Vertigo is not a disease but a symptom and can occur for a variety of reasons. Vertigo is briefly described as a motion illusion or hallucination. This movement can sometimes be in the form of a true rotation or sometimes it is described by patients as feeling of imbalance, insecurity or swinging (also called “dizziness, unsteadiness and lightheadedness”). Patients can also express this vertigo like “I feel like I’m falling,” “the ground is slipping under my feet”, “objects seem to be moving ‘,” my head is not on my shoulders “.
What are the most common causes of vertigo?
Vertigos are divided into two main groups as non-cerebral (extra-brain or peripheral) causes or cerebral (brain-related or central) causes. Non-cerebral ones are also divided into two groups as aural (vestibular) or non-aural causes.
Central reasons; It occurs with infection-inflammation, trauma and systemic diseases of the Central Nervous System. Patients mostly describe feeling of imbalance and insecurity in vertigo that occurs due to central reasons.
Non-aural causes include eye diseases, heart and metabolic diseases and organ failure.
Aural causes are benign paroxysmal positional vertigo (It is the most common group and triggered by head movements), vestibular neuritis, Meniere’s disease (endolymphatic hydrops), vestibular ototoxicity (due to the harmful effects of some drugs to the inner ear such as streptomycin), otosclerosis (calcification in the ossicular chain), and labyrinthitis (inner ear infections). In case of vertigo related to the ear (peripheral vertigo), patients describe a real rotation (The sensation that you are spinning, or the room is spinning around you) and there is no loss of consciousness in these patients.
How is Vertigo diagnosed?
The characteristics of the vertigo, other associated symptoms, and the patient’s history should be well investigated. For this purpose, the following questions should be asked in the patient’s history:
- Is the room spinning or is there a feeling of falling?
- Does fainting or loss of consciousness occur?
- Are there any gait disturbances?
- When did your dizziness start?
- Is it continuous or in attacks?
- If it is in attacks, how long does an attack last?
- In which situations do attacks occur?
- Are you completely normal between attacks?
- Do you have hearing loss or tinnitus together?
- Is there nausea and vomiting together?
- Are there any positions in which vertigo occurs or increases?
- Have you had such complaints before?
- Do you smoke or drink alcohol?
- Have you had a head injury or any surgery?
- What do you think is the reason for this complaint?
After this detailed history, a complete ear, nose and throat examination, neurological examination, evaluation of the presence and characteristics of rapid eye movements called nystagmus, hearing and balance tests, routine blood biochemical examinations and, if necessary, ECG, EEG, CT, and MR imaging should be performed.
In the presence of rapid eye movements (nystagmus), the characteristics of this nystagmus (such as direction, severity, fatigue or does not fatigue) contribute to the distinction of vertigo in terms of central or ear related causes.
How should vertigo treatment be done?
Vertigo treatment should be directed primarily to the cause, if the cause is known. However, since there is often no obvious reason treatment can also be done symptomatically. These treatment measures;
- Elimination of triggering factors
- Prevention of existing stress in the patient
- Prohibition of alcohol and smoking
- Caffeine and salt restriction
- Avoiding them if the position or other factors that cause vertigo are determined
- Drug therapy:
- Drugs to regulate the balance system and / or sedate (such as dimenhydrinate, diazepam, betahistine)
- Drugs with toxic effects to the inner ear such as streptomycin or gentamicin in vertigo with hearing loss
Surgical Treatment: Used in cases that do not respond to long-term drug treatments. These are divided into two as “destructive (sacrificing existing hearing) surgeries” and “conservative (preserving hearing) surgeries”. Examples of destructive surgeries are labyrinthectomy surgeries in which the vestibuler portion of the inner ear is removed. Examples of conservative surgeries are endolymphatic sac surgery and cutting of the balance nerve.
