Vertigo uncovered: Causes and treatment

Vertigo can be caused by various underlying conditions, ranging from benign inner ear disturbances to more serious neurological disorders.

Mr Craig Murray, highly respected consultant ENT surgeon, provides an expert insight into vertigo, including its causes and treatment options, including the effectiveness of vestibular rehabilitation therapy.

What is vertigo?

Vertigo is a sensation of spinning or dizziness, where you feel like you or your surroundings are moving, when they actually aren’t. People experiencing vertigo may feel as though they are tilting, falling, or rotating, even when standing still. This sensation can last for a few seconds, minutes or, in severe cases, even hours. Above all, it’s important to note that vertigo itself isn’t a condition, but a symptom of an underlying health issue.

What causes vertigo?

Vertigo is commonly caused by problems within the inner ear or the vestibular system, which is responsible for maintaining balance and spatial orientation. Some of the most common underlying conditions include:

Benign paroxysmal positional vertigo (BPPV)

BPPV happens when small crystals in the inner ear, known as otoconia, become dislodged and travel into the semicircular canals. This disruption causes the brain to receive abnormal signals, resulting in brief episodes of vertigo when you quickly move your head in certain directions, such as when lying down or looking upwards.

Ménière's disease

Ménière's disease is a condition that occurs due to fluid build-up in the inner ear, leading to episodes of vertigo, along with hearing loss, tinnitus and a feeling of fullness or pressure in the ear. The exact cause of this fluid build-up isn’t fully understood.

Vestibular neuritis and labyrinthitis

Vestibular neuritis occurs when the vestibular nerve becomes inflamed, usually due to a viral infection. This inflammation disrupts the normal signals between the inner ear and the brain, leading to vertigo, balance problems and nausea.

Labyrinthitis is similar to vestibular neuritis but involves inflammation of both the vestibular nerve and the cochlear nerve. It’s usually caused by a viral or bacterial infection, and the symptoms of vertigo are often accompanied by hearing loss.

How is vertigo treated?

The treatment for vertigo depends on the underlying cause. Some common treatments include:

Medications

Medications may be prescribed in cases of vertigo associated with inflammation, infection or nausea. These can include antihistamines, antiemetics (to reduce nausea) or corticosteroids to reduce inflammation. In some cases, medications to treat underlying conditions, such as antibiotics for ear infections, may be required.

Canalith repositioning manoeuvres

Canalith repositioning manoeuvres, such as the Epley manoeuvre, are commonly used for BPPV. This treatment involves a series of head movements performed by a healthcare professional to relocate the dislodged crystals in the inner ear back to their original position, thereby reducing vertigo.

Surgery

Surgery is typically only considered in severe cases where other treatments haven’t worked. For example, in cases of Ménière's disease that don't improve with medications, a surgical procedure may be recommended to reduce fluid build-up in the inner ear. Vestibular nerve section or labyrinthectomy are surgical options for some vestibular disorders.

How effective is vestibular rehabilitation therapy for vertigo?

Vestibular rehabilitation therapy (VRT) is a specialised form of physiotherapy designed for people with vertigo, particularly those with vestibular disorders or BPPV. The therapy incorporates targeted exercises that retrain the brain to process signals from balance systems in the body to compensate for any changes caused by inner ear dysfunction.

Research demonstrates that VRT can significantly reduce dizziness, improve stability and enable people to resume their normal daily activities. Many people begin to notice improvements within just a few weeks of starting therapy. However, it’s essential to consult with a healthcare professional and have an accurate vertigo diagnosis to determine whether VRT is appropriate for your specific condition.

To book an appointment with Mr Craig Murray, head on over to his Top Doctors profile today.