Vertigo is special kind of dizziness that give you a severe sense of spinning or motion. It is usually a sign of an inner ear disorder, but can be a result of problems with the balance nerve (vestibulo-cochlear nerve) or balance center disorder in the brain. Vertigo can be quite severe and troubling, accounting for a large number of emergency department visits.
The balance portions of the inner ear systems are like miniature gyroscopes that send signals to your brain about the relative position and motion of your head. Electronic devices like iPhones have little “accelerometers” in them that do similar things, allowing your device to know “which way is up” and which way the phone is pointed.
The miniature gyroscopes have a series of fluid-filled channels with sensors and small crystals that can detect how the head is moving, and what position the head is in relative to the pull of gravity.
A good description of the vertigo, how it starts and how long it lasts is critical in understanding what type of vertigo you are dealing with. We usually couple our balance evaluation with an audiogram (hearing test) because this is another way of evaluating the strength of the inner ear. Many times a subtle hearing loss can be present along with vertigo that gives us further clues about its cause and therefore the best treatment.
Benign Positional Vertigo (or Benign Paroxysmal Positional Vertigo)
One of the most common types of vertigo is called Benign Paroxysmal Positional Vertigo or BPPV. BPPV is a result of dislocated microscopic calcium crystals within the inner ear.
Minor trauma or just back luck can result in these tiny crystals becoming displaced and “falling” into other parts of the inner ear. This causes a severe but short-lived short-circuit in the system, causing the brain to think your head is spinning out of control.
Typically BPPV is triggered by certain specific head movements, and will give a dramatic spinning feeling for about 30 seconds. This may feel like a lot longer! This feeling is usually followed by a general sense of fatigue, illness or nausea for several minutes or an hour.
The good news is this particular type of vertigo is very curable with fairly simple treatment steps done in the office. You should be able to get back on your feet and moving again in just a few minutes with a special physical treatment called the Epley maneuver. This treatment puts the microscopic crystals back into their normal position and solves the problem. Recurrences may happen in the future, but it remains easy to fix usually.
Vestibular Neuritis, sometimes called labyrinthitis, is a very severe form of temporary vertigo. Often a patient who gets this will be extremely vertiginous (spinning) for hours on end. It causes nausea, vomiting and a general fear of death. Many patients report to the emergency room or call 911 because they are worried about having a stroke. Patients feel their only comfortable position may be sitting upright with their head perfectly still. Most patients cannot go to work with this, and people who work in certain physical occupations may be disabled for a few weeks until their balance system is functioning safely again.
This form of vertigo is usually caused by a viral infection of the inner ear or the balance nerve. It usually results in a slight permanent weakness of the affected nerve. Typically a person will have severe symptoms for about 72 hours then will improve substantially, usually about 10% improvement per day.
The affected nerve can be partially recovered and the brain works to compensate for the weakness and re-calibrates the balance system. Modest physical activity such as walking helps to speed up recovery. Special balance exercises and balance therapy can also be recommended for difficult cases.