Vertigo and Dysequilibrium
Vertigo refers to the sensation of spinning, which usually occurs in attacks. Dysequilibrium is the sensation of being “vaguely off balance” or swaying.
Vertigo is usually due to inner ear problems including:
- Benign Paroxysmal Positional Vertigo (BPPV)
- Vestibular Neuronitis
- Meniere`s Disease
- Labyrinthitis
These can be diagnosed on history and by examining the vestibular system.
Dysequilibrium has multiple causes and further investigation might be necessary, such as an audiogram or MRI scan.
- BPPV – a spinning sensation lasting around 30 seconds on turning over in bed, leaning forwards or looking up. Due to loose otoliths (crystals) in the inner ear. It can be treated in the rooms by doing the correct particular otolith repositioning manoeuvre. Medication is not needed.
- Vestibular neuronitis – Severe vertigo , nearly incapacitating, often with vomiting, for 2-3 days and gradually getting better over 7-10 days. Caused by an inner ear viral infection. Prednisone is given to encourage it to settle and to minimize the chances of damage to the nerve.
- Meniere`s Disease- Swelling and raised pressure of the inner ear fluid. Vertigo attacks last 30 minutes to several hours. Often with vomiting. Maybe associated with muffling of the hearing and tinnitus. Medication or middle ear injections can be used.
- Labyrinthitis. Similar to vestibular neuronitis but with associated hearing loss Disequilibrium is treated with balance exercises in order to allow the brain to compensate for abnormal balance. A careful history and examination of the ears, hearing and vestibular/balance system is needed to determine the cause. Treatment is specific to each diagnosis.