Have you ever experienced that unsettling sensation of the world spinning around you when you’re perfectly still? If so, you may have encountered vertigo – a perplexing condition that can leave even the most grounded individuals feeling off-balance and disoriented.
In this blog, we’ll delve into the complexities of vertigo, exploring its causes, symptoms, and potential treatments, while also offering insights into how individuals can effectively manage this challenging condition.
Understanding Vertigo:
Vertigo is not merely feeling dizzy; it’s a specific type of dizziness characterised by a sensation of spinning or motion when there is no actual movement. It’s often caused by issues in the inner ear labyrinth or nerves, which plays a crucial role in balance and spatial orientation.
There are 2 main types of vertigo:
Peripheral Vertigo:
This type of vertigo is caused by problems within the inner ear or nerves, which connects the inner ear to the brain.
Central Vertigo:
Central vertigo is less common and usually stems from issues within the brainstem or cerebellum, which are involved in processing sensory information related to balance and spatial orientation. Conditions such as migraines, stroke, or multiple sclerosis can cause central vertigo.
What is the vestibular system?
Vertigo symptoms will arise from the vestibular system. It is a sensory system located in the inner ear that plays a crucial role in maintaining balance, spatial orientation, and eye movement control.
The system consists of several interconnected structures that work together to detect changes in head position and movement and provide information to the brain about the body’s position in space.
Components of the Vestibular System:
Semicircular Canals: The semicircular canals are three fluid-filled tubes arranged at right angles to each other. They detect rotational movements of the head in three planes: horizontal (side-to-side), anterior-posterior (forward-backward), and vertical (up-and-down).
Vestibule: The vestibule is located between the semicircular canals and contains two structures: the utricle and the saccule. These structures contain tiny hair cells and calcium carbonate crystals (otoconia) that detect linear acceleration and changes in head position relative to gravity.
Vestibular Nerve: The nerve is a branch of the eighth cranial nerve (vestibulocochlear nerve) that carries sensory information from the vestibular organs in the inner ear to the brainstem and cerebellum.
Function of the Vestibular System:
Balance: It provides information to the brain about the body’s position in space and detects changes in head movement and orientation. This information is essential for maintaining postural stability and controls balance during both static (stationary) and dynamic (moving) activities. When this system fails it really throws you off balance.
Spatial Orientation: It helps orient the body in relation to the surrounding environment, allowing for accurate perception of up and down, left and right, and forward and backward.
Eye Movement Control: It coordinates eye movements (known as vestibulo-ocular reflexes) to stabilise vision during head movements and maintain visual fixation on objects of interest.
Causes of Vertigo:
There are several potential causes of vertigo, including and all fall under the realm of peripheral vertigo: They are typically inner ear problems.
Benign Paroxysmal Positional Vertigo (BPPV): This is one of the most common causes of vertigo and occurs when tiny calcium particles clump together in the inner ear canal, disrupting the normal flow of fluid and sending false signals to the brain about your body’s position.
Meniere’s Disease: This is a disorder of the inner ear that can lead to episodes of vertigo, with associated ringing in the ears (tinnitus) and hearing loss.
Vestibular Neuritis: Inflammation of the vestibular nerve, often triggered by a viral infection, leading to sudden, severe vertigo.
Migraine-Associated Vertigo: Some individuals may experience vertigo as a symptom of migraines, known as a vestibular migraine.
Benign paroxysmal positional vertigo (BPPV)
This is one of the most common causes of vertigo, and can be aided by physiotherapy. It can be diagnosed as part of a physical examination and also referred to as Benign Positional Vertigo. But what exactly is BPPV?
It’s a common inner ear disorder that causes brief episodes of intense dizziness or spinning sensations (vertigo) triggered by specific changes in head position.
The condition occurs when tiny calcium particles (otoconia) become dislodged from their normal position within the inner ear and accumulate in the ear’s semicircular canals. These canals are responsible for detecting head movements and helping maintain balance.
In a normal semicircular canal, there is fluid and small sensory hair cells that line the canals. These hair cells detect movement of the head. As our head tilts and moves, the fluid swooshes around the canal causing movement of the hair cells. The sensation of this movement is sent to the brain and gives it the information it needs to understand which direction the head is moving in and where our head is now sitting in space.
Otoconia are important structures within out ear that also help to detect movement, but only when we move forward, back, up and down. The semicircular canals are responsible for detecting rotation. sometimes the dislodged otoconia can move into these canals. We now have a foreign particle in the canal which can influence movement of the hair cells. This can send false information to the brain about rotation and movement to the head, causing us to feel dizzy or out of balance.
BPPV typically occurs when the head is tilted upward or downward, or when lying down, turning over in bed, or looking up. Often people describe it as being on a rocking boat.
Meniere’s disease
Meniere’s disease is a chronic disorder of the inner ear characterised by recurrent episodes of vertigo, hearing loss, tinnitus, and a feeling of pressure in the affected ear. The condition is named after the French physician Prosper Ménière, who first described it in 1861.
The exact cause of Meniere’s disease is not fully understood, but it’s believed to involve a combination of factors, including fluid buildup in the inner ear, changes in the composition of inner ear fluid, and abnormalities in the vestibular system (responsible for balance and spatial orientation).
Possible contributing factors may include genetics, autoimmune factors, allergies, viral infections, and abnormalities in the blood vessels or fluid regulation in the inner ear.
Meniere’s disease typically manifests in episodic attacks, during which individuals may experience severe vertigo, fluctuating hearing loss (which may become permanent over time), tinnitus, and a feeling of fullness or pressure in the ear. These vertigo attacks can last from several minutes to several hours and may be accompanied by nausea, vomiting, sweating, and anxiety.
Vestibular Neuritis
Vestibular neuritis, also known as vestibular neuronitis, is a condition characterised by inflammation of the vestibular nerve, a nerve that connects the inner ear to the brainstem and plays a crucial role in balance and spatial orientation. When the nerve becomes inflamed, it disrupts the transmission of sensory information from the inner ear to the brain, leading to symptoms such as vertigo, dizziness, and imbalance.
The exact cause of vestibular neuritis is often unclear, but it’s commonly believed to be triggered by a viral infection, most frequently by the herpes simplex virus or, less commonly, by the varicella-zoster virus or other viral pathogens. The inflammation of the nerve may result from an infection spreading to the nerve or from an immune response to the virus affecting the nerve.
Migraine associated Vertigo
Vestibular migraines are a type of migraine that involves symptoms of vertigo or dizziness, along with other migraine symptoms such as headache, nausea, and hypersensitivity to light and sound. These are considered a subtype of migraine and can be difficult to diagnose and manage due to the combination of symptoms.
For the Vertigo to be considered a result of the migraine, we need to see vertigo occur in conjunction with the migraine.
What are the vertigo symptoms?
Vertigo can manifest in various ways, including:
Spinning sensation:
Feeling as though you or your surroundings are spinning or moving.
Nausea and vomiting:
The sensation of spinning can trigger feelings of nausea, and in severe cases, vomiting may occur.
Balance problems:
Difficulty maintaining balance, which can lead to falls or stumbling.
Nystagmus:
Involuntary eye movements, often described as jerking or bouncing.
How do you manage Benign Paroxysmal Positional Vertigo?
The treatment options for BPPV focus primarily on physical maneuvers to reposition the displaced calcium particles in the inner ear. Here are the current treatment options for BPPV:
This is the most common treatment for BPPV. It involves a series of specific head and body movements designed to move the dislodged calcium particles (canaliths) out of the semicircular canal in the inner ear.
The Epley manoeuvre is typically performed by a healthcare professional and will help to quickly ease vertigo symptoms. You can learn how to perform this manoeuvre at home.
Medication:
In some cases, medications such as vestibular suppressants or anti-nausea drugs may be prescribed to help manage symptoms of vertigo associated with BPPV.
These medications do not treat the underlying cause of BPPV and are typically used on a short-term basis to improve symptoms and provide symptomatic relief.
Vestibular Rehabilitation Therapy (VRT):
VRT is a specialised form of physiotherapy designed to improve balance and reduce dizziness in individuals with vestibular disorders, including BPPV.
Vestibular rehabilitation typically involves a series of exercises and manoeuvres tailored to the individual’s specific symptoms and functional limitations to help relieve symptoms.
In Summary
Vertigo is a very unpleasant, but very treatable condition. Although there are many causes of vertigo, the majority fall under BPPV.
At Lilyfield Physiotherapy we can help diagnose vertigo that is affecting your daily life. Vertigo has various causes and treatment options and may need further referral to a specialist.
Let us assess your vertigo and provide an appropriate treatment path to help resolve your vertigo symptoms.