Vertigo, commonly known as dizziness, is a very common condition that is often seen in otolaryngology or neurology. For people who suffer from vertigo frequently, they are anxious to know the causes of vertigo, the dangers of vertigo and how to treat it. However, vertigo attacks can take very diverse forms, from attacks that occur for a few seconds with a change in position, to sudden onset after a cold or viral infection, to recurrent attacks during exertion or mood swings, to appearing after trauma or the use of ototoxic drugs. The typical symptoms of vertigo are sudden spinning, feeling that the surrounding objects are spinning, swaying or jumping, accompanied by nausea, vomiting, and profuse sweating, with no aura during the attack, causing the patient to panic and lie in bed with eyes closed. Unsteady walking can also occur, and specific body positions can induce vertigo. Vertigo can occur alone or in combination with other conditions such as deafness, facial paralysis, and otitis media. These conditions cause great pain to patients and seriously affect work, life and school. There are many diseases that can cause vertigo, and vertigo caused by ear diseases accounts for a large part of them. The diagnosis of the cause of vertigo is made after a series of formal hearing and vestibular function tests and imaging tests (CT, MRI).
Because there are many causes of vertigo and many overlapping symptoms associated with vertigo, even clinicians may not be able to distinguish between these causes, let alone patients with vertigo. For this reason, we would like to introduce the concept of vertigo and several common types of vertigo.
I. The concept of vertigo
Vertigo is the illusion of movement of oneself or the objects in the surroundings that occurs suddenly without external stimulation, which can be rotation, rising, falling or swaying sensation. Balance disorder refers to the feeling of instability or repeated deflection when walking. Dizziness and lightheadedness refer to the feeling of discomfort within the head that cannot be clearly expressed, such as dizziness and a sense of confusion.
Vertigo is usually caused by inner ear disease, in other words, otogenic, and should be seen in the ENT department. Vertigo can be a single episode (only one episode) or recurrent. Some diseases are accompanied by tinnitus and hearing loss, commonly known as Meniere’s disease, sudden deafness, traumatic vertigo, otosclerosis, chronic suppurative otitis media (cholesteatoma), auditory neuroma, RemsayHunt syndrome (herpes zoster), etc. Other diseases do not have tinnitus and hearing loss, commonly known as benign paroxysmal positional vertigo, vestibular neuronitis, etc. Ototoxic drugs mostly cause balance disorders, sometimes accompanied by tinnitus and hearing loss. In general, balance disorders and dizziness and lightheadedness are mostly caused by neurological disorders, vascular disorders or systemic diseases, such as brainstem disorders, intracranial tumors, intracranial infections, cardiovascular disorders, postural hypotension, hypoglycemia, and thyroid dysfunction. From the above definitions, symptom characteristics and disease classification, it is easy to know that only vertigo is closely related to the ear, and it is important not to rush to the doctor. On the other hand, there are many causes of vertigo, so you should visit a regular hospital, and only with correct diagnosis can you get correct treatment.
II. Diseases causing vertigo
1.Ménière’s disease.
Meniere’s disease, which used to be called Meniere’s syndrome, is one of the common causes of vertigo, with membrane vagal effusion as the main pathological feature. The etiology is still unclear, and possible causes include impaired endolymphatic fluid circulation, impaired absorption of endolymphatic sacs caused by autoimmune reactions, and plant nerve dysfunction. The typical manifestation of Ménière’s disease is recurrent vertigo with hearing loss, tinnitus and a feeling of ear congestion. The vertigo is rotational or swaying and lasts from tens of minutes to several hours, up to twenty-four hours. The attacks are often accompanied by pallor, cold sweats, nausea, and vomiting. Intermittent vertigo disappears. Patients with Ménière’s disease experience fluctuating hearing loss, i.e., hearing loss during episodes, while hearing may partially or fully recover during intervals. As the disease progresses, the hearing loss stops fluctuating and gradually worsens. Tinnitus mostly appears before the onset of vertigo and worsens during the vertigo, which can be known as a precursor of vertigo in patients with long-standing disease; intermittent periods disappear with the relief of vertigo, but tinnitus can persist in patients with recurrent attacks. The diagnosis of Ménière’s disease should be made after a series of hearing and vestibular function tests and exclusion of other diseases that cause vertigo, and it is important not to diagnose Ménière’s disease in patients with vertigo. There is no specific treatment or prevention method for Ménière’s disease, but about 80% of patients can relieve the symptoms and control the disease through medication. However, there are a few patients who have poor results after medication, with recurrent attacks of vertigo and gradual hearing loss, so treatment should be chosen according to the vertigo condition and hearing level of the patient. Intractable Ménière’s disease can be treated by surgery.
2. Benign paroxysmal positional vertigo.
This type of vertigo is the most common, with attacks related to a specific head position, often induced when lying down, getting up or turning over, and lasting only a few seconds or minutes. It is not accompanied by tinnitus or deafness. Benign paroxysmal positional vertigo is mostly self-resolving, but sometimes recurrent. Its etiology is unknown, but it may be due to a dislodged otolith on the vestibular receptors deposited on the ridge of the semicircular canal jugular, which can induce vertigo and nystagmus in a specific head position due to gravitational traction. Treatment is mostly by manual repositioning, and surgery is available for particularly severe cases.
3.Auditory neuroma.
Vertigo caused by auditory neuroma is milder and occurs gradually, mostly with unstable walking and less rotation. Adults with hearing loss and tinnitus in one ear, which gradually develops into severe neurological deafness and vertigo at the same time, should be especially alert to auditory neuroma. Auditory neuromas also sometimes cause sudden hearing loss and are often diagnosed as sudden deafness. Magnetic resonance imaging (MRI) scans of the internal auditory tract and pontocerebellar horn can confirm the diagnosis. Auditory neuromas require surgical treatment.
4. Sudden deafness.
Sudden deafness is a sudden loss or loss of hearing, some of which may be accompanied by vertigo, nausea, and vomiting. It is mostly accompanied by tinnitus, but does not recur. The cause is unknown, and sometimes hearing can be partially restored. Sudden deafness needs to be treated as early as possible, otherwise the best treatment period will be missed.
5. Labyrinthitis.
A history of cholesteatoma type otitis media with long-term recurrent pus flow from the affected ear, accompanied by hearing loss. Once vertigo occurs, it is mostly caused by cholesteatoma damaging the vagus bone wall and inflammation entering the inner ear. In the case of otitis media caused by cholesteatoma, the vagus must be treated surgically.
6. RemsayHunt syndrome.
RemsayHunt syndrome is caused by herpes zoster virus infection, also known as shingles, and is often associated with mild vertigo, tinnitus and hearing impairment. There can be severe ear pain. Herpes zoster appears on the skin of the ear and can cause facial paralysis. Antiviral and hormonal treatment should be used.
7. Ear drug toxicity.
There is a history of ototoxic drugs such as streptomycin or gentamicin. Ear drug poisoning is mostly binaural involvement, vertigo is mostly unstable feeling, a few have rotational. There will be no recurrent attacks, mostly accompanied by hearing loss and tinnitus.
8. Vestibular neuronitis.
It mostly develops after viral infection of the upper respiratory tract, probably due to viral infection of the vestibular neurons. It is characterized clinically by sudden vertigo and spontaneous nystagmus with nausea and vomiting, without tinnitus and deafness. The vertigo lasts for a long time. The vertigo is mostly swaying and unstable, but can also be rotational in nature and has a tendency to resolve spontaneously. It rarely recurs after healing.
9. Insufficient blood supply to the vertebral basilar artery.
The vertigo caused by the narrowing of the vertebral artery foramen in the cervical spine due to cervical spine lesions, resulting in the obstruction of blood flow in the vertebral artery, is called transient ischemic vertigo of the vertebrobasilar artery. It is important to note that vertigo can only occur when the vertebral artery is narrowed due to osteophytes in the cervical spine. It is important not to assume that the cause of vertigo is cervical spine disease when you see osteophytes in any part of the cervical spine on X-rays or CT films. Magnetic resonance imaging (MRA) of the vertebral artery can help in the diagnosis of this disease by understanding the blood supply to the artery.
Manifestations of inadequate blood supply to the vertebrobasilar artery
1. Vertigo lasts for several minutes, with several episodes per day or once every few days. Vertigo may be rotational, or dizziness, heavy head feeling, loss of balance, unsteadiness, tipping sensation, sudden collapse, ataxia, etc.
2. Weakness, paralysis, and inflexible movement of the limbs.
3.Partial numbness of face and/or limbs, sensory loss or abnormality.
4.Blurred vision or diplopia black.
5.Swallowing difficulty, dysarthria. If you have item 1 and any 1 or more of items 2~5 at the same time, the diagnosis can be made by audiology, vestibular function, MRA and exclusion of other vertigo disorders.