Balance depends upon co-ordination between the nervous system and the senses. It’s a complex interaction. Eyesight provides input about the surroundings. Skin, muscles and joints tell us about the body’s position and our orientation in space, and the inner ear’s vestibular system tells us about equilibrium, spatial position and rotation or linear movement.
When the brain processes all this information, the body is able to maintain its balance and move without falling. The whole process occurs automatically and continually, which is the only reason activities like ballroom dancing, ice skating and ballet are feasible.
Dizziness is a feeling of lightheadedness, fainting or spinning, and vertigo is one of the most common types of dizziness. It is the sensation of motion where there is none, or an exaggerated sense of motion when moving.
Nausea, vomiting, pallor and perspiration can accompany vertigo, and vertigo can be acute, chronic or recurrent. About 1.5 million Canadians have a diagnosis of vertigo, while about a third of the population report they have experienced dizziness.
Unfortunately, these numbers are only guesses because many people do not seek medical attention and in other cases, the symptoms may clear before the patient seeks medical attention.
The vestibular system in the inner ear is responsible for balance when moving. It is filled with fluid and lined with hair cells, and it looks like three concentric circles each with a different orientation.
When movement occurs, the fluid in the vestibular system also moves, and these movements stimulate the hair cells. Think of how the waves from behind a motorboat hit the shore. The hair cells are linked to the nervous system which uses this information to interpret balance.
Benign paroxysmal positional vertigo accounts for 20 to 40 per cent of all vertigo cases and is thought to be the result of infection, surgery, trauma or even inflammation of the inner ear.
Debris or small crystals are found in the semicircular canals of the inner ear. With this condition, bouts of vertigo occur, especially with head movement. However, the vertigo can clear on its own or alternatively become chronic. Physical manipulation by a trained professional can reposition the fluid as well as the debris or particles, thereby resolving the problem. This non-drug approach is usually more successful than medication.
Meniere’s disease is probably the most familiar type of vertigo, although it is actually only the second-most common type. It is thought to be the result of circulation problems, viral infections, an allergy, an immune system problem, migraine headaches or even a genetic trait.
There can be an aura or warning that the dizziness will occur, and common symptoms include fluctuating hearing loss, tinnitus or ringing in the ears, and a feeling of fullness. The onset is usually abrupt with episodes lasting for about 30 minutes. Current thinking is that increased pressure in the inner ear is the cause, so treatment is aimed at reducing pressure, for example with a low salt diet, avoiding caffeine, smoking cessation, diuretics or water pills.
Betahistine is the most commonly used drug for vertigo, and it is believed to help stabilize the vestibular system. It has mixed results and can cause drowsiness and gastrointestinal side effects. Taking it with food can reduce these symptoms.
Historically, benzodiazepines and flunarizine were used to reduce vestibular excitability, but today these drugs are not considered effective. For the nausea that can accompany vertigo, anti-nausea drugs like dimenhydrinate tablets and scopolamine patches are usually recommended.
Ideally, any underlying causes for vertigo should be investigated and corrected, but some cannot be, for example older age, family history, previous head trauma.
Other contributing factors can be addressed and treated, for example high blood pressure, heart disease, diabetes, smoking, diminished eyesight or hearing, and alcohol consumption.
The key take-home is this: Vertigo is definitely a condition that should not be dismissed because it can lead to falls and broken bones! Don’t ignore it.