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People with vertigo express a sensation of spinning of the objects and people around them during a vertigo attack. The spinning sensation a healthy person gets after turning around themselves 4 or 5 times or getting off a Ferris wheel in an amusement park is a very close picture of vertigo. Tilting right or left due to loss of balance, light-headedness, sensation of heaviness in the head, or the ground slipping away is not vertigo. These conditions are referred to as dizziness, and although it is a subcategory of balance disorder, its treatment differ from that of vertigo.
Vertigo is not a disease but a symptom, i.e. a finding. Just as headache, arm pain, or numbness in feet is not a disease but results from a disease, so too vertigo is a finding caused by a disease. Thus, diagnosis should be made by investigating which disease(s) vertigo results from. Each disease causing vertigo has a different treatment. Therefore, vertigo treatment should be initiated after the underlying disease has been identified.
The common public belief that vertigo is incurable is wrong. The main reason for the failure of vertigo treatment is mostly a wrong diagnosis. Over 90% of the cases are treated successfully with a single manoeuvre in Benign Paroxysmal Positional Vertigo, the most common cause of vertigo defined as scattering of the balance crystals, as long as the diagnosis is made correctly and also the semi-circular canal where the crystals become detached is identified correctly.
Also in other diseases causing vertigo, when the patients adopt the required lifestyle and take their drugs regularly, complaints are either resolved completely or reduced to a level that does not affect the course of life.
Which disease may cause vertigo?
Disease causing vertigo and loss of balance are listed below depending on their prevalence.
Short review of the diseases commonly causing vertigo and balance disorder:
1 - Benign Paroxysmal Positional Vertigo: It presents itself with the vertigo resulting from head movements while lying down on the bed, getting out of the bed, bending down to tie the shoelaces, or lifting the head up to reach something on the shelf. Most patients experience head spinning for 5 to 15 seconds, and only few have it for one minute or above. In this disease known as "scattering of the balance crystals" by the public, calcium carbonate crystals become detached from their normal locations in the vestibular organ of the inner ear and fall into the semi-circular canals where they move freely in the fluid, which results in spinning sensation. When the patient changes from sitting position to the lying position, they experience a severe dizziness which repeats when they switch back to sitting position from the lying position. Each ear has 3 semicircular canals extending different directions. Once the semi-circular canal where the crystals fall into has been identified definitively, a 10-minute manoeuvre is administered to send them back to the location they have got detached from. Treatment success with the first manoeuvre without using any medication is above 85%.
2 - Meniere's disease: It was named after the French scientist who first identified the disease. In the inner ear, vibrations resulting from sound waves are converted into electrical energy and transmitted to the brain through vibrations of the fluids of the inner ear. Movements of the body and the head are also determined based on the movements of the inner ear fluids, and the waves in these fluids are converted to electrical waves by the receptors and then transmitted to the brain. Increased level of pressure from these inner ear fluids results in Meniere's disease. Attacks where the inner ear fluid pressure increases present with vertigo, hearing loss, ringing, and fullness in the ear. Vertigo may be accompanied by nausea and vomiting. The attacks may last from minutes to hours, or one day. While there are cases experiencing attacks once a year, there are also ones having an attack a week which may prevent people from going on with their daily lives. Even though its cause has not yet been fully discovered, heredity, inflammation of the middle ear, head trauma, ear surgeries, and anatomical problems of the inner ear can cause this disease. The recommended treatment involves reducing the salt intake, avoiding caffeinated drinks, quitting smoking, and avoiding stress. Furthermore, depending on the severity and number of attacks, drug treatment is initiated, and if that option fails, medications may be directly applied to the middle ear or various surgeries may be preferred.
3- Vestibular neuronitis: It is caused by the inflammation of the vestibular nerve transmitting information between the organ of balance in the inner ear and the brain. Severe acute vertigo, nausea and vomiting cause panic in people, which sometimes invokes the fear of death. When the spinning is very severe, it may not be possible to get out of the bed for days, and severe nausea may cause difficulty eating and drinking water. Vertigo becomes less and less severe in a matter of days, but balance disorder may continue for months, and even years where the required follow-up and treatment are not provided. In the first days of the severe dizziness, the patient should, if necessary, be hospitalised for intensive drip-feeding, and it should be ensured that they move at the earliest stage.
What is Benign Paroxysmal Positional Vertigo (BPPV) - Scattering of Crystals in the Ear?
Benign Paroxysmal Positional Vertigo (BPPV) is not a brain-related dizziness, so it is mostly treated by ENT specialists. The most common form of positional vertigo, which constitutes the majority of dizziness cases, is the accumulation of calcium crystals in the vestibular canals, also known as canalolythiasis The underlying disorder usually responds to canalith repositioning manoeuvres, an office-based procedure, and a treatment method patients are taught to perform themselves at home.
Who is under the highest risk of Benign Paroxysmal Positional Vertigo?
A population-based study reported the lifetime prevalence of Benign Paroxysmal Positional Vertigo (BPPV) to be 2.4%. In the relevant study, annual prevalence of BPPV increased with age, up to seven times more in patients above 60 compared to patients aged 18 to 39. BPPV is more prevalent in women than in men of any age group, and the ratio is 2:1 to 3:1.
What causes Benign Paroxysmal Positional Vertigo?
There are a total of 6 vestibular canals in two ears, each ear having three, namely anterior, horizontal and posterior semicircular canals. Posterior semicircular canal is the most common origin of disease. 35% of posterior canal BPPV cases are of unknown origin. Approximately 15% have a history of relatively small prior head trauma. On the other hand, BPPV is mostly a permanent consequence of Meniere's disease (30 percent), vestibular neuronitis, ear surgery, herpes zoster oticus, and various balance disorders such as ischemia of the inner ear and sudden sensorineural hearing loss. Most horizontal canal BPPV are idiopathic and associated with minor head trauma. A population-based survey reports that BPPV is independently associated with age, migraine, hypertension, hyperlipidaemia, and stroke, suggesting the presence of at least a potential vascular mechanism in some BPPV cases. Another theory suggests that bone loss may be the cause of the calcium carbonate particles forming the crystal accumulation.
