment of perilymph fistula is surgical. In surgery the areas of leakage of the inner ear fluid (perilymph) is patched using tissues from behind the ear.

Superior Canal Dehiscence (For more on superior canal   dehiscence click here)

Characteristics: Intermittent dizziness associated with hearing loss.

What Brings on the Symptoms: Various movements, or especially loud noise can cause the symptoms of spinning dizziness.

Associated Symptoms: Hearing loss.

Duration: The vertigo does not last very long, but the problem is long lasting.

What Causes It: The bony portion of one the canals of the inner ear (superior canal - the top-most canal) gets eroded away probably because of pressure and pulsations of the brain. Therefore, the inner ear fluid compartments have an outflow tract which leads to the symptoms of dizziness, hearing loss, and especially the sensitivity to sound (which causes vertigo).

Treatment: The treatment of superior canal dehiscence is by doing surgery and patching the hole in the superior canal.