Are you Experiencing Vertigo?

February 3, 2020

 

Ever experience episodes of dizziness, being off balance, or the room is spinning? You may have a form of vertigo.

 

There are two categories for vertigo: peripheral and central. Peripheral vertigo occurs as a result of an inner ear problem or the vestibular nerve. Central vertigo occurs as a result of a problem in the brain, usually the cerebellum or vestibular nuclei.  This can include strokes, tumors, infection, and multiple sclerosis.

 

Most cases involve peripheral vertigo. The following are peripheral:

 

Benign paraoxysmal positional vertigo (BPPV)

BPPV is the most common vertigo. It is caused by calcium crystal floating in the semicircular canals of the ear. This type of vertigo brings a sensation by changes in head position. This can occur from head trauma, dental work, a virus, ear surgery, or degeneration of the vestibular system. Treatment can be done with an epleys maneuver in physical therapy.

 

Meniere's Disease

This is an inner ear disorder that affects balance and hearing though to be caused by an alteration in the production flow and absorption of inner ear fluids. The underlying origin is unknown. Symptoms are severe spinning for 1-24 hours, fluctuating hearing loss, tinnitus, and nausea. Episodes can be 1 every few years to daily/weekly episodes. Can only be treated when episodes are very frequent.

 

Labyrinthitis 

This is an inflammation of the labyrinth (cochlea). It occurs usually due to an upper respiratory infection, flu, or bacterial infection occurring up to 2 weeks prior to onset of symptoms. Symptoms can consist of sudden onset of vertigo last days with nausea, along with imbalance, tinnitus, hearing loss and dizziness. Symptoms get worse with head movement, stress, weather changes, altitude changes, too much visual stimuli and fatigue. 80% get better on their own.

 

Vestivular Neuritis

Consists of inflammation of the vestibular nerve. Symptoms are the same for labyrinthitis, except hearing is spared.

 

Acoustic Neuroma 

A slow growing benign tumor on the cranial nerve which compresses and causes hearing loss, then tinnitus, then decreased vestibular function with impaired balance. There usually is no dizziness. Surgery is usually recommended to remove the tumor.

 

Superior Canal Dehiscence  (SCD)

SCD is thinning or opening in the temporal bone overlying the semicircular canal. The thinning is caused be a developmental abnormality in which symptoms present following too much intracranial pressure like in heavy weight lifting (trauma). Symptoms include vertigo caused be loud noises and activities increased intracranial pressure (coughing, sneezing, etc), sensitivity to sound, fatigue, and fullness in the ear. A tragal pressure test can tell if you possibly have this.

 

Perilymphatic Fistula 

A rare condition consisting of a tear or defect in the round window that separates the inner and middle ear. Usually occurs following trauma or rapid changes in intracranial or atmospheric pressure (scuba diving, trauma). Symptoms include vertigo, nausea, and imbalance, which all increased with pressure and altitude changes. They do not get better with therapy, only strict bed rest or surgery. These people respond also to a tarsal pressure test. SCD gets ruled out first with a CT scan.

 

Ototoxicity 

Damage to the hair cells of the inner ear caused by antibiotic or chemo drugs mainly delivered by IV for more than 6 days. Symptoms include imbalance, ataxia, oscillopsia (illusion of being unstable), and gaze instability. Symptoms will be worse with increased loss of hair cells. Treatment can include physical therapy to help the brain get accustomed to the altered balance, as well as cochlear implants or hearing aids.

 

 

 

 

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