The word vertigo means the feeling of spinning or whirling. Dizziness means feeling out of balance, lightheaded, or faint.
Most cases are mild and brief and are due to changes in the inner ear (the vestibular system). Structures in this system sense the position and movement of the head. In a condition called benign paroxysmal positional vertigo (BPPV), very tiny crystals in semicircular canals of the fluid-filled chamber in the inner ear (labyrinth) can loosen and irritate nerve endings. The feeling of spinning results. Viral infections, aging, and head trauma are the most common causes. Another common cause is labyrinthitis, or inflammation (swelling) of the labyrinth from an inner ear infection. Middle ear infections can also cause vertigo.v Medicines, such as high blood pressure pills and high doses of aspirin, can also lead to vertigo.
More serious causes include stroke, Meniere’s disease, epilepsy, infections, multiple sclerosis, vascular disease, and tumors (acoustic neuroma). In Meniere’s disease, there’s too much pressure on membranes in the labyrinth. An acoustic neuroma is a benign tumor (not cancer) of a nerve from the brain.
People usually have spinning with nausea and sometimes vomiting and nystagmus. Nystagmus is slow movement of the eyes to one side followed by quick movement back to their original position. Meniere’s disease involves decreased hearing and ringing or buzzing in the ear (tinnitus). Acoustic neuromas cause hearing loss, usually subtle and occurring slowly. Sudden hearing loss can also occur. A growing tumor may press on nerves and cause facial numbness and tingling (trigeminal nerve), or facial muscle paralysis and loss of facial expression (facial nerve).
Stroke often involves weakness on one side of the body, trouble speaking, and vision problems.
The health care provider will make a diagnosis from the medical history and physical examination. The health care provider may do other tests, such as magnetic resonance imaging (MRI), depending on the possible cause.
Treatment depends on the cause. Medicines that may be causing vertigo will be stopped. Other drugs such as meclizine may be given to help vertigo go away. For BPPV, the health care provider may move the head in certain directions to improve the vertigo. This treatment is called canalith repositioning (or the Epley maneuver). For more serious causes (such as an acoustic neuroma), surgery or radiation therapy may be needed. The best treatment depends on the specific cause of the vertigo.
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Copyright © 2017 by Saunders, an imprint of Elsevier, Inc.
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