Vertigo is a sensation of feeling off-balance. In other words, the sensation of your surroundings moving about or the feeling of yourself moving around when the background remains still is vertigo. It is a common ENT (Ear, Nose, and Throat) symptom for which many patients seek treatment. It can happen when there is a problem with your inner ear, brain, or sensory nerve pathway.

Before we look at the causes of vertigo,  there are some similar sensations that must be distinguished from vertigo. These include:

1. Lightheadedness. It is defined as the momentary sensation of fainting when you feel you may lose consciousness. There is no true rotatory sensation and it is usually related to your blood vessels.

2. Imbalance. The sensation of being unable to maintain balance or swaying to one side or another. This is usually related to some problem with the cerebellar part of your brain or its connections. Your brain has three main parts, namely the cerebrum, cerebellum, and brain stem. The cerebellum, which means “little brain,” is primarily involved in coordinating movement and balance.

3. Syncope. Syncope is the medical term for fainting or passing out. It is caused by a temporary drop in the amount of blood that flows to your brain. 

If you have to be diagnosed with true vertigo, there must be a sensation of objects moving around, either horizontally or vertically. Vertigo is a symptom and not a disease.

Causes of Vertigo

Vertigo is often caused by an inner ear problem. Your ear consists of three main parts - the outer ear, the middle ear, and the inner ear. The inner ear, also called the labyrinth, contains the sensory organs of hearing and of maintaining equilibrium. Your inner ear is responsible for converting sound waves into electrical signals to send them to the brain. 

There are many causes of vertigo, some of which are: 

1.Benign Paroxysmal Positional Vertigo (BPPV). BPPV is a momentary sensation of spinning, usually related to a movement of your neck. It lasts for a very short duration and is self-limiting. It is caused by the building up of some calcareous (mostly or partly composed of calcium carbonate) crystals in your semicircular canals - the three paired canals that maintain your body in equilibrium, and they reside in your inner ear. 

BPPV is one of the commonest causes of vertigo, especially in the elderly. For the diagnosis as well as management of BPPV, certain simple procedures are performed by your ENT. 

2. Acute Vestibular Neuritis. Vestibular Neuritis is caused by a viral infection leading to inflammation of the vestibular nerve. The vestibular nerve, also called the auditory vestibular nerve, is known as the eighth cranial nerve, which is responsible for transmitting sound and equilibrium (balance) information from your inner ear to the brain. 

Know that an acute episode of severe vertigo (can last for several hours or days) is usually preceded by a viral fever or a cold. The giddiness usually resolves over a period of days to weeks. Bed rest in the initial phase may be necessary.

3. Meniere's Disease. It is a disorder of your inner ear. A common cause of debilitating giddiness, this disease is accompanied by tinnitus (a constant buzzing sound in your ears), nausea and vomiting, as well as a low frequency of hearing loss. Hearing loss is a common type of hearing impairment and occurs when the hair cells in your inner ear (mainly in the cochlea or the hearing organ) are damaged. 

The disease is of a recurrent nature and attacks can come out of the blue. A well-regulated lifestyle, reduction of salt intake, and medication for the acute attack are the way to manage this.

4. Acute Labyrinthitis. Labyrinthitis is an inner ear disorder. The two vestibular nerves in your inner ear send information about your navigation and balance control to the brain. When one of these nerves becomes inflamed, it leads to labyrinthitis.

Acute labyrinthitis is a severe sudden attack of giddiness, associated with severe nausea and vomiting, extreme prostration (weakness in which the patient lies down with the face turned towards the ground), usually requiring hospitalization. An audiogram (a graph that shows the softest sounds you can hear at different pitches or frequencies) might reveal a hearing loss. 

If acute labyrinthitis is the cause of your vertigo, then you might take a long time to recover completely. Vestibular rehabilitation exercises are helpful in this case. Vestibular Rehabilitation Therapy (VRT) is an exercise-based program primarily designed to reduce vertigo and dizziness.

5. Perilymph Fistula. A perilymph fistula (PLF) is a tear in either one of the membranes separating your middle and inner ear. Vertigo is the most common symptom of perilymph fistula. A small tear in the fluid-filled inner ear causes fluid to leak into your middle ear. This leakage disturbs the equilibrium and leads to vertigo spells.

Other factors that cause vertigo include:

  • Migraine headaches (severe throbbing pulsating headache on one or both sides of your head which incapacitates you)

  • A head injury

  • Ear surgery

  • Otosclerosis (a condition when a middle ear bone growth problem leads to a hearing loss)

  • Multiple sclerosis (an auto-immune disease that eats away the protective covering of nerves in your brain and central nervous system)

Vertigo is a symptom and its causes are fairly easy to diagnose. Treatment will depend upon the cause. If you have repeated episodes of lightheadedness, tinnitus, nausea, vomiting, headaches, and severe spinning sensation, consult your ENT specialist immediately. 

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.