Do you feel that the room is spinning often or all the time? If you do, then you might have vertigo. Vertigo is a subtype of dizziness, which is commonly described as a sensation of the room spinning. It is often associated with nausea and vomiting as well as difficulty balancing while standing or walking. Common causes of vertigo include benign paroxysmal positional vertigo (BPPV), Ménière’s disease, vestibular neuritis and labyrinthitis.
Benign paroxysmal positional vertigo (BPPV)
BPPV is the most common cause of vertigo, affecting up to 80% of patients with vertigo. It is a disorder arising in the inner ear. Collections of calcium crystals, known as otoliths, are present within the inner ear and sometimes these otoliths may be dislodged from their usual position due to infection, trauma or without any specific cause. The otoliths can then migrate to various locations within the inner ear depending on the patient’s head position, resulting in vertigo.
BPPV is characterized by vertigo lasting 10 to 30 seconds when the head is placed in a particular position – usually lying down, looking upwards or looking up while bending down. Although BPPV can be a bothersome problem, it is rarely a serious condition. The good news is that BPPV is a self-limiting condition that resolves spontaneously in the majority of patients over several weeks to months. However, in some patients this condition can persist up to several years and may also recur. BPPV is treated by the particle repositioning manoeuvre, or Epley manoeuvre, which aims at returning the displaced otoliths to their original position. The success rate is 80% after one treatment and up to 95% after repeated manoeuvres.
Ménière’s disease is a disorder of the inner ear, characterized by a triad of vertigo lasting from 20 minutes to 24 hours, ringing in the ear (or tinnitus) and hearing loss that comes and goes. Usually only one ear is affected. Ménière’s disease is due to an increase in the amount of fluid (known as endolymphatic fluid) in the inner ear. It is believed that salt and caffeine can increase the amount of fluid within the inner ear, hence salt and caffeine intake should be reduced. Medications are also available in the treatment of Ménière’s disease.
Vestibular neuritis is caused by a viral infection or reduction in blood flow to the nerve responsible for hearing. It usually only affects one ear. There may be a history of flu-like illness just prior to the onset of vertigo. The vertigo is severe, which can be a sudden single attack, multiple attacks or persistent condition that diminishes over 3 to 6 weeks. Unlike labyrinthitis, there is no hearing loss or other symptoms affecting the ear. Treatment involves physical therapy, such as head and eye movements, postural changes and walking exercises that help to reduce the vertigo.
Labyrinthitis refers to inflammation of the inner ear. It is usually due to a viral infection, but can also be caused by bacterial infections. There is usually preceeding flu-like symptoms, followed by the development of vertigo, hearing loss, ringing in the ears (tinnitus) or imbalance. Treatment involves bed rest and medications to help reduce symptoms.