Vertigo
Overview
Vertigo, dizziness and balance-related conditions are among the most common health problems in adults. Nearly 40 percent of U.S. adults experience vertigo at least once in their lifetime, with women slightly more likely to get it than men. It can occur because of a problem with the body's vestibular system, which includes structures of the inner ear, vestibular nerve, brain stem and cerebellum, a region of the brain that integrates sensory perception, coordination and motor control. This system regulates balance, posture and the body's orientation in space.
Causes
Although the cause is unknown in many cases, a number of disorders can cause vertigo, dizziness and imbalance. Those conditions include:
Benign paroxysmal positional vertigo (BPPV)
In people with BPPV, head or body movements — particularly when lying in bed or leaning over — can cause a brief vertigo attack that lasts less than one minute. BPPV occurs when microscopic calcium deposits called otoliths are trapped in one of the three semicircular canals that make up the vestibular system. BPPV is the most common cause of vertigo and can be treated effectively.
Meniere's disease
Meniere's Disease results from an imbalance of fluids in the inner ear, which can cause periods of vertigo lasting from minutes to hours. It's frequently accompanied by fluctuating, low-frequency hearing loss, tinnitus and a feeling of fullness or pressure in the ears, known as aural fullness.
Viral and bacterial labyrinthitis
Labyrinthitis results from inflammation within the inner ear, and may cause vertigo attacks lasting from hours to days.
Other causes
Various neurological conditions can also cause vertigo. These include:
- Brain tumor
- Migraine headaches
- Strokes
- Transient ischemic attacks or TIAs
- Multiple sclerosis
Other, non-neurological causes include:
- Diabetes
- Heart arrhythmias
- Hyperventilation
- Orthostatic hypotension, a sudden decrease in blood pressure when you stand up
- Psychiatric or emotional problems such as panic attacks and anxiety
- Use of multiple prescription and non-prescription medications
Our approach to vertigo
UCSF offers state-of-the-art evaluation and treatment for vertigo, dizziness and other balance problems. Our team includes specialists in audiology, otolaryngology (ear and throat disorders), neurology and physical therapy, who collaborate to identify the cause of an individual’s symptoms and design a plan to address them. Treatment for vertigo depends on the diagnosis and may include medications or surgery, as well as physical therapy to improve stabilization, retrain the brain and relieve symptoms.
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Signs & symptoms
By definition, vertigo is a false sensation that you or your surroundings are moving. The sensation is best described as spinning, whirling or moving vertically or horizontally. Vertigo attacks may be constant or sporadic and can last from seconds to days.
Other symptoms may include, but are not limited to:
- Abnormal or involuntary eye movements, called nystagmus
- Blurred vision, known as diplopia
- Difficulty speaking or slurred speech, called dysarthria
- Difficulty walking, known as ataxic gait
- Feeling faint
- Hearing loss
- Nausea or vomiting
- Sweating, also known as diaphoresis
- Tinnitus
- Visual disturbances, known as oscillopsia
- Weakness and numbness
Even medical professionals can misinterpret a patient's description of vertigo symptoms. To get the correct diagnosis, it's essential to give an accurate description of your symptoms.
Diagnosis
To assess what's causing your vertigo, the Balance Center at UCSF will give you a number of subtests that examine the effectiveness and interaction of the vestibular system, or inner ear, the somatosensory system, or flex and pressure sensors in your feet, and the vision system — as well as how these systems contribute to your overall stability and balance. The assessment helps determine which system or systems may be contributing to your symptoms and gives direction for treatment.
The assessment includes a videonystagmography (VNG) or electronystagmography (ENG) test. The VNG or ENG evaluation is separated into three subtests.
- Oculomotor. This assesses the oculomotor system, the visual system for balance. In this part of the test, we measure voluntary eye movements by having you complete a series of exercises while visually following a dot on a light bar.
- Positional or positioning. This part of the test focuses on the vestibular system, which is the balance structure of the inner ear. We will ask you to move your head, or head and body, to monitor how the vestibular system reacts to these movements and to changes in gravity.
- Calorics. This measurement determines how well the vestibular system responds by applying warm and cool air into each ear canal separately. Comparisons are then made of the vestibular system's performance from one side to the other, and whether there's a possible weakness or hyperresponse in the inner ear. During the caloric test, it isn't unusual to experience a sensation of movement, which goes away immediately when the test is complete.
Treatments
Treatment will vary depending on the diagnosis and may include medications, surgery, vestibular rehabilitation training, balance training or canalith repositioning maneuvers.
Vestibular rehabilitation is the primary treatment for many disorders and is also used along with surgery or medications. Vestibular rehabilitation includes exercises that are designed to retrain the brain to compensate for, and adapt to, loss of function in the vestibular system.
Canalith repositioning maneuvers are very effective for treating BPPV. These maneuvers consist of a series of head movements designed to move the calcium deposits out of the canal in the vestibular system in which they're trapped, and back to their normal position.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
