Understanding Vertigo: Exploring Proper Terminology and Causes
What is Vertigo?
Vertigo is a term often used to describe feelings of dizziness. However, its true definition refers specifically to the perception of motion when there is no actual movement. Vertigo occurs due to an issue within the vestibular system, which is responsible for detecting head movements and helping us maintain balance. This system allows us to keep our eyes steady even when our head moves, such as when we walk and look around without losing our balance.
The vestibular system is a sensory network housed within the inner ear, which explains why balance is closely associated with ear function. The inner ear itself is located in the bony labyrinth of the temporal bone and contains crucial structures like the cochlea, semicircular canals, and the otolith organs.
The inner ear detects head movement through fluid displacement, which disrupts hair cells within the three semicircular canals. Meanwhile, the otolith organs contain calcium carbonate crystals (called otoconia), providing mass that helps sense movement in relation to gravity.
What Causes Vertigo?
Several conditions can lead to vertigo, including:
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Benign Paroxysmal Positional Vertigo (BPPV): BPPV is the most common cause of vertigo. It occurs when hardened otoconia dislodge from the otolith organ and move into one of the semicircular canals. This disrupts the normal flow of signals to the brain, leading to brief episodes of dizziness, which typically last from seconds to a minute. These episodes are often triggered by specific head movements, such as turning in bed, looking up or down, or tilting the head. Rapid, involuntary eye movements known as nystagmus often accompany BPPV.
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Vestibular Neuritis: This condition arises from inflammation of the vestibular nerve, which plays a key role in balance and spatial awareness. Vestibular neuritis is typically caused by a viral infection and results in sudden, intense vertigo, often accompanied by nausea and balance problems.
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Meniere’s Disease: A chronic condition that affects the inner ear, Meniere’s disease is characterized by recurring episodes of vertigo, fluctuating hearing loss, tinnitus (ringing in the ears), and a sense of fullness or pressure in the ear.
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Migraine-Associated Vertigo: For some individuals, migraines come with episodes of vertigo, which can be severe and debilitating. These episodes may coincide with typical migraine symptoms such as headaches, light sensitivity, and visual disturbances.
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Labyrinthitis: This condition involves inflammation of the labyrinth within the inner ear, which is responsible for detecting motion and gravity. Labyrinthitis can be triggered by viral or bacterial infections, leading to vertigo and hearing loss in the affected ear.
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Head Injuries: Trauma to the head can disrupt the delicate structures of the inner ear, resulting in vertigo.
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Certain Medications: Some medications, particularly those affecting the inner ear or the brain, may cause dizziness or vertigo as side effects.
At Emery Physical Therapy, BPPV is the most common cause of vertigo we treat. The Dix-Hallpike maneuver is a well-known test we use to diagnose BPPV, along with other vestibular assessments. During this test, the patient’s head is moved into specific positions to provoke vertigo and nystagmus, helping to identify which ear and which semicircular canal is involved. The posterior semicircular canal is the most frequently affected, accounting for 85-95% of BPPV episodes.
BPPV Treatment:
Treating BPPV at Emery Physical Therapy involves a canalith repositioning maneuver, a series of head movements performed in a specific sequence to guide the displaced otoconia out of the affected semicircular canal and back into the utricle of the inner ear. This procedure is highly effective in relieving vertigo symptoms associated with BPPV.
A comprehensive assessment is essential in determining the underlying cause of vertigo, as treatment and management depend on identifying the correct source. Although vertigo is a complex condition, it can be effectively managed with the help of a trained vestibular physiotherapist.
If you are experiencing vertigo, Emery Physical Therapy’s vestibular physiotherapists are specially trained to assess and diagnose vestibular disorders. They will conduct a thorough evaluation to pinpoint the cause of your vertigo, ensuring the treatment is precisely tailored to your condition, as each vestibular disorder requires its own unique approach.
References:
- von Brevern, M et al. (2015). ‘Benign Paroxysmal Positional Vertigo: Diagnostic Criteria’. Journal of Vestibular Research, 25, 105–117. DOI 10.3233/VES-150553
- Epley, JM. (1995). Positional vertigo related to semicircular canalithiasis. Otolaryngol Head Neck Surg, 112, 154-61. [PubMed]
- Bhattacharyya, N., Baugh, RF., Orvidas, L., et al. (2008). Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg, 139, S47-81. DOI 10.1016/j.otohns.2008.08.022 [PubMed]