Vertigo and dizziness

It can be hard to differentiate between vertigo and dizziness, and the two terms are often used interchangeably. However, they are not exactly the same. Dizziness is a broad term commonly used to describe lightheadedness, weakness or unsteadiness. Most of us have experienced dizziness before, from things as simple as dehydration, low blood sugar or alcohol consumption.

Vertigo, on the other hand, is less common than dizziness. What you experience during a vertigo attack is a very particular type of dizziness — a false sensation of movement that often feels like the world around you is spinning.

The symptoms of vertigo in adults may vary from case to case depending on the type of vertigo experienced, but some of the most common symptoms include:

• A sensation that the world around you is spinning or moving even though you are perfectly still
• Dizziness
• Feeling unsteady or unbalanced on your feet
• Lightheadedness
• Feeling generally faint
• Headaches
• Nausea
• Vomiting
• A ringing in the ears
• Hearing loss
• Abnormal eye movements
• Sweating.

Some people may find that certain activities or movements can trigger a vertigo attack. Identifying any potential triggers, such as bending over or looking up, can be useful as you learn how to deal with vertigo symptoms.

The causes of vertigo are typically defined as being central or peripheral. Common causes of peripheral vertigo are issues affecting the inner ear, including:

• Benign paroxysmal positional vertigo, where certain movements cause vertigo attacks that are short yet recurrent and intense.
• Ménière's disease, where too much fluid accumulates in the inner ear.
• Vestibular neuronitis, where the nerve connecting the labyrinth (a structure inside the ear) to the brain gets inflamed.
• Labyrinthitis, where the labyrinth itself becomes inflamed.
• Certain medications. If you suspect this is the case, speak with your doctor to potentially find an alternative drug.

Central vertigo is caused by issues with the spinal cord or brain, which might be:

• A concussion or head injury
• A stroke or transient ischemic attack
• Migraines
• Multiple sclerosis
• Brain tumours.

There are also lifestyle and environmental factors that can trigger vertigo:

• Stress. When we feel stressed or anxious, our bodies produce higher levels of cortisol, histamine and other hormones. These hormones can make it harder for signals to travel between the vestibular system and the brain, increasing the risk of experiencing vertigo symptoms.
• Atmospheric pressure. A drop in atmospheric pressure may lead to a higher prevalence of vertigo symptoms among those living with conditions such as Ménière's disease. However, not everyone will be affected in the same way, if at all.
• Dehydration. When you become dehydrated, your blood pressure falls, potentially leading to feelings of dizziness. This can also happen after you stand up too quickly.

As diagnosing vertigo may not be as straightforward as some other common ear conditions, your health professional may recommend a suite of tests to help determine the cause of your symptoms.

In addition to a thorough examination of your medical history, some tests that may be recommended to assist in a vertigo diagnosis include:

• A physical examination of the ears and eyes
• A blood pressure check
• Hearing and balance tests
• Medical imaging, including CT scans and MRIs

When attending an appointment to investigate your vertigo diagnosis, it’s a good idea to have some notes on hand detailing when the symptoms started occurring, how often they occur, how long the symptoms last and any foods or actions that you believe may trigger an attack.

Vertigo treatments can vary depending on the root cause of the condition. Potential treatments include:

• The canalith repositioning manoeuvre. Also known as the Epley manoeuvre, this is a type of exercise where you lie down and a health professional tilts your head from side to side, following a specific routine, helping to move calcium carbonate deposits from the ear canal to the inner ear. You can also perform this manoeuvre at home.
• Vestibular rehabilitation therapy and other balance exercises. Vestibular rehabilitation therapy is an exercise-based treatment for vertigo, which you can do with the assistance of a physical therapist or at home. Depending on your symptoms, it may include eye movement exercises, balance retraining, stabilisation exercises, stretches, and the above-mentioned canalith repositioning manoeuvre.
• Medications, including anti-nausea medications, motion sickness medications, migraine medications and steroids. You may also be prescribed antibiotics if an infection is found to be the cause of the symptoms.
• Cognitive behaviour therapy and counselling. Some research suggests that CBT, a type of talk therapy, can help minimise dizziness, with one study stating that it “has a limited long-term effect on phobic postural vertigo”. However, more research is needed to confirm how effective this type of therapy is at treating vertigo
• Avoid triggers. If you’ve noticed that specific foods, movements or positions lead to the onset of a vertigo attack, look to avoid them. Additionally, minimising your consumption of certain substances, such as alcohol, caffeine, and excess salt, may also reduce the severity of vertigo symptoms.
• Surgery, although it is only required in a few cases. The type of surgery recommended will depend on what’s causing the vertigo; for instance, if you have Ménière's disease, your doctor might recommend an endolymphatic compression, whereas if you have otosclerosis, they might discuss stapes surgery instead.

The type of vertigo you experience, and the accompanying symptoms will help inform your healthcare professional of the best care plan for your individual needs.

It’s also worth noting that some people who experience vertigo may find that the condition improves over time without medical intervention, while others experience repeated episodes that require some form of vertigo treatment.

When attending an appointment to investigate your vertigo diagnosis, it’s a good idea to have some notes on hand detailing when the symptoms started occurring, how often they occur, how long the symptoms last, and any foods or actions you believe may trigger an attack.

Vertigo can be an overwhelming experience, but with the right treatment, you can manage it effectively. If you’ve been experiencing vertigo attacks and want to take the next step in your hearing health journey, book an appointment with Bay Audiology, and our hearing specialists will help you find a solution that works for you.

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• https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/home-epley-maneuver
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259492
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• https://dizziness-and-balance.com/treatment/psychiatric/CBT.html
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