Vertigo: What Is It, Symptoms, Causes, and How to Treat It?

Vertigo is commonly seen in the general population.

However, there is a lot of incorrect information circulating in society regarding the definition and treatment of vertigo. What is vertigo, and what causes it? How is vertigo treated? You can find the answers to all these questions in the continuation of this article.

What is Vertigo?

Vertigo is a type of dizziness where a person feels as if their surroundings are spinning. Rather than being a disease itself, vertigo is a symptom that can be observed in many different conditions. Disorders in the inner ear, brain, and the nerve pathways between the two can cause vertigo.

Vertigo can be a temporary condition, but it may also affect a person for a prolonged period.

Vertigo can be categorized into different groups:

Peripheral Vertigo:
Approximately 80% of all vertigo cases are classified as peripheral vertigo. Peripheral vertigo usually results from a problem with the inner ear. The small organs in the inner ear are responsible for detecting gravity and sending information about a person’s position to the brain. Thanks to this connection, individuals can maintain their balance while standing. Any disturbance in this connection leads to the formation of vertigo.

Central Vertigo:
Problems with the brainstem or cerebellum, which are part of the central nervous system, can lead to central vertigo. Around 20% of vertigo cases are classified as central vertigo.

What are the Symptoms of Vertigo?

People with vertigo perceive either themselves or their surroundings as spinning or moving. While vertigo itself is a symptom, it can be accompanied by other signs. Some of the symptoms that may accompany vertigo include:

• Balance problems
• Dizziness
• Feeling of motion sickness (like car sickness)
• Nausea, vomiting
• Tinnitus (ringing in the ears)
• Sensation of fullness or blockage in the ear
• Headaches
• Uncontrolled eye movements, such as nystagmus (rapid, jerky eye movement)

What Causes Vertigo?

Vertigo occurs due to a disorder in the structures of the inner ear that are responsible for balance, or a problem in the central nervous system. Conditions that can cause vertigo include:

Labyrinthitis:
The labyrinth is a structure located in the inner ear, which contains the vestibulocochlear nerve responsible for hearing and balance. Labyrinthitis is the inflammation that occurs in this structure due to an infection. This inflammation in the inner ear disrupts the function of the vestibulocochlear nerve, which is responsible for many functions, such as head movements, body position, and hearing. As a result of the damage to the vestibulocochlear nerve, disruptions in the transmission of messages to the brain occur. Individuals experiencing labyrinthitis may show symptoms ranging from vertigo to hearing loss, headaches, and tinnitus.

Vestibular Neuritis:
Inflammation of the vestibular nerve is called vestibular neuritis. While similar to labyrinthitis, vestibular neuritis does not affect a person's hearing. In patients with vestibular neuritis, symptoms such as vertigo, blurred vision, severe nausea, loss of balance, and falling may be observed.

Cholesteatoma:
Cholesteatoma is a non-cancerous, benign structure that typically develops in the middle ear due to recurring infections. As the cholesteatoma grows behind the eardrum, it can damage the bony structures in the ear, leading to issues such as vertigo and hearing loss.

Meniere's Disease:
Meniere’s disease is a condition caused by the accumulation of fluid in the inner ear, which leads to vertigo attacks. In addition to vertigo, individuals with Meniere's disease may also experience hearing loss and tinnitus. This disease is most commonly seen in individuals aged 40-60. The exact cause of Meniere’s disease is not fully understood, but it is believed to be related to narrowing of blood vessels or autoimmune causes. There is also evidence that infections and genetic predisposition may play a role in the development of the disease.

Benign Paroxysmal Positional Vertigo (BPPV):
In the inner ear, there are structures called otolithic organs that contain fluid and calcium carbonate crystals. In BPPV, these crystals move out of place and fall into the semicircular canals. When these crystals touch the sensory hair cells in the canal with each movement, the brain fails to receive accurate information about position and motion from the ear. This leads to dizziness and vertigo. In BPPV, patients typically experience vertigo attacks lasting less than a minute, but nausea and other symptoms can also occur.

Other Conditions That Can Cause Vertigo Include:

• Migraine
• Head trauma
• Ear surgery
• Perilymphatic fistula (rupture of the membrane between the inner and middle ear, causing ear fluid to flow into the middle ear)
• Shingles (Herpes zoster)
• Otosclerosis (growth of bones in the inner ear)
• Syphilis
• Ataxia
• Stroke
• Diseases affecting the cerebellum or brainstem
• Acoustic neuroma
• Multiple sclerosis (MS)

How is Vertigo Diagnosed?

Patients seeking medical attention for vertigo are asked to provide a detailed medical history. This helps determine the possible causes of dizziness. To identify conditions that could cause dizziness, a physical examination, blood tests, imaging techniques such as ultrasound or MRI may be used.

Some common neurological examination methods for patients presenting with dizziness include:

• Examination of eye movements known as nystagmus
• Head shaking test
• Romberg Test: The doctor asks the patient to stand up straight and remain still. Then, the patient is asked to bring their feet together and close their eyes. If the patient loses balance after closing their eyes, it may indicate a problem with the central nervous system.
• Fukuda-Unterberger Test: In this test, the patient is asked to walk in place with their eyes closed for 30 seconds. If the patient turns to one side when they stop, it may indicate an issue with the inner ear.
• VNG test, which is becoming more common today: This involves the use of glasses and a computer to evaluate eye movements and visual muscle movements.
• Caloric tests and evaluation of eye movements with VNG equipment.

What Symptoms Often Accompany Vertigo?

Vertigo is more commonly seen in pregnant women than in the general population. Hormonal changes during pregnancy also affect the fluid balance in the woman's body. The fluid in the inner ear is influenced by these changes. Therefore, pregnant women may experience vertigo, nausea, hearing difficulties, balance problems, and a feeling of fullness in the ear due to fluid changes. Nausea tends to be more intense in the early stages of pregnancy, while it decreases towards the end of pregnancy. Balance disorders tend to increase in the second and third trimesters. As the body adapts to fluid changes caused by hormonal shifts, vertigo may decrease.

There are medications available to alleviate various symptoms such as nausea, vertigo, and balance loss during pregnancy. However, pregnant women should consult their doctor before using these medications and begin treatment only after receiving medical approval.

What Should Be Done During a Vertigo Attack?

In some cases, vertigo resolves on its own without the need for treatment. However, for vertigo to be permanently corrected, the underlying cause must be addressed.

For vertigo caused by infections, antibiotics may be used in treatment, while antiviral medications may be required for vertigo associated with shingles.

Antihistamines or antiemetic (anti-nausea) drugs can be administered to alleviate symptoms such as nausea, vomiting, and motion sickness that may accompany vertigo.

Surgical procedures may also be considered in the treatment of vertigo when other treatments are ineffective. Surgery is appropriate in conditions like BPPV and acoustic neuroma.

Loss of balance and dizziness in vertigo patients can lead to serious injuries. Therefore, vertigo is a condition that should not be overlooked in diagnosis and treatment. Identifying and treating the underlying cause of vertigo helps protect individuals from potential risks like falls and improves their quality of life.