Vertigo: recognition and treatment

In 90% of cases, vertigo is due to changes in 2 organs, the ear and the brain. These different types of vertigo that can be distinguished from a clinical point of view, i.e. during the specialist appointment, at the same time require also instrumental investigations for a more appropriate diagnosis.

Peripheral vertigo

“It is called peripheral, when it is caused by a vestibular problem of the inner ear, of which the most frequent is benign paroxysmal positional vertigo (BPPV). This type of vertigo, linked to the movement of the head, leads a person to lose a perception of their head in space. This sensation stops a few seconds after the movement of the head stops.

The cause of BPPV is linked to a detachment of small crystals of calcium oxalate, called otoliths, from the vestibular apparatus inside the ear, which would cause this vertigo every time a movement is made. This phenomenon is called cupololithiasis.

When these otoliths, as a result of a trauma, sports accidents, familiarity or other causes, detach from the structure that holds them together, they cause anomalous disorders that by touching other parts of the inner ear, transmit a different signal to the brain from one ear to the other. If two different signals arrive in the brain, vertigo is generated, since the two signals are not synchronized,” explains Dr. Bassi.

In addition to benign paroxysmal vertigo, there is also a pathology of the nerve which, once known as labyrinthitis, is now called vestibular neuronitis. It is an inflammation or ischemia of the vestibular nerve that connects the labyrinth (i.e. the set of canals that make up the vestibular apparatus of the inner ear) to the brain. This connection, used to regulate balance, if damaged, causes the sensation of vertigo. More often, vestibular neuronitis has a viral inflammatory origin.

Central vertigo

“Central vertigo, on the other hand, derives from a problem of the brain (more frequently from the brain stem or cerebellum) and can sometimes be a sign of even more serious diseases, such as:

• those of an inflammatory nature, for example, multiple sclerosis;
• neoplastic, for example, brain tumor;
• vascular pathologies, for example, cerebral ischemia, stroke”.

The pseudo-vertigo

“In addition to peripheral and central, there are also pseudo-dizziness, or feelings of instability that have different characteristics compared to real vertigo (especially sense of instability when walking). More frequently, this instability has a microvascular origin”.

The most important risk factors related to the onset of vertigo are:

• incorrect posture and habits;
• hypertension;
• diabetes;
• wrong nutrition;
• ototoxic drugs (i.e. harmful to the ear).

The symptoms that accompany the sensation of vertigo, in addition to spatial disorientation, can also include:

• nausea;
• vomit;
• loss of balance;
• nystagmus, that is, oscillating movements of the eyes;
• hearing disorders;
• fall to the ground.

Duration of dizziness varies and depends on the cause. It can appear both gradually and suddenly and, if frequent, they must lead the person suffering from it to contact an expert as soon as possible.

"The specialists to whom we turn to, are the otolaryngologist and the neurologist and it is not uncommon for them to work in close synergy. The first step is certainly an objective examination that will direct the specialist to prescribe the most suitable diagnostic path.

It is important to evaluate the external auditory canal and the nystagmus analysis to test the involuntary movements of the eyeballs.

The figure of the otolaryngologist is essential to exclude more ‘trivial’ pathologies (e.g. earwax plug, rupture of the eardrum) and refer the patient to the neurologist, who will investigate that particular pathology through specialist examinations.

Almost always we proceed with diagnostic imaging. MRI provides the specialist with more detailed images of the internal organs and tissues of the human body and compared to CT, which was used more in the past, it is safer because it does not use ionizing radiation, which is more harmful to health” - explains Dr. Bassi.

The treatment of vertigo varies according to the origin of the disorder:

• benign paroxysmal positional vertigo (BPPV): therapy consists in liberating maneuvers such as the Hallpike maneuver, the most frequent, useful to lead the otoliths to a point where they can no longer harm by restoring person's balance. These particular maneuvers must be performed only by experienced specialists. They provide for a number of sessions that can vary depending on the number of otoliths scattered in the inner ear. Healing can happen very quickly or within a few weeks or months.
• vestibular neuronitis, i.e. inflammation of the nerve: drug therapy is used with addition of specific drugs such as cortisone, antihistamines or neuroleptics.
• central vertigo: it is necessary to investigate the causes of the illness more thoroughly, treating them with targeted therapies.

In addition to these indications, it is advisable to apply some useful behaviors from a preventive point of view, such as:

• avoid sudden movements with the head;
• avoid getting out of bed too quickly;
• avoid turning around with the only movement of the neck when, for example, you are called;
• avoid, as far as possible, stressful situations that could make the symptoms arise or worsen.