Woman with vertigo. Young female patient

VERTIGO

Many different factors can affect the inner ear and cause vertigo.

One way to distinguish them is by the duration of the dizziness.

Short Episodes (few seconds to minutes).

Condition and Symptoms

An extremely common type of vertigo is benign paroxsysmal positional vertigo (BPPV). This is typically a very sudden onset of dizziness, which settles rapidly after a few seconds or at most a couple of minutes.

It is often started when the person suddenly looking upwards or sideways, and some people describe vertigo when they turn over in bed. In between attacks, the sufferer feels entirely normal. 

Treatment

Mrs Bentley will be able to diagnose this type of vertigo at the initial consultation. She can then perform a specific manoeuvre (Epley’s Manoeuvre) which can be extremely effective in selective patients with this form of vertigo.

Medium Episodes (half-hour to several hours)

Condition and Symptoms

These types of vertigo are rarer and are thought to be due to an increase in pressure of the fluid in the inner ear.

Menière's disease or endolymphatic hydrops result in episodes of severe vertigo that can last up to several hours. The dizzy episodes are usually linked with vomiting and the sufferer can often tell an episode is about to start because he or she notices a drop in their hearing, a feeling of fullness in the ear and some tinnitus. The hearing recovers once the vertigo has settled, but may gradually deteriorate with time.


Menière's Disease

Condition and Symptoms

This is a longer-term disease and there are two aims of treatment. One is to treat the acute episodes of dizziness with vestibular sedatives (see above), and the other is to try to reduce the frequency of the dizzy episodes.

Treatment

Mrs Bentley might advise dietary changes eg restrict intake of salt, caffeine and alcohol, which can help some patients with Menière's disease. Increasing the bloodflow of the inner ear may help and so drugs like Betahistine (Serc) are often prescribed.

Some people with Menière's disease may benefit from surgery if the episodes of vertigo are frequent and disabling and not responding to medical treatment.

Longer Episodes (days to weeks)

Condition and Symptoms

An infection of the inner ear (labyrinthitis) or an inflammation of the balance nerve (vestibular neuronitis) can give rise to severe rotatory dizziness for up to two to three weeks, with a slow return to normal balance which can take a further few weeks.

Again, the initial episode is often associated with vomiting and the patient can be bed-bound because the dizziness is so severe. 

After a thorough consultation and examination of the balance system Mrs Bentley often commences treatment with a vestibular sedatives and vestibular physiotherapy.

A full history will be taken, and full examination including balance testing. Hearing tests, blood tests (rarely) and radiological examinations such as an MRI scan or CT scan might be requested.

Treatment

In general, Mrs Bentley will target the treatment of vertigo towards the symptoms. The body is very good at overcoming the imbalance experienced during inner ear disease, and so symptomatic treatment is usually short-lived and specific exercises will be advised often in the form of Cawthorne-Cooksey Exercises.

There are specifically targeted exercises to speed up the brain's natural compensation after inner ear disease. 

Mrs Bentley may prescribe vestibular sedatives to reduce the overactivity of the balance system and so reduce the dizziness and vomiting that can occur in inner ear problems.