Causes of Vertigo
Vertigo is caused by problems in the inner ear that disrupt balance and sense of motion. The most common causes of vertigo include:
- Benign paroxysmal positional vertigo (BPPV): Tiny crystals in the inner ear called otoconia become dislodged and enter one of the semicircular canals, causing brief periods of vertigo when the head is moved in certain positions. BPPV is one of the most common causes of vertigo.
- Labyrinthitis: Vertigo Treatments is viral or bacterial infection causes inflammation in the inner ear that results in vertigo and hearing loss. Symptoms typically last a few days but can occur for weeks.
- Ménière's disease: Fluid builds up in the inner ear, causing vertigo, ringing in the ears (tinnitus), and temporary hearing loss. Attacks can occur without warning and last for hours.
- Head injuries: Even minor head trauma can lead to labyrinthine concussion or damage to the vestibular system that controls balance.
- Tumors or vascular conditions: Rarely, noncancerous tumors or conditions affecting blood vessels near the inner ear can cause vertigo.
Diagnosing the Cause
Seeing a doctor is important to accurately diagnose the cause of vertigo. Examinations may include:
- Neurological exams to check eye movements, balance, coordination, and other reflexes.
- Head thrust test to check vestibular function. The doctor moves the patient's head while watching eye movement.
- Hearing tests like audiograms to check for hearing loss.
- Visual tests such as an electro nystagmography (ENG) to check eye movements during vertigo episodes.
- MRI or CT scan in rare cases to check for tumors or vascular abnormalities.
- Other blood tests if an infection or other systemic cause is suspected.
Pinpointing the cause helps guide the most effective treatment approach. For example, conditions like BPPV often respond well to simple head repositioning maneuvers.
Treating BPPV with Repositioning Maneuvers
BPPV is one of the most treatable causes of vertigo. Treatment involves performing canalith repositioning maneuvers, also called the Epley maneuver or Semont maneuver.
During these maneuvers, a doctor carefully moves the patient's head into specific positions to guide any loose particles out of the semicircular canal, providing immediate relief for up to 95% of BPPV cases. The maneuvers are often taught to patients to self-treat future episodes:
- The Epley maneuver involves four positions held for 30-60 seconds each, rotating the head to allow particles to shift away from the affected canal.
- The Semont maneuver positions the head in three positions on one side, then repeated on the other side.
- Both are usually performed with the doctor 2-3 times, but patients may need occasional repeat treatments for recurrent BPPV.
Along with providing instant relief, repositioning effectively treats the underlying cause of BPPV in most cases to prevent future attacks. When performed correctly under medical guidance, it carries very little risk.
Medication Options for Other Vertigo Causes
For other causes of vertigo like Ménière's disease or labyrinthitis, medications are sometimes used along with lifestyle changes to manage vertigo attacks and balance problems:
- Anti-nausea and motion sickness medicines aid symptom relief during attacks. Common options include meclizine, dimenhydrinate, and scopolamine patches.
- Antihistamines and corticosteroids may help reduce inflammation and shorten the duration of viral or bacterial labyrinthitis.
- Diuretics are sometimes used for Ménière's disease to decrease pressure on the inner ear from excess fluid buildup. Common choices include hydrochlorothiazide.
- Anticonvulsants and antibiotics as needed if epilepsy, Lyme disease, or another infectious cause is suspected.
Medications alone usually don't cure the underlying disorder but may help control vertigo severity and frequency until other treatments take effect. Close monitoring is important, as some medications can cause side effects.
Additional Therapies for Managing Vertigo
Lifestyle Changes
- Getting adequate rest, managing stress, avoiding triggers that worsen vertigo like volatile chemicals.
Physical Therapy
- Vestibular rehabilitation exercises focus on gaze stability, head and body movement activities to retrain the balance system.
Alternative Treatments
- Acupuncture, motion sickness bands applied to the wrist, or gentle massage are sometimes helpful alone or combined with other measures.
Surgery (rare)
- Decompressing nerves for Ménière's disease or removing a vascular malformation pressing on balance structures.
- Cochlear implants for rare inner ear causes accompanied by total hearing loss.
In the various effective treatment options exist for vertigo once the underlying cause is properly diagnosed. For common vestibular conditions like BPPV, simple repositioning maneuvers often provide lasting relief. For other causes, a personalized treatment plan combining medication, lifestyle changes, and rehabilitation aims to manage vertigo symptoms and restore normal balance function over time. Seeking prompt medical evaluation is key.
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