Vertigo or giddiness is a very common symptom encountered in routine practice. Its estimated that more than 10% of population of all age groups will suffer from this at least once in their life time. Its also one symptom which is very difficult to diagnose and treat and many patients with vertigo tend to consult multiple doctors of multiple specialties without much of benefit. 

One has to understand that vertigo is not a disease per se. Its a symptom of many diseases related to inner ear, brain, eye and sensory system. Inner ear diseases contribute to more than 80% of patients complaining of vertigo.

True vertigo is defined as sensation of spinning of surroundings. it should not be confused with sensation of imbalance, unsteadiness, weakness or blackouts. This article is intended to give information about common causes for vertigo and imbalance which are mainly due to inner ear related diseases which is one of the important organ which maintains balance of an individual, technically termed as vestibular system.

Below are the common inner ear related diseases which can cause vertigo and imbalance

  • BPPV (benign Paroxysmal Positional vertigo): Its a harmless condition commonly involving one of the inner ears. In this condition patients will complain of Short lasting multiple episodes of vertigo which occurs during particular position of the head. It will never stay for more than few minutes and will occur repeatedly in a day. Without Treatment it may continue to occur for many days to weeks. Usually no predisposing diseases can be identified except for few patients who will have history of head injury. 
  • Meniere's Disease : Its a common condition where patients will have sudden attacks of severe vertigo with sensation of ear fullness and ringing sensation in the ear. Many patients with recurrent attacks can even complain of hearing loss. Symptoms of vertigo are usually severe and associated with vomiting sensation or vomiting. Vertigo usually lasts for 20 minutes to a day unless treated early. Patients can have such attacks every few days or few months depending on the severity.
  • Vestibular Neuronitis: This is a viral Infection of part of nerve connected to inner ear which Carries balance sensation to brain. Vertigo in these patients will be sudden and severe. symptoms may last for few days to weeks if not treated appropriately. This condition is usually devoid of any ear related problems. This is one condition where vertigo is continuous all through the day for many days and its very disabling.
  • Labyrinthitis: Its a uncommon condition nowadays and is usually because of untreated middle ear infections. It usually will be severe and most commonly is associted with long standing ear discharge. 
  • Vestibular migraine (Migrainous vertigo): This a type of a headache disorder known as migraine. In this condition patients will have recurrent vertigo associated with features of migrainous headache. Patients will have disabling vertigo and imbalance during, before or after an attack of migraine.
  • Vestibular paroxysmia: This is a rare disorder occurring in young adults and old aged patients mimicking BPPV. Thorough evaluation by a specialist is required to differentiate between the two.
  • Phobic Postural vertigo: Its more of a functional disorder where patients complain more of imbalance when they are in crowded places. Its type of Phobic disorder and requires specific treatment and counseling
  • Drug Induced vertigo: Certain medicines can injure inner ear especially commonly used antibiotics such as gentamycin and streptomycin. 

Apart from these common causes there are many rare vertigo and imbalance disorders which can exist. Vertigo can also be a symptom of many central nervous system (brain) diseases such as Acoustic neuroma, cerebellar stroke, cerebellar tumors, Brain stem disorders, degenerative brain disorders etc

Its should be noted that unless the cause of vertigo is established its not possible to treat the symptom. Patients who suffer from vertigo are advised to consult specialist who has special interest in management of these diseases. Otolaryngologist (ENT Specialist) and Neurologist are usually specialized in this subject and patients are advised to consult these specialists. Patients should avoid self medication of anti vertigo drugs as they can cause severe side effects and sometimes aggravate symptoms of vertigo and imbalance.