Vertigo: BPPV and Balance Disorders

Introduction

Vertigo is a subtype of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system. It is often associated with nausea and vomiting as well as a balance disorder, causing difficulties with standing or walking.

Main Document

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo - the sudden sensation that you're spinning or that the inside of your head is spinning. Causes of dizziness related to the ear are often characterized by vertigo (spinning) and nausea.

Vertigo is a serious disease as it increases the risk factor for some serious disorders such as strokes and tumors. Hence, the treatment of the vertigo is a necessity as it may lead to severe imbalance problems.

The 3 Different Symptoms of Vertigo:

• The first is known as objective and describes when the patient has the sensation that objects in the environment are moving.
• The second type of vertigo is known as subjective and refers to when the patient feels as if they are moving.
• The third type is known as pseudovertigo, an intensive sensation of rotation inside the patient's head.

Different Types of Vertigo:

• Peripheral vertigo
• Objective vertigo
• Central vertigo

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The human balance system works with our visual and skeletal systems to maintain orientation or balance. Visual signals are sent to the human brain about the body's position relating to its surroundings. These signals are processed by the brain, and compared to information from the vestibular, visual and the skeletal systems.

Balance Problems related to the ear or the brain include:

• Bilateral Vestibulopathy - a condition caused by loss of inner ear balance function.
• Benign Paroxysmal Positional Vertigo (BPPV) - The most common cause of vertigo described as a brief, intense sensation of spinning that occurs because of a specific change in the position of head, such as getting out of bed in the morning, or getting up from a chair too quickly. (See below for Brandt-Daroff exercises and other exercises to assist BPPV)
• Labyrinthitis - Inner ear infection or inflammation causing both dizziness (vertigo) and hearing loss.
• Meniere's Disease - Inner ear fluid balance disorder that causes lasting episodes of vertigo, fluctuating hearing loss, tinnitus (a ringing or roaring in the ears), or the sensation of fullness in the ear.
• Perilymph Fistula - a leakage of inner ear fluid from the inner ear.
• Superior Canal Dehiscence Syndrome - Loss of balance and hearing disorder caused by a gap in the temporal bone, leading to the dysfunction of the superior canal.

Brain Related Balance Conditions Include:

• CNS or Posterior Neoplasms: Benign or Malignant.
• Degenerative: Age related decline in balance function.
• Infectious: Meningitis, encephalitis, epidural abscess, Syphilis
• Circulatory: Cerebral or Cerebellar ischemia or hypoperfusion, Stroke, Lateral medullary syndrome (Wallenberg's syndrome)
• Autoimmune: Cogan syndrome
• Structural: Arnold-Chiari malformation, Hydrocephalus
• Systemic: Multiple Sclerosis, Parkinson's Disease
• There are other causes of dizziness not related to the human ear:
• Mal de Debarquement - (land legs or sea legs) a disorder of imbalance caused by being on a ship. Patients feel sea sick even when they get off the ship.
• Motion Sickness - a conflict between the input from the various systems involved in balance causes an unpleasant sensation.

How to Treat Vertigo

There are various options for treating balance disorders. One option includes treatment for a disease or disorder that may be contributing to the balance problem, such as ear infection, stroke, or multiple sclerosis. Individual treatment will vary and will be based upon symptoms, medical history, general health, examination by a physician, and the results of medical tests. Most types of balance disorders will require balance training, prescribed by a physiotherapist.

The disease is usually treated symptomatically since it will help to reduce the severity of manifestations. The issue is in the inner ear, which includes dislocation of calcium crystals and infections such as Benign Positional Paroxysmal Vertigo (BPPV) and can be treated with certain exercises such as physical maneuvers. However, brain damage or cardiac concerns are more serious and hence have to be treated cautiously.

Particle repositioning maneuver is a specific treatment for vertigo caused by mis-positioning of calcium carbonate crystals. In the treatment, the head has to be moved in such a manner to reposition the crystals and to give relief from the symptoms of imbalance.

Drugs for the treatment of vertigo can be administrated orally, through intravenous injections or patches in the skin. In case of any bacterial infections, antibiotics are preferred to stop the further complications. Meclizine hydrochloride, Diphenhydramine, Promethazine Hydrochloride, Diazepam, and Scopolamine transdermal patch are some commonly used for the treatment of vertigo.

Exercises for BPPV

Exercises for vestibular rehabilitation are also used as remedy for vertigo in which the patient repeatedly undergoes the position change from lying state to sitting and vice versa. This is repeated until the patient has recovered completely and, most often, the recurrence of the disease will not occur.

In serious cases, surgery in the inner ear to insert a plug is recommended to overcome the disorder. It has high success rate and only 5% of people have to repeat the treatment.

Rest is the immediate solution to vertigo, as soon as the symptoms are felt. Use of a cane is also sometime necessary to retain steadiness and balance. A patient with a tendency for vertigo must be prudent to adjust their movements at a slow pace.

Exercises are a method of treating BPPV (Benign Paroxysmal Positional Vertigo). Exercises include the Epley — Brandt-Daroff exercises — Semont Maneuvers. These maneuvers are effective treatment in that they help speed up compensation by the brain. When these maneuvers work, they can relieve the symptoms of vertigo quickly.

Balance Disorder Statistics

One recent large epidemiological study estimates that as many as 35% of adults aged 40 years or older in the United States, approximately 69 million Americans, have experienced some form of vestibular dysfunction.

• Balance disorders are the number one health complaint of patients over age 70.
• Falls account for 50% of accidental deaths in the elderly, and 10% of falls result in hospitalization.
• Mild to severe head trauma is a leading risk factor for dizziness, with 2 million new cases of traumatic brain injury every year.
• Nearly 20% of Americans 65-75 years of age currently have a balance disorder, with that number increasing to 25% by age 75.
• Less than 10% of patients with balance and vestibular disorders are ever evaluated by a specialist (audiologist, otologist, otolaryngologist or neurologist).
• Falls are the leading cause of injury deaths among people over 65. The costs to the Medicare and Medicaid programs and society as a whole from falls by elderly persons continue to climb much faster than inflation and population growth.
• 90 million Americans go to health care providers because of vertigo, dizziness, or balance problems. It is the second most common complaint heard in doctor's offices, and will occur in 70% of the nation's population at sometime in their lives.
• Although adults are typically plagued with dizziness and vertigo disorders, children also experience dizziness and vertigo. Children may be affected more than adults, and this prevents normal childhood activities that range from athletics to playground activities. The most common cause of childhood vertigo is benign paroxysmal vertigo of childhood.
• Vertigo can be caused by both peripheral and central vestibular deficits. About three-fourths of vestibular disorders are peripheral (inner ear and vestibular nerve). The most common peripheral vestibular disorder is benign paroxysmal positional vertigo, followed by uncompensated Meniere disease, vestibular neuritis, labyrinthitis, perilymphatic fistula, and acoustic neuroma. Central vestibular deficits cause about one-fourth of dizziness. The most common central causes of dizziness and vertigo are cerebrovascular disorders, cerebellar disease, migraine, multiple sclerosis, tumors of the posterior fossa, neurodegenerative disorders, medications, and psychiatric disorders.

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