What causes vertigo?

Written by: Mr Richard Irving
Edited by: Nicholas Howley

Our body’s balancing system is complex and involves lots of different parts – so when a patient has symptoms of vertigo it can be difficult to work out what’s going wrong. We interviewed leading ENT surgeon Mr Richard Irving for an overview of the different causes of vertigo and how it can be treated.

What is vertigo?

Vertigo is a symptom of a disordered system of balance. It is strictly defined as a hallucination of movement.

Patients do struggle to describe their symptoms very precisely, and symptoms can range from dizziness, lightheadedness, to problems with coordination and movement.

One of the important things I need to do as a treating doctor is to work out from the patient's symptoms precisely what they're describing and which body part that's likely to be associated with.

What parts of the body does vertigo affect?

The symptom of vertigo can arise from disorders in many different parts of the body .

Our balance function is coordinated by the brain and the brain is central to the process of maintaining balance.

However, in order to do this the brain receives signals from our eyes, which give us information on our orientation and space. In addition, the brain receives signals from the inner ear, our joints and the soles of our feet, which carry information on our movement.

The brain takes all of this information, analyses it, and uses the information to maintain our state of balance.

What causes vertigo?

Vertigo can be a symptom of disease in many different parts of the body. I most commonly deal with inner ear disorders and vertigo is a characteristic feature of diseases of the inner ear.

In addition, these symptoms of balance disturbance and vertigo can arise from diseases of the brain and conditions that affect our ability to maintain our position in space.

Any impairment of vision can result in poor balance and any conditions affecting our limbs and our mobility, such as arthritis or peripheral neuropathy can result in difficulties with balance and cause symptoms of vertigo.

Occasionally, a patient will present following a fall.

What are the symptoms?

It depends on the condition responsible for the symptoms:

  • If the disease is affecting the inner ears, patients will often present with associated hearing loss, tinnitus or problems with discharge or infection in the ears.
  • The next most common system to be involved in patients with balance disturbance is the neurological system. These patients would present typically with headaches and visual disturbance.
  • If the problem is with the cardiovascular system, patients may complain of lightheadedness, and may have a history of palpitations, heart disease, minor strokes or even blackouts.

How is vertigo treated?

My particular interest is in managing patients with in-ear causes for their vertigo.

By far the commonest cause that I come across is a condition called benign positional vertigo. This condition results from degeneration in the inner ear causing free-floating particles to be symptomatic within the balance canals. This condition can be very effectively treated by repositioning manoeuvres – patients typically require just one or two treatments with the vast majority having complete resolution of their symptoms.

The next most common condition that I would treat would be Meniere's disease. This results in hearing loss, balance disturbance, fullness in the ear and tinnitus. The vertigo can be effectively controlled by medical treatments, injections and occasionally surgical procedures on the ear.

Finally, I see many patients who've lost inner ear function either as a result of trauma or viral infection. Typically, these patients will present with an initial acute vertigo and then a more chronic balance disturbance. My management of these patients is to use vestibular rehabilitation therapy, which is a form of exercise treatment. This can be extremely effective but may take many months before a significant or complete recovery is achieved.

If you're worried about symptoms of vertigo, book a consultation with Mr Irving today.

By Mr Richard Irving
Otolaryngology / ENT

Mr Richard Irving is a specialist in otology, neurotology and skull base surgery in Birmingham. He specialises in the conditions of the ear, hearing and balance in both adults and children. This includes cholesteatoma, cochlear and middle ear implants, facial paralysis, Ménière's disease, perforation of the eardrum, tinnitus and tumours of the skull base.

Mr Irving qualified from London University in 1985 and furthermore trained in London, Cambridge and San Francisco. During his training, he was awarded a fellowship to the Universitatspital in Zurich and to the Causse Ear Clinic in France. He was awarded the intercollegiate gold medal for best performance in the FRCS(ORL-HNS) examination in 1996.

Whilst training in Cambridge, Mr Irving undertook pioneering research into the molecular genetics of tumours of the inner ear, which led to the award of an MD in 1996. For this work, he was awarded the Royal Society of Medicine short papers prize in 1993 and the Xomed-Treace Prize in 1994. Mr Irving’s current research activity address the issues facing the hearing impaired, those with facial paralysis, balance disturbance and skull base tumours. He has received awards of over £2 million for deafness research into translational projects involving bringing technology into clinical practice.

He has published over 100 peer review articles on a variety of subjects related to ear diseases. Richard lectures regularly at national and international conferences. He assists with training overseas surgeons and works as advisor and external surgeon to teams in India, Bangladesh and Oman. Richard serves on the editorial board of a number of journals and has worked with NICE to develop guidelines to manage hearing loss in the UK. He is heavily involved in postgraduate teaching and training, runs a prestigious fellowship training course, and is a past President of the British Society of Otology and the current President of the Royal Society of Medicine Section of Otology.

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