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, but vertigo caused by ear disease accounts for a significant portion of them.
Because there are many causes of vertigo and many symptoms accompanying vertigo overlap, even clinicians may not be able to distinguish these causes, let alone patients with vertigo. Therefore, there are many misunderstandings in the understanding of vertigo, which leads to the inability of vertigo to be treated correctly. For this reason, we would like to provide some correct guidance for vertigo patients from the following aspects.
I. About what is vertigo
Myth: Almost all patients confuse vertigo, balance disorder and dizziness, and once they occur, they all attribute them to “dizziness and lightheadedness”, and quite a few of them consult the neurology department as an emergency, not knowing that different symptoms are often caused by different causes, and the treatment is very different. So what exactly is vertigo?
Correction: Vertigo is the illusion of movement of oneself or objects in the surroundings that occurs suddenly and without external stimuli, and can be a sense of rotation, ascent, descent or swaying. Balance disorder refers to the feeling of instability when walking or the feeling of repeatedly falling over. 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, Remsay Hunt 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 correct diagnosis can lead to correct treatment.
II. About Meniere’s disease
Myth: Once you have dizziness and lightheadedness, you will think that you have Meniere’s syndrome regardless of the cause. Some patients come to the clinic and the first thing they say is “I have Meniere’s syndrome”, which is a misunderstanding of this disease. So what is Meniere’s syndrome?
Correction: Meniere’s syndrome, now called Meniere’s disease, is one of the common causes of vertigo, and is characterized by the accumulation of fluid in the membranous vagus as the main pathological feature. The etiology is still unclear, and possible causes include impaired circulation of endolymphatic fluid, impaired absorption of endolymphatic sacs due to 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 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 some patients who do not have good effect after medication, and the vertigo is recurring and the hearing is gradually decreasing, so the treatment should be chosen according to the vertigo condition and hearing level of the patient.
About “cervical spondylosis”
Myth: Some patients with vertigo have been examined for cervical spondylosis, such as cervical spine osteophytes and straightening of the physiological curvature of the cervical spine, so they attribute the cause of vertigo to cervical spondylosis from then on. “Cervical spondylosis” is another common cause of vertigo besides Meniere’s disease, but cervical spondylosis and straightening of the physiological curvature of the cervical spine are not the real cause of vertigo. So what does vertigo related to cervical spondylosis look like?
Correction: Vertigo caused by narrowing of the foramen of the vertebral artery in the cervical spine due to cervical spine pathology, resulting in impaired blood flow to the vertebral artery is called transient ischemic vertigo of the basilar artery. It is important to note that vertigo will only occur when the vertebral artery stenosis is caused by osteophytes of the cervical spine. It is important not to assume the cause of vertigo as cervical spine disease when you see osteophytes in any part of the cervical spine on X-rays or CT films. Transcranial Doppler can help in the diagnosis of this disease by understanding the blood supply of the arteries. Transient ischemic vertigo of the vertebral basilar artery is characterized by.
(1) Vertigo lasting for several minutes, with several episodes per day or once in several days. The vertigo may be rotational, or dizziness, feeling of heaviness in the head, loss of balance, unsteadiness, tipping, sudden collapse, ataxia, etc.
(2) Limb weakness, paralysis, and inflexible movement.
(3) Partial numbness of the face and/or limbs, sensory loss or abnormality.
(4) Blurred or double vision. Blackness.
(5) Difficulty in swallowing, dysarthria. If you have item 1 and any one or more of items 2 to 5 at the same time, the diagnosis can be made by audiology, vestibular function, transcranial Doppler and exclusion of other vertigo disorders.
IV. Treatment of vertigo.
Myth: Once vertigo appears, patients mostly ask for infusion treatment, which is a misconception about vertigo treatment. Then how should vertigo be treated?
Correction: Because there are many diseases that cause vertigo, the treatment is very complicated, and medication only accounts for a small part of it. For example, benign paroxysmal positional vertigo requires only postural rehabilitation, while vertigo caused by cholesteatoma and auditory neuroma should receive surgical treatment. Among the diseases causing vertigo, Ménière’s disease is more common, so let’s introduce the treatment method as an example.
In the initial stage of Ménière’s disease, it can be treated with medication, namely vertigo control treatment in the attack period and maintenance treatment in the interval period. For vertigo control in the attack period, sedatives (Valium), anti-vertigo drugs (vertigo stop), diuretics (dihydrocoumarol), antiemetics (vitamin B6), and vasodilators (Mineralocort) are available, while maintenance treatment in the interval period includes exercise, appropriate work and rest, and low salt diet.
Oral hormones are effective for Ménière’s disease with mild symptoms. If there is concern that taking hormones may cause side effects, or if there is hypertension, diabetes, or gastroduodenal ulcers that prevent systemic hormones, hormones can be administered intra-durally by tympanic membrane puncture. Injections are given twice a week for three weeks. The goal of intra-implantation therapy is to maximize the effect of local medication on the inner ear without causing systemic side effects.
If the above treatment does not control the vertigo caused by Ménière’s disease and there is hearing loss, intra-dural administration of gentamicin, a method known as chemical vagotomy, may be used. The injections are given once or twice a week for three to four weeks, but this method carries the risk of causing continued hearing loss. The current method of titration administration is commonly used to control vertigo while preserving hearing.
However, some patients still have severe vertigo symptoms (persistent Ménière’s disease), such as frequent vertigo attacks and significant hearing loss, and the general medication is ineffective, which seriously affects the patient’s work and quality of life, and surgery should be considered. Surgical methods include endolymphatic sac surgery, vestibular neurectomy, and vagotomy. Among them, endolymphatic capsule surgery is relatively simple and can relieve some patients’ vertigo symptoms, while selective vestibular neurectomy is the most effective and lighter damage among all kinds of surgical treatment methods, which can effectively control vertigo, stop hearing loss, improve tinnitus and preserve hearing better than weekly intra-drum injection of gentamicin. Labyrinthectomy, for patients without practical hearing or who cannot tolerate intracranial surgery, is similar to vestibular neurectomy.
In fact, vertigo is not terrible, but the key is to understand it correctly, avoid the above-mentioned misconceptions, and treat it correctly, so that you can stay away from vertigo and live a peaceful life.