Spinning around as fast as possible until one feels too dizzy to stand up straight is one of the most amusing activities commonly practiced by children; and they engage in this merriment because the spinning action creates a false sensation of movement known as vertigo. But for the 69 million adult Americans who suffer from this disorder, experiencing the sudden onset of unprovoked vertigo is not as much fun. Patients with vertigo have a hard time carrying out simple tasks given that they feel as if they are constantly traveling on a ship being tossed about in the open ocean. Despite the fact that vertigo can be an extremely uncomfortable scenario, it is generally due to a benign cause such as disequilibrium in the ear canal [although in older patients, vertigo might signify an ominous sign related to cerebrovascular disease]. The good news is that for the majority of cases of vertigo, simple and effective treatment is available.
Vertigo can be perceived as self-motion versus motion of the actual environment, and in order to understand vertigo one must first comprehend how balance is coordinated in the human body. The two systems involved are the vestibular system (structures in the ear that sense angular and linear motion) and the brain. The vestibular system on the right and left sides exist in perfect harmony; however, when the head turns one way or the other the brain reads the inner nerve signals and is able to interpret that to mean the body is leaning in a specific direction. Yet, when there are abnormalities within the vestibular system itself (making it unbalanced at its baseline state) and patients proceed to physically move their head, the brain receives too many signals resulting in vertigo. In addition to the spinning sensation, patients with vertigo also experience significant nausea and vomiting. The most common causes for vertigo include stones (calcification of fluid, like gall or kidney stones) in the ear canals, inflammation of the canal due to viruses and bacteria, excess fluid in the ear canal, medication toxicity, or a tumor. In older patients with known risk factors for cardiovascular disease, vertigo could be caused by a brainstem (area of the brain where balance processing occurs) stroke. The diagnosis of vertigo is mostly clinical, with the exception of tumors and strokes which require an imaging modality such as an MRI. The treatment encompasses medications (e.g. meclizine) which suppress the vestibular symptoms. In addition to this, certain physical maneuvers can be conducted to ameliorate the symptoms.
For patients who develop new onset vertigo, a visit to a primary care doctor might do the trick. In a preponderance of cases, vertigo is a short-lived condition that can be readily treated with medications. On the other hand, if patients have refractory symptoms they might need to undergo vestibular rehabilitation (physical therapy). Lastly, for the patients who suffer from intermittent benign vertigo, all that is needed is to stop by the nearest pharmacy and purchase the available over-the-counter medications. Whatever the case, taking action at the first sign of symptoms will promote quick relief and ensure that things don’t spin out of control.