Definition &CausesSymptomsInvestigations & TreatmentsRisk Factors & PreventionOutcome
Definition and Causes:


A condition in which one feels dizzy or off balance, often seen in elderly, however; may occur at any age and in both genders.

It can be either:

  • Objective vertigo (where the surrouding is moving or spinning)


  • Subjective vertigo (the individual feels to be moving or spinning with respect to the surrounding)


1-1-Image-Vertigo-Patients- Anatomy-Definition



Benign paroxysmal positional vertigo (BPPV):

  • The most common form of vertigo, usually initiated by sudden head movements or on moving the head in a certain direction. This type of vertigo is rarely serious and can be treated


  • It is mostly associated with minor to severe blow to the head, or may involve some disorder or damage to the inner most part of the ear


  • Inside the inner most part of the ear there are tiny organs and include structures like circular bony canals fluid and fine hair like sensors to monitor the rotation of the head


  • Other structures also known as "otolith organs" - utricle and saccule monitor the up and down, back and front movements related to the gravity. The otolith organs contain crystals which make us sensitive to gravity. Sometimes for variety of reasons these crystals may dislodge and move into the bony canals and thus make the canals sensitive to head position changes and cause symptoms of vertigo


2-Image-Vertigo-Patients-Vestibular System-Definition



  • Untreated ear infections caused by bacteria can get into the inner most part of the ear leading to swelling and sudden onset of vertigo with hearing loss



  • Viral neuronitis is just like labyrinthitis; caused by certain viruses, which may affect the nerves in the region leading to vertigo


Meniere's disease:

  • The symptoms are associated with increased amount of fluid in the inner ear. The disease presents with sudden onset vertigo, ringing in the ear and hearing loss


Head trauma:

  • People who have received a violent blow on the head can suffer temporary or permanent damage to the inner ear, causing balance problems and vertigo


Acoustic neuroma

  • A type of tumor of the nerve tissue that can cause vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss


Multiple sclerosis:

  • A disease that affects the brain and spinal cord. Swelling (inflammation) caused by the abnormal defence response (immune response) within our body, leads to the injury of the protective covering of the delicate nerve cells within our brain and spinal cord. Patients with this disease usually present with sudden onset of vertigo as a first symptom



  • A severe form of headache which may also cause vertigo



  • Sometimes can be caused by decreased blood flow to the brain


Some medications can damage the human balance system which is controlled by the vestibular system (situated in the inner most part of the ear) in high doses or with prolonged use such as:


  • Acetylsalicylic acid (ASA)
  • Tranquilizers
  • Sedatives
  • Some antibiotics


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If eyes are closed during an episode of vertigo, sensation of spinning or falling occurs.


Vertigo should not be confused with symptoms of lightheadedness or fainting, and it differs from motion sickness which is a feeling of being off-balance, caused by repeated motions such as riding in a car or boat.


True vertigo includes a sensation of disorientation or motion. In addition, the individual may also have any or all of the following symptoms.


  • Nausea/ vomiting
  • Sweating/ dizziness
  • Headaches
  • Head and neck muscle stiffness
  • Abnormal eye movements


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Investigations and Treatment:



  • Inquire if true vertigo exists, such as presence of sensation of motion
  • Duration of vertigo i.e. if they come and go or are constant for sometime
  • Are they related to sudden change in position especially head
  • Associated symptoms such as, nausea, vomiting, sweating or abnormal eye movements
  • Any trauma or injury to the head
  • Ringing in the ears or loss of hearing


Physical examination:

  • Detailed physical exam including the ear and neurological examination is required to evaluate true vertigo



  • Blood test to check sugar levels and ECG may be helpful, if the physician is suspecting the vertigo is due to the decreased blood flow to the brain



Computed Tomography (CT) scan:

  • This device uses x-rays. Patients will lie on a table with the head placed inside of the scanner (resembles a large donut). Computer analysis of x-ray images produces detailed cross- sectional images. The scanning time is usually very rapid (less than 1 minute). The scan can provide detailed images of the brain if the injury is suspected to be a cause of vertigo



The choice of treatment depends on the underlying cause, and may require additional treatment and referrals


  • Infection of the middle ear may require antibiotics
  • Recurrent ear infections may lead to a hole in the ear drum, requiring referral to an ear, nose, and throat (ENT) specialist for surgery
  • In addition to the drugs for benign paroxysmal positional vertigo (BPPV), some physical maneuvers can be used to treat the condition such as:
    • Epley maneuvers: The patient is asked to sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo completely ceases. The maneuver is repeated until the vertigo no longer occurs
  • Vertigo caused by Meniere's disease, in addition to symptomatic treatment, patient may require a low salt diet



These medications should be taken only as directed and under the supervision of a doctor.


The most commonly used drugs include:


1-Vertigo-Patients-Medications-Investigations and Treatment


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Risk Factors and Prevention:



  • Precautions should be taken to prevent injuries from risk of falling due to imbalance caused by vertigo
  • Encourage smoking cessation
  • Individuals with Meniere's disease should limit salt intake


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The prognosis depends on the underlying cause.

  • Middle and inner ear infections are self-limiting, in some cases may require treatment and are completely cured or make the condition tolerable
  • Vertigo caused by a brain tumor or brain injury may need emergency evaluation by a neurologist and/or neurosurgeon


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