Vertigo balance disorders

Vertigo is a feeling of motion or spinning that is often described as dizziness. Vertigo is a specific type of dizziness and vertigo is not the same as light-headedness.

The main symptom is a sensation that you or the room is moving or spinning, even when you are still.

Vertigo is usually caused by inner ear problems. Your inner ear is important for both hearing and balance.

There are two types of vertigo: Peripheral vertigo and Central vertigo.

The three most common causes are:

• Benign paroxysmal positional vertigo (BPPV)
• Labyrinthitis
• Meniere's disease

Balance disorders can be a sign of another health problem, such as an ear infection or a stroke. In some cases, treating the illness that is causing the disorder will help with the balance problem.

Treatment may include certain medications as well as physical therapy. Surgery may be required for those diagnosed with Meniere's disease.

The main symptom is a sensation that you or the room is moving or spinning, even when you are still. The spinning sensation may cause nausea and vomiting.

Other symptoms can include:

• Trouble focusing the eyes/ blurred vision
• Dizziness
• Hearing loss in one ear
• Falling or feeling as if you are going to fall
• Ringing in the ears (tinnitus)

If you have vertigo due to problems in the brain (central vertigo), symptoms may include:

• Trouble swallowing
• Double vision
• Eye movement problems
• Facial paralysis
• Slurred speech
• Weakness of the limbs

Other symptoms may include:

• Lightheadedness, faintness, or a floating sensation
• Confusion or disorientation

Symptoms may come and go over short time periods or last for a long time.

There are two types of vertigo: Peripheral vertigo and Central vertigo.

• Peripheral vertigo: The problem is due to the part of the inner ear that controls balance. These areas are called the vestibular labyrinth or semicircular canals. The problem may also involve the vestibular nerve, which connects the inner ear to the brainstem.
• Central vertigo: This type is due to a problem in the brain, usually in the brainstem or the back part of the brain (cerebellum).

Peripheral vertigo may be caused by:

• Benign positional vertigo (benign paroxysmal positional vertigo) (BPPV)
• Certain medications such as aminoglycoside antibiotics, cisplatin, diuretics, or salicylates
• Head injury
• Inflammation of the vestibular nerve (neuronitis)
• Labyrinthitis: Labyrinthitis is irritation and swelling of the inner ear usually caused by an infection. Having a cold or flu can trigger labyrinthitis
• Meniere's disease: Meniere's disease is an inner ear disorder that affects balance and hearing. It may occur when the pressure of the fluid in part of the inner ear gets too high.
• Pressure on the vestibular nerve, usually from a noncancerous tumor

Central vertigo may be caused by:

• Blood vessel disease
• Certain medications such as anticonvulsants, aspirin, and alcohol
• Migraine
• Multiple sclerosis
• Seizures (rarely)
• Stroke
• Tumors (usually noncancerous)

Problems that affect the skeletal or visual systems, such as arthritis or eye muscle imbalance, can also cause balance disorders. Your risk of having balance problem will increase as you get older.

Your doctor will ask questions about your medical history and symptoms, which may include:

• When did your vertigo begin?
• Do your symptoms happen when you move?
• What other symptoms do you notice?
• Does the vertigo continue or does it come and go?
• How long does it last?

The doctor will perform a physical exam to look for:

• Difficulty walking due to loss of balance
• Eye movement problems or involuntary eye movements (nystagmus)
• Hearing loss
• Lack of coordination and balance
• Weakness

Your doctor may order the following tests:

• Blood tests
• Hearing test
• Brainstem auditory evoked potential studies (BAER)- measures the brain wave activity
• Caloric stimulation- uses differences in temperature to diagnose damage to the acoustic nerve
• Electroencephalogram (EEG)
• Balance test
• Head CT (Computed tomography)
• Lumbar puncture
• Magnetic resonance imaging (MRI) scan of head
• Magnetic resonance angiography (MRA) scan of blood vessels of the brain- MRI exam of the blood vessels

To find out if you have a balance problem, your doctor may refer you see an otolaryngologist, which is a physician and surgeon who specializes in diseases and disorders of the ear, nose, neck, and throat.

If you have vertigo, try the following tips to help prevent your symptoms from becoming worse:

• Keep still and rest when symptoms occur. Sit or lie down when symptoms occur.
• Gradually resume activity.
• Avoid sudden movements or position changes.
• Slowly increase activity.
• You may need a cane or another devices to help you get around when you have a loss of balance during a vertigo attack.
• Avoid bright lights, TV, and reading during vertigo attacks.

Avoid activities such as driving, operating heavy machinery, and climbing for 1 week after your symptoms disappear. A sudden dizzy spell during these activities can be dangerous.

If you have a cold, the flu, or other viral illness, drink plenty of fluids to prevent getting dehydrated.

Ask your doctor about balance therapy. This therapy can help once nausea and vomiting have passed.

If you notice you are experiencing stress as a result of vertigo, talk to your doctor about ways to manage and reduce your stress.

Medications to treat peripheral vertigo may include:

• Anticholinergics such as scopolamine (Transderm-Scop)
• Antihistamines such as meclizine (Antivert) or dimenhydrinate (Dramamine)
• Benzodiazepines such as diazepam (Valium), lorazepam (Ativan), or clonazepam (Klonopin)
• Anti-nausea medications such as promethazine (Phenergan) 

If your vertigo is caused by Ménière's disease, your doctor may recommend ways to reduce the amount of fluid in your body. This can often help control symptoms.

• Water pills (diuretics) may help relieve fluid pressure in the inner ear
• A low-salt diet may also help

Persistent balance problems may improve with physical therapy.

Other treatment depends on the cause of the vertigo. Brain disorders causing vertigo will need to be identified by your doctor and treated accordingly. Surgery may be required for those diagnosed with Meniere's disease.

The outcome will usually depend on the cause of the vertigo.

Vertigo can interfere with driving, work, and lifestyle.

Vertigo can also cause falls, which can lead to many injuries, including hip fractures.

You may need to be admitted to the hospital if you have severe vomiting associated with vertigo.

Rarely, is hearing loss permanent with labyrinthitis.