Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Coping With Vertigo

What is vertigo?

Attacks of vertigo are something that many people suffer especially as they grow older.  It is a sensation of movement when the head and body are actually still.  The sensation may be one of falling or, more commonly, that either you or the room is spinning.  This vertigo, or dizziness, may be accompanied by nausea or vomiting.

What causes vertigo?

The inner ear contains a sensitive mechanism filled with liquid, which moves when the head changes position and stimulates hair cells with crystals to result in messages being sent to the brain.  This is how the brain can tell if, and how, the head is moving, even in the dark or when the eyes are shut.

Vertigo results from malfunction of this mechanism; a conflict in the information received by the higher centres of the brain from the three principal inputs from the inner ear balance mechanism, the eyes and the “dorsal columns”, which provide positional sensation information to the brain leads to a “sensory mismatch” and the unpleasant sensation of dizziness.  This may involve rotational vertigo, usually horizontal rather than vertical, or an unsteadiness which may be related to movement (positional vertigo).

The commonest cause of vertigo is Benign Paroxysmal Positional Vertigo (BPPV).  This is most likely due to a change in the crystals in the inner ear balance receptors which classically produces a “positional vertigo”, with precipitation of symptoms by head movement.  Vestibular Neuronitis may follow a viral infection and involves clusters of attacks of vertigo which – generally – gradually reduce in frequency and severity.  Increase in pressure of the inner ear fluids (endolymphatic hydrops) may produce a constellation of symptoms which can include associated alteration of hearing acuity and tinnitus, often termed “Meniere’s Disease”.

What can I do about it?

Full examination and investigation by an ENT specialist is essential to diagnose the problem, exclude more serious pathology and to direct treatment and management.  Tests may include blood assays, audiological tests, imaging, such as MRI scanning (often open MRI or CT if claustrophobic) and – rarely – vestibular tests.

Certain measures can help to avoid vertigo attacks, or at least, make them less frequent or severe.  Cigarette smoking causes spasm in the blood vessels, which can aggravate the condition and stopping smoking may be beneficial.  Avoidance of sudden changes in position, for example, in the morning getting up slowly, may help.  Not moving the head quickly can avoid triggering an attack of vertigo.  Low salt diets are advised by some doctors – it is important that you seek your doctor’s advice on the subject.  If a low salt diet is recommended it may be necessary to reduce the amount of salt used in cooking or substitute it with an artificial salt.  An excessive amount of alcohol can induce vertigo even in a healthy person! Certain exercises have been designed to help sufferers to build up tolerance to vertigo.

How is it treated?

There are a number of effective treatments for vertigo and your doctor will want to try you on one or more of these.

Medication

It is important that you take the full course of treatment which your doctor has prescribed even if you think it may not be working.  Some medication is a treatment for the underlying condition, which is the cause of the vertigo.  Because of this, it may take some time before you notice an improvement in your symptoms.