Vertigo is a symptom of a disordered system of balance. It is strictly defined as a hallucination of movement. Patients do struggle to describe their symptoms very precisely and they present to me with symptoms that they describe ranging from dizziness, lightheadedness, problems with coordination, movement and occasionally a patient will present following a fall. You need to work out from the patient’s symptoms precisely what they’re describing and which body part that’s likely to be associated with. The symptom of vertigo can arise from disorders in many different parts of the body. Our balance function is coordinated by the brain and the brain is central to the process of maintaining balance.
However, the brain receives signals from our eyes giving us information on our orientation and space. In addition, the brain receives signals from the inner ear in relation to our movement, and input is also from sensors within our joints and within the soles of our feet. The brain takes all of this information, analyses this information and using this information maintains our state of balance function. Vertigo can be a symptom of disease in many different parts of the body. I most commonly deal with inner ear disorders and vertigo is a characteristic feature of diseases of the inner ear. But in addition, these symptoms of balance disturbance and vertigo can also arise from diseases of the brain and conditions that affect our ability to maintain our position in space. Any impairment of vision can result in poor balance and any conditions affecting our limbs and our mobility, such as arthritis or peripheral neuropathy can also result in difficulties with balance and give rise to symptoms of vertigo. When you meet a patient with vertigo, you need to work through the history and the story with the patient, working through the three common systems that can give rise to the symptom. If the disease is affecting the inner ears, patients will often present with associated hearing loss, tinnitus or problems with discharge or infection in the ears. The next most common system to be involved in patients with balance disturbance is the neurological system. With one of the commonest conditions I see being an association with migraine. And these patients would present typically with headaches and visual disturbance.
Patients with balance disturbance may have problems with their cardiovascular system. And these will be patients who are complaining more of lightheadedness, may have a history of palpitations, heart disease, minor strokes or even blackouts. My particular interest is in managing patients with inner ear causes for their vertigo. By far the commonest cause that I come across as a condition called benign positional vertigo. This condition results from degeneration in the inner ear causing free-floating particles to be symptomatic within the balance canals. This condition can be very effectively treated by repositioning manoeuvres and patients typically require just one or two treatments with the vast majority following this having complete resolution of their symptoms. The next most common condition that I would treat would be Meniere’s disease. This results in hearing loss, balance disturbance, fullness in the ear and tinnitus. The vertigo can be effectively controlled by medical treatments, injections and occasionally surgical procedures on the ear.
Finally, I see many patients who’ve lost inner ear function either as a result of trauma or viral infection. Typically, these patients will present with an initial acute vertigo and then a more chronic balance disturbance. My management of these patients is to use Vestibular Rehabilitation Therapy, which is a form of exercise treatment which can be extremely effective but may take many months before a significant or complete recovery is achieved.