Vertigo: A symptom, not a condition

Vertigo is a symptoms, not a diagnosis

• Vertigo is a perception of movement when there's none. It can be perceived internally spinning, internally non-spinning or externally spinning, externally non-spinning.
• It is a feeling of whirling and loss of balance, especially associated with looking down from a great height, or triggered by the inner ear or vestibular nerve disease; giddiness.

For a start, lets look first look at our Balance Sensory Input.

We have three of them;

1. Balance Organ (Vestibules)

2. Visual (Vision)

3. Somatosensory (Touch, Pressure and Joint Proprioception)

Maintaining balance relies on input from the eyes, muscles and joints, and vestibular organs in the inner ear that the brain receives. You can experience impaired balance followed by other symptoms such as dizziness, vertigo, vision issues, nausea, exhaustion, and focus difficulties when this system is damaged by harm to one or more components through injury, illness, or the ageing process.

There are several Medical Condition that causes Vertigo. They are listed as such;

1. Benign Paroxysmal Positional Vertigo (BPPV)

• Brief spells of external spinning upon lying down and turning head to one side
• May also be provoked at hair dresser or tilting head back to get something from high shelf
• Often repeated episodes over several days or weeks
• Often spontaneously resolve but may recur
• Cause - loose crystal in the balance organ ending up in the wrong chamber
• Treatment - manoeuvre to reposition crystals to where they belong
• 'Cure' is possible but not unusual to have recurrence

2. Vestibular Neuronitis

• Single attack of severe vertigo with nausea and vomiting, lasting from hours to few days
• Vertigo often followed by a period of unsteadiness that can last days to weeks

• Cause by inflammation of balance nerve by viral reactivation feeding to sudden loss or reduction of balance signal in one ear
• Treatment - Early stage of vertigo, injection is used to suppress vertigo. Later stage of imbalance, Vestibular Rehabilitation Therapy

3. Meniere's Disease

• Repeated attacks of vertigo associated with hearing loss, tinnitus (the perception of noise or ringing in the ears) and fullness of the ear
• Attacks last minutes to hours

• Clustering of vertigo attacks with period of no symptoms in between
• Hearing loss, tinnitus and ear fullness tend to resolve between attacks of vertigo
• Longer term - tend to lead to progressive hearing lost
• Cause - 'high fluid pressure in balance in hearing organ'
• Treatment - 'Control & Manage' rather than 'Cure"
• Medication - (1) Prophylactic - Diuretic & Betahistine, (2) Reliever - Vestibular sedatives

4. Motion Sickness

• Very common one
• Due to conflict of sensory inputs between balance organ and vision
• Provoked by; (1) In a bumpy vehicle, (2) Video games especially with VR

• Imagine a situation: We are reading a book or scrolling through our social medias while riding on a bus. When the bus breaks, inertia happens to make us move forward. Here our eyes and our phone move forward together. Thus, our visual organ are telling the brain that we are not moving. Whereas our vestibules are telling our brain that we are indeed moving. With the conflict between the two, our brain starts to get confused, and thus, motion sickness occurs.
• Different individual have different levels of tolerance to balance sensory inputs mismatch
• Extremely common in migraine patients
• Can overcome by looking outside of moving vehicle as much as possible

Further diagnosis is needed in order to identify the correct disease one have. Do seek medical attention if you feel that the vertigo is affecting your daily life.

Credit to Dr Ho Eu Chin from Tan Tock Seng Hospital for giving a webinar about Vertigo on 26th September 2020

References:

1. https://www.houstonmethodist.org/blog/articles/2020/feb/when-vertigo-strikes-what-was-that-and-other-questions-i-needed-answered/
2. https://www.britannica.com/science/ear/The-physiology-of-balance-vestibular-function
3. https://medium.com/intuitive-physics/degree-of-freedom-what-is-the-need-for-this-concept-291364b7f189
4. https://vestibular.org/article/what-is-vestibular/the-human-balance-system/the-human-balance-system/