Vertigo is a form of dizziness often described as a spinning sensation. It may also be felt as motion sickness or leaning to one side. Other symptoms of vertigo include:
- loss of hearing in one ear
- ringing in the ears
- difficulty focusing eyes
- loss of balance
There are two different forms of vertigo: peripheral vertigo and central vertigo. According to the American Institute of Balance, peripheral vertigo is usually more severe than central vertigo (AIB).
Peripheral vertigo is caused by a problem with the inner ear, which controls balance. Central vertigo refers to problems within the brain or brainstem. There are several different forms of peripheral vertigo.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is considered the most common form of peripheral vertigo. This type tends to cause short, frequent bouts of vertigo and is usually triggered by certain head movements. BPPV is thought to be caused when small pieces of debris break off from the inner ear canals and stimulate the small hairs that line the inner ear. This confuses the brain, producing the sensation of dizziness.
Labyrinthitis causes dizziness or a feeling that you are moving when you are not. This form of vertigo is caused by inner ear infection. As a result, it often occurs along with other symptoms such as fever and earache. The infection is in the labyrinth, which is a structure in the inner ear that controls balance and hearing. The infection is usually caused by a viral illness, such as a cold or flu, but may also be caused by a bacterial ear infection.
Vestibular neuronitis may also be called vestibular neuritis. This type of vertigo has a sudden onset and may cause unsteadiness, earache, nausea, and vomiting. Vestibular neuronitis is caused by an infection that has spread to the vestibular nerve, which controls balance. This condition usually follows a viral infection, such as a cold or flu.
Ménière’s disease causes sudden vertigo that can last for up to 24 hours. The vertigo is often so severe that it causes nausea and vomiting. Ménière’s disease also causes hearing loss, ringing in the ears, and a feeling of fullness in the ears.
There are several ways to help your doctor determine if you have peripheral vertigo. Your doctor may examine your ears to look for signs of infection, as well as see if you can walk in a straight line to test your balance. If your doctor suspects BPPV, he or she may perform a Dix-Hallpike maneuver. During this test, your doctor will move you quickly from a sitting position to a lying-down position, with your head being the lowest point of your body. You will be facing your doctor and you will need to keep your eyes open so your doctor can track your eye movements. This maneuver will bring on symptoms of vertigo in individuals with BPPV.
Your doctor may also order balance and hearing tests. Depending on your symptoms, your doctor may also order imaging of the brain and neck to rule out other causes of vertigo.
Drugs and Medication
There are a number of medications used for peripheral vertigo, including:
- antibiotics (to treat infections)
- prochlorperazine (to relieve nausea)
- benzodiazepines (anxiety medications that can also relieve physical symptoms of vertigo)
People with Ménière’s disease are often prescribed a medication called betahistine, which can help reduce pressure caused by fluid in the inner ear and relieve symptoms of the disease.
Treating Hearing Loss
Individuals with Ménière’s disease may need treatment for ringing in the ears and hearing loss. Treatment may include medication and hearing aids.
If you have been diagnosed with BPPV, your doctor may teach you the Epley maneuver and/or Brandt-Daroff exercises. Both exercises involve moving the head in a series of three or four guided movements. The Epley maneuver is typically performed by your doctor and requires more rapid movement and turning of the head. It is not recommended for people with neck or back problems. Brandt-Daroff exercises can be done at home and are the most commonly used exercises to treat vertigo.
To perform Brandt-Daroff exercises:
- Sit at the edge of your bed (near the middle) with your legs hanging over the side.
- Lie down on your right side and turn your head toward the ceiling. Hold this position for at least 30 seconds. If you feel dizzy, hold this position until it passes.
- Return to an upright position and stare directly ahead for 30 seconds.
- Repeat step 2, this time on your left side.
- Sit upright and look straight ahead for 30 seconds.
These exercises are thought to help move the debris causing the vertigo. They should be repeated at home three to four times per day (UMM).
Vestibular rehabilitation therapy (VRT) is another treatment option for peripheral vertigo. This involves working with a physical therapist to improve balance by helping the brain learn to compensate for inner ear problems.
Severe, persistent cases of vertigo can be treated with surgery if other treatment methods are unsuccessful. This surgery involves removing part or all of the inner ear.
Though initial vertigo usually cannot be prevented, certain behaviors can help prevent another vertigo attack, such as:
- avoiding bright lights
- standing up slowly
- avoiding rapid head movement
- avoiding bending over
- avoiding looking up
- sleeping with the head propped up