VERTIGO- I FEEL THE EARTH MOVE UNDER MY FEET

Vertigo refers to a symptom of spinning sensation; either patient feel themselves spinning or the room spinning around them. It is a very distressing symptom associated with nausea and vomiting.

It is foolhardy to determine the cause of vertigo with this short article. However there a few clues that the doctors will elicit from a patient with vertigo:

• How long does the vertigo lasts; seconds, minutes or hours?
• Is there sensation of ear fullness/block or tinnitus?
• Does a certain head position bring on the vertigo, such as looking left or right?
• Do you experience nausea or vomiting?
• Have you been feeling unwell or had fever in the last 2 weeks?
• Is there any ear discharge or ear pain?
• Did you bump your head or fell?
• Do you experience any weakness or numbness in other parts of your body?
• Did you faint or lose consciousness?
• Do you have any history of migraine, diabetes or hypertension?

What are the causes of vertigo?

There is an exhaustive list of possible causes of vertigo. Therefore it takes proper consultation and examination before the doctor can provide a possible cause and treat accordingly.

• Benign paroxysmal positional vertigo- The most common cause of vertigo. Patients experience a short duration of vertigo related to certain head positions. The doctor can reproduce this vertigo during Dix-Hallpike examination and confirm the diagnosis. The treatment is simply a manouvre that is done in the clinic which gives immediate relief. Sometimes the manouvre needs to be repeated for complete resolution.

• Meniere’s disease-Patient’s have vertigo lasting minutes to hours associated with tinnitus and reduced hearing. Often there is nausea and vomiting too.  In between episodes, patients are symptoms free.

• Vestibular neuronitis- It is a condition due to inflammation of the vestibular nerve.  It is hypothesized to be due to viral infection. Patients have vertigo symptoms with nausea and vomiting. There is no hearing loss or tinnitus.

• Labyrinthitis- This is another condition due to inflammation of the inner ear or labyrinth. Patients have vertigo with hearing loss and tinnitus. The hearing loss can be severe and permanent if not treated early. It is due to viral or bacterial infection.

• Middle ear disease such as otitis media or cholesteatoma. Cholesteatoma is a non tumour condition resulting in whitish debris seen within the middle ear. Treatment of cholesteatoma often require surgery.

• Cerebellar stroke or hemorrhage leading to disruption of oxygen supply and blood flow to the base of the brain area (cerebellum) which is an important central portion that controls balance.

• Head trauma can cause vertigo or dizziness which is often temporary.

• Vertebrobasilar insufficiency is related to cervical spine problems. This can lead to occlusion of blood supply to the inner ear especially when patient looks up or down.

Other causes of vertigo which are less common: Ototoxicity, Cerebellopontine angle tumour, Migraine

Treatment of vertigo

The treatment recommended for the patient will depend on the diagnosis. And recovery from the vertigo will also depend on the diagnosis and patient factors such as age and other co-morbidities.

The choice of treatment can be a combination of the following:

Medication- Betahistine is commonly used for vertigo. Other medications are also used during the acute attack of vertigo such as prochloperazine and metoclopramide. In the case of bacterial infections in labyrinthitis, antibiotics are prescribed as well.

Vestibular rehabilitation exercises which are a series of movements that can help patients regain their balance. Other similar exercises recommended include tai-chi.

Particle repositioning manouvres which is a manouvre that is performed in the doctor’s office for benign paroxysmal positional vertigo such as the Epley’s manouvre. There are other types of manouvres that can be performed depending on the semicircular canal involved.

Lifestyle advice which includes avoiding alcohol, reducing stress, low salt diet for Meniere’s disease, reducing caffeine intake, good adequate sleep and rest