Vertigo, or dizziness, is one of the most common health problems in adults. Anyone who has experienced vertigo knows just how difficult it can be to cope with this condition. Vertigo is the sudden sensation that you are unsteady or that your surroundings are moving. You may feel like you're spinning around on a merry-go-round or that your head is spinning inside. Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that can cause vertigo. According to the National Institutes of Health (NIH), about 40% of people in the United States experience feeling dizzy at least once during their lifetime. Prevalence is slightly higher in women and increases with age.
Causes
Vertigo, or dizziness, usually results from a disorder in the peripheral vestibular system (i.e.,structures of the inner ear). Dizziness also may occur as a result of a disorder in the centralvestibular system (i.e., vestibular nerve, brainstem, and cerebellum). In some cases, the cause of vertigo is unknown.
Peripheral vestibular disorders include the following:
• Benign paroxysmal positional vertigo (BPPV; most common peripheral disorder; may be
accompanied by hearing loss, reduced cognitive function, and facial muscle weakness)
• Cogan's syndrome (inflammation of connective tissue in the cornea; results in vertigo,
ringing in the ears [tinnitus], and loss of hearing)
• Ménière disease (fluctuating pressure of inner ear fluid [endolymph]; results in severe
vertigo, ringing in the ears [tinnitus], and progressive hearing loss)
• Ototoxicity (i.e., ear poisoning)
• Vestibular neuritis (inflammation of vestibular nerve cells; may be caused by viral
infection)
Some medications and environmental chemicals (e.g., lead, mercury, tin) can cause
ototoxicity (i.e., ear poisoning), which may result in damage to the inner ear or the 8th cranial nerve (acoustic nerve) and cause vertigo. The damage can be permanent or temporary. Longterm use or high doses of certain antibiotics (e.g., aminoglycosides [streptomycin,gentamicin]) and antineoplastics (e.g., cisplatin, carboplatin) can cause permanent ototoxicity.
Alcohol, even in small amounts, can cause temporary vertigo in some people.
Vertigo, or dizziness, is one of the most common health problems
in adults. Anyone who has experienced vertigo knows just how difficult it can be to cope with this condition. Vertigo is the suddensensation that you are unsteady or that your surroundings aremoving. You may feel like you're spinning around on a merry-goround
or that your head is spinning inside. Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that can cause vertigo. According to the National Institutes ofHealth (NIH), about 40% of people in the United Statesexperience feeling dizzy at least once during their lifetime.Prevalence is slightly higher in women and increases with age.
Medications that may cause temporary ototoxicity include the following:
• Prescription and over-the-counter cold medicines
• Quinine (e.g., chloroquine, quinidine)
Diagnosis
It is important to diagnose the cause of vertigo, or dizziness, as quickly as possible to rule out serious conditions such as cardiovascular disease, stroke, hemorrhage, or tumor. Diagnosis includes clinical history, physical and neurological examination, blood tests, and imaging tests (e.g., CT scan, MRI scan).
Important considerations include the following:
• What triggers the vertigo?
• What other symptoms occur?
• How long does the dizziness last?
• What improves or worsens symptoms?
Physical examination includes measuring blood pressure and heart rate. Neurological
examination includes testing facial and vestibular nerves and muscles, strength, coordination, balance, and walking (gait).
The positional vertigo test is used to help distinguish peripheral from central vestibular
disorders. In this test, the patient sits on a table with the head turned to the side. The physician then supports the head and lowers it gently below the table while the patient lies back. The patient reports symptoms of vertigo while the physician looks for circular movement of the eyes (called nystagmus).
Lifestyle and home remedies
If you experience dizziness associated with benign paroxysmal positional vertigo (BPPV), consider these tips:
�� Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
�� Sit down immediately when you feel dizzy.
�� Move slowly when making movements that cause dizziness.
�� Use good lighting if you get up at night.
�� Walk with a cane for stability, if you are at risk of a fall.
�� Work closely with your doctor to manage your symptoms effectively.
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