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Causes of Vertigo Symptoms

So, you have vertigo and are dizzy

    About 80% of our practice time is spent treating patients with vertigo symptoms and treating patients with chronic dizziness.  Most of these patients have failed conventional medical therapies and come to our office to help cure their dizziness, typically as a last resort before giving up all hope. Most have been misdiagnosed with labyrinthitis and given Meclizine as a course of drug therapy destined to fail.  Worse still, Meclizine increases the probability of a fall associated with imbalance significantly, thus increasing morbidity associated with a fall from unexpected balance loss associated with Meclizine drug therapy, prescribed inappropriately as treatment of  dizziness.  Unfortunately, this is currently the accepted medical approach to treatment of vertigo and treatment of dizziness.  Most of these patients, following failed therapy, will report to our office for evaluation, either by referral or other.  Fortunately, the vast majority of these patients do report improvement of dizziness and improvement of vertigo symptoms within two or three visits, with most achieving complete recovery within 3-5 visits.  On average, our patients report seeing 6 medical specialists prior to visiting us.  They typically have a roster of lab tests, such as MRI, audiology, etc.  (Reference comments in our guest book).

    If this describes you or someone you love, then we invite you to come in for a free consultation, one on one with the doctor, no cost, no obligations.  Just discuss your situation and get answers to questions that you may have prior to considering treatment of your vertigo symptoms and dizziness.  We will also provide you with a free balance and stability/fall risk assessment. (Reference Our Vestibular Laboratory; CAPS assessment).

    You would be well served to know that we now offer a FREE report for vertigo and dizziness victims.  You can now receive an electronic version of this report simply by clicking on My FREE Vertigo Report.  You can also access the link to the free report simply by joining our E-News Service.  Our E-News is free and you may unsubscribe at any time.

   For those of you who would like to know more regarding various causes of vertigo and dizziness, read on...

Common Balance Conditions Which Are Commonly Confused

Vertigo Symptoms

Vertigo symptoms are always associated with a "spinning" sensation. Nausea and vomiting are typical.

Disequilibrium  and Imbalance

Disequilibrium, or imbalance, is never associated with the spinning sensation associated with vertigo symptoms.  Typically associated with a "drunken" gait and sense of balance loss. Nausea and vomiting can also occur with Dysequilibrium and imbalance.

Dizziness Symptoms

Dizziness symptoms are typically associated with a "lightheadedness", (like head congestion associated with allergies/cold), or a feeling of being close to passing out. Nausea and vomiting can also occur with dizziness.  This is most often confused with vertigo symptoms and disequilibrium/imbalance.

Untreated vertigo invariably leads to dizziness and dysequilibrium due to central compensation of the nervous system.

Benign Paroxysmal Positional Vertigo, (BPPV) as a Cause of Dizziness

    By far, the most common cause of vertigo symptoms is benign paroxysmal positional vertigo, commonly abbreviated BPPV.  Unfortunately, it is also the easiest cause of vertigo symptoms and dizziness to manage and in reality, the most commonly mismanaged.  Positional vertigo, or BPPV, is most often treated, inappropriately, with drug therapy.  Positional vertigo/BPPV cannot be treated with drug therapy, leaving those afflicted with the condition frustrated after being given medication, typically a vestibular suppressant, (Meclizine), only to find that their dizziness and imbalance symptoms oftentimes become worse. This is due to the fact that a vestibular suppressant is going to do just that, suppress the vestibular system.  In doing so, you decrease your ability to maintain balance, and increase your likelihood to lose you balance, i.e. fall.  So now you have two problems, vertigo symptoms and imbalance, or dysequilibrium. This invariably leads to a fall. Falls are among the leading cause of death and nonfatal unintentional injuries, in all age groups.  Treatment of positional vertigo, (BPPV), with drug therapy is therefore inappropriate and destined to fail.

What is BPPV/Positional Vertigo?

    Benign Paroxysmal Positional Vertigo, (BPPV), causes vertigo symptoms due to debris, (otoconia), within the semicircular canal of the inner ear. Small crystals of calcium carbonate, derived from structures in the ear called otoliths become damaged by head injury, (Motor vehicle accidents #1 cause), infection, or other disorder of the inner ear, or degenerated because of age.

    Symptoms of BPPV/positional vertigo invariably include a spinning sensation, (vertigo symptom), typically associated with head movements.  However, the presence of same does not necessarily mean a diagnosis of positional vertigo/BPPV.  As many disorders cause similar findings of vertigo symptoms or dizziness symptoms, we always examine prior to treating.  

Treatment of Positional Vertigo, (BPPV)

    Treatment of positional vertigo/BPPV is fast, efficacious and painless, if performed by someone properly trained to treat vertigo and dizziness.  The vast majority of our patients with positional vertigo/BPPV are cured in 1-2 treatments.  Less then 5% have had recurrence of vertigo, and they were cured with additional treatment.  As with all vertigo type disorders, occasionally follow-up treatment is advisable to correct associated dizziness and imbalance/disequilibrium caused by the episodes of vertigo.  

    It should also be noted that treatment of vertigo symptoms provided by those less than adequately trained to treat vertigo symptoms, will provide less than adequate outcomes.  Further, self treatments, often available off the internet, or from friends who know a friend who has a brother whose sister had similar vertigo symptoms... often just antagonize vertigo symptoms, which increases imbalance.  Treatments for this disorder are exacting, and if not performed as such, they will just antagonize and thus amplify vertigo symptoms and imbalance.  You can see that this is less than desirable.

Other Cause of Dizziness and Vertigo Symptom Type Disorders

    As vertigo symptoms can be caused by anything affecting the natural left to right balance of input from the inner ears to the brain, it is imperative that a proper examination be performed prior to the undertaking of any treatment of vertigo symptoms. Most patients with vertigo symptoms and dizziness are mistreated with drug therapy, only to find their dizziness worsening. Vertigo symptoms and dizziness disorders can only be properly treated thought proper vestibular rehabilitation, and this must be performed in accordance with the actual loss for beneficial results to occur.  As dizziness and imbalance are commonly caused by vertigo symptoms, a complete course of treatment should address those afflicted with dizziness or vertigo symptoms.

Perilymph Fistula; As a Cause of Dizziness and Vertigo Symptoms

    Perilymph fistula is in essence a defect in the oval window, (the small membrane that separates the middle ear from the inner ear). Changes in middle ear pressure will directly affect the inner ear thus causing vertigo symptoms.  Symptoms of a perilymph fistula include episodic vertigo. Head trauma is the most common cause of perilymph fistulas, or, following rapid changes in atmospheric pressure.  Treatment is based on accurate diagnosis and can usually be successful in a single visit.  Occasionally follow-up treatment is advisable to correct associated dizziness and disequilibrium caused by the vertigo induced from a  perilymph fistula.

Ménière's Disease; As a Cause of Dizziness and Vertigo Symptoms

    Meniere's Disease is a disorder characterized by episodic vertigo, dizziness and tinnitus, (ringing in the ear), and progressive hearing loss, usually but not always in one ear. It is caused by an increase in volume of the endolymphatic fluid and thus pressure in the inner ear.  There is no known cure for this disorder and profound cause of vertigo symptoms.  Ménière's management can be afforded through specific Meniere's dietary measures, and using specific vestibular rehabilitative techniques, specific to the expression of symptomatology.  Using this approach, symptoms of vertigo and dizziness can be reduced and often relinquished.

Dizziness

    Dizziness, ironic as it may be, is the number one side affect of any drug that you look up in the PDR. (Physician's Desk Reference), including Antivert, (meclizine), the number one prescribed drug for vertigo symptoms and for dizziness symptoms.  It can be a complication to cardiac disorders, a complication of aging, associated with a motor vehicle accident, and associated with many neurologic disorders.  Many patients suffering with dizziness can be managed conservatively without drugs depending on the underlying cause.

    Our sensation of balance is derived from all of the sensory inputs to the brain. Visual input from the eyes gives the brain information regarding body position relative to the external environment. The inner ears are composed of the semicircular canals and the otolith organs. The semicircular canals detect angular acceleration of the head and the otolith organs detect linear acceleration of the head. The semicircular canals are oriented in the x, y and z planes, (pitch, roll & yaw), so that head motion occurring within those planes will stimulate or inhibit sensory input leading from the semicircular canals toward the brain. The muscles in our legs, back and neck are always correcting, continually contracting and relaxing depending on the earth’s gravitational field and the contour of the terrain we find ourselves in. The constant change in the state of the contraction of these muscles is reported back to the brain. This kind of input is referred to as proprioceptive input. The brain uses the visual , inner ear and proprioceptive inputs to allow us to perceive a sense of balance.

    Dizziness can occur from disorders of central regulation, from cardiac disorders and from other body systems as well.

Vasovagal Disorder; As a Cause of Dizziness and Vertigo Symptoms

    A common cardiac cause of dizziness is vasovagal syndrome, or, presyncope, (almost fainting).  Dizziness associated with presyncope occurs when an individual lies down, and the carotid stretch reflex sends a message to the brain to tell the heart to slow down, as blood flows naturally into the head in this position.  Upon standing up, the same reflex now triggers the heart to increase its rate so that blood can be efficaciously pumped up to the head.  In patients with vasovagal disorder/presyncope, this reflex is delayed, causing a dizziness called presyncope.  Presyncope is a feeling that you are about to pass out.  This occurs because it is taking to long to get blood to the head.  Presyncope dizziness is easily corrected, when properly diagnosed.

Panic Disorder and Anxiety Disorder

    By definition, a panic attack is an event of fear.  The fear may be real, or in most instances, not real.  However, the brains reaction is very real with an autonomic reaction of "Fright, Fight, Flight".  As with real fear, this is accompanied by palpitations, (pounding heart) tachycardia, (accelerated heart rate), chest pain, sweating, shortness of breath, nausea, dizziness, hot flashes and parasthesias, (numbness and tingling typically at the limbs, or lips).  More serious reactions can involve vasovagal presyncope, (almost fainting), or, syncope, (fainting).

    Proper management always depends on proper diagnosis.  Dizziness often has multiple causative factors and treatment can be more difficult than with other forms of balance disorder, but as each cause is isolated and rehabilitated, success can be achieved.

Reference Accounts

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Also reference comments made by real patients in our guest book.