Vertigo: Frequently Asked Questions
- What exactly is vertigo?
- The precise definition of vertigo is an illusion of motion. But in common parlance, it refers not just to illusions of motions but chronic or intermittent sensation of loss of balance.
- What are common causes of vertigo?
- There are a large number of causes of vertigo, but it is commonly caused by cold viruses, head trauma, or Meniere's disease. Those are the most common causes.
- What do these conditions do to cause this problem?
- These are all conditions that affect the inner ear. The inner ear is responsible for our sense of balance and also our sense of position in space. When the inner ear dysfunctions, we lose our sense of balance and frequently suffer symptoms such as vertigo, nausea, vomiting, and loss of balance.
- How can this be treated and whom should one see for treatment?
- Most causes of vertigo are readily treatable with physical therapy, medication, surgery, and time. By time, I mean, waiting because many causes of vertigo resolve spontaneously. Because of the many causes of vertigo, the critical issue in choosing a physician is their experience with vertigo. There are two types of physicians whose specialties include dizziness: neurologists and otolaryngologists. If one has a chronic form of vertigo, one should see either an otoneurologist, a neurologist who specializes in dizzyness, or a neurotologist who is an otolaryngologist who specializes in ear disease. Since many types of vertigo go away without treatment, initial evaluation by a general practitioner or family doctor is appropriate early on, reserving specialty care for chronic cases.
- Is there a certain age this is usually brought on, or is it extremely variable?
- It is extremely rare, but not impossible, for young children to have vertigo. It becomes more common in the early 20s and affects all ages commonly after that. Its consequences however become more substantial as you get older because loss of balance in the elderly commonly leads to major fractures.
- Can a child get vertigo from playing a video game that simulates movement?
- 3-dimensional video games can cause a brief sensation of vertigo, but it would not persist.
- Can stress cause vertigo? Is it always physical trauma or can it be psychological or mental trauma that causes vertigo?
- Mental stress can make many forms of vertigo worse, but will not, by itself, produce vertigo.
- What is positional vertigo?
- Positional vertigo refers to a variety of conditions where a change in the position of your head produces a sense of vertigo. The most common form is a condition called benign paroxysmal positional vertigo or BPPV for short. In BPPV when one lies down with the affected ear toward the floor, one gets a brief but very intense feeling of the world spinning around.
- Is ataxia related to vertigo?
- Ataxia refers to clumsiness. Disease of the inner ear does not produce ataxia per se but can be confused with ataxia. Ataxia is produced by disease of the cerebellum, a part of the brain that works with the inner ears to help maintain balance and also fine motor control.
- Might the symptoms of vertigo be confused with the symptoms of other diseases or conditions?
- Yes. This is a common occurrence. Usually they are mistaken because of use of the word dizziness. Dizziness means many things to many people. Dizziness can refer to lightheadedness, which is not vertigo and is commonly produced by vascular problems. Dizziness also can mean vertigo, and there are very few causes of vertigo that do not come from the inner ear. Occasionally, rare types of strokes can cause vertigo, but these are usually associated with other neurological symptoms as well.
- Are there any surgical procedures to correct vertigo?
- There are surgical procedures to correct certain types of vertigo. If the vertigo is caused by a disease such as Meniere's disease, where the function of the involved ear changes over time, and these changes do not respond to medical therapy, then surgical intervention may eliminate the vertigo.
- How does physical therapy help vertigo?
- In forms of vertigo, where the inner ear has suffered damage and the function of that ear is fixed, not changing over time, physical therapy can be quite helpful. When the inner ear is damaged, people commonly experience severe spinning for several days. If after several weeks the person still has a loss of balance, then physical therapy can help restore this balance. The reason physical therapy is helpful is that it helps train the brain to compensate for the loss of function in the ear. Just as you can make a muscle stronger by exercising it, you can make the balance system in the brain work better by exercising it.
- What kind of physical therapy works to reduce vertigo?
- It's called vestibular rehabilitation, and it is a relatively new form of physical therapy. Not all physical therapists are trained in the practice. Typically the exercises consist of movements that initially make the vertigo worse and balance tasks that are quite difficult. By doing these repetitively, the balance system in the brain learns to function better. Common exercises include moving the eyes from side to side, rotating the head from side to side, rotating the head from side to side while walking down a corridor, and things like this.
- I have Meniere's disease and notice the vertigo during onset of my menstrual period. Is this related?
- This is not an uncommon symptom because Meniere's disease is exacerbated by salt retention, and menstrual periods are associated with salt retention. Some women with Meniere's disease have worse symptoms during their menstrual period.
- Is anxiety associated with vertigo?
- Yes. Vertigo causes extreme anxiety in most people. Anxiety, by itself, does not produce vertigo. However, in association with conditions that do produce vertigo, anxiety can make the vertigo much worse. People with certain anxiety disorders such as panic attacks can sometimes also experience vertigo.
- What is particle repositioning maneuver?
- Particle positioning maneuvers are a treatment for BPPV, which we defined earlier in this chat. BPPV is caused by loose otoconia within the inner ear. Otoconia are small calcium carbonate crystals that are part of the balance mechanism. In BPPV, these crystals break loose from their normal attachments and are free to tumble around the inner ear. When the involved ear is suddenly put in a downward position, the otoconia stimulate part of the inner ear abnormally. This results in a brief but intense whirling vertigo. Particle position maneuvers are a series of body turns that maneuver the otoconia into a different part of the inner ear where they will not cause symptoms. It is a very effective maneuver that takes just a few minutes to perform.
- Will taking Antivert and Valium for vertigo work? Do you have any suggestions?
- Valium and Antivert are vestibular suppressants. They are appropriate for certain forms of acute vertigo. They are inappropriate for chronic vertigo. The reason for this is that because they suppress the inner ear they prevent the balance part of the brain from properly compensating for the inner ear damage. Thus, episodes of vertigo, which might resolve in a few days to a few weeks, can be prolonged for months or years through the indiscriminate use of vestibular suppressants.
- Can you be on Antivert and do vestibular rehab at the same time?
- Yes you can, but the vestibular rehab will be much less effective. Usually I recommend stopping Antivert when one is beginning vestibular rehab. However, there are occasional patients in whom Antivert cannot be readily stopped, and what we do then is taper the Antivert while the patient is undergoing vestibular rehab.
- Could you explain vertigo in relation to labrynthitis?
- Labyrinthitis or vestibular neuronitis is a presumed viral infection of the vestibular nerve. It causes sudden loss of function in the balance system of one ear. The brain normally compares the two ears. When you turn in any direction, the output of one ear to the brain goes up and the output of the other goes down. The brain looks at the difference between the two ears and says "I'm turning." When one ear develops labyrinthitis, its output suddenly drops. The brain sees a difference between the two ears, and that produces the feeling of spinning. This is commonly associated with nausea and vomiting and the worst part of it usually lasts for about three days. For several weeks afterward, it is common to feel a little bit off balance. Typically, after three to four weeks the balance returns to normal.
Vertigo is a subjective sensation. Nobody other than the patient can experience what that person is experiencing. Many people with this disorder are inadequately evaluated.
Since most forms of vertigo are readily treated, I would encourage anyone with this condition to seek further attention despite the fact that prior visits to one's physician may not have resulted in alleviation of this condition.
Jay Rubinstein, MD
Division of Otolaryngology - Head and Neck Surgery
University of Iowa Hospitals and Clinics