Almost all people experience vertigo throughout their lives. Children in the first years of life and after gaining the ability to stand and walk can move around for a fairly long time without feeling any trouble. As they grow older, the duration of these rotations decreases, because with the maturity of the vestibular system and its central connections, the child feels dizzy and imbalance, which is unpleasant and causes him to fall. This example shows that even normal people experience vertigo. But the cause of this dizziness is the movement of the inner ear fluid and, consequently, the movement of the eyes. After stopping of the rotation, due to the movement of the fluid in the inner ear, the eyes continue to move, and the person falsely feels that the surrounding area is moving and rotating. This type of eye movement is called “nystagmus” which is seen as the result of continuous rotation or disorders that damage inner ear structures. Moreover, central disorders can lead to nystagmus, dizziness and imbalance.
The most common inner ear diseases that cause vertigo include benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuritis, superior semicircular canal dehiscence (SCDS), perilymphatic fistula and otitis media. Central nervous system disorders such as vestibular schwannoma, vertebrobasilar insufficiency, multiple sclerosis and vestibular migraine are the common causes of dizziness and vertigo.
In cases of acute vertigo, such as attacks of Meniere’s disease and vestibular neuritis, due to severe and intolerable vertigo, the patient often refers to the doctor. But the important thing about dizziness and vertigo is that in many cases, due to the ability of the central nervous system to compensate for the lesion, the severity of symptoms is reduced. This issue is not due to recovery of the lesion, and shows the adaptation of central nervous system. This issue hides the underlying cause of dizziness and vertigo (such as vestibular schwannoma and vestibular neuritis) and consequently creates some challenges in treatment process. Therefore, vertiginous patients must refer to physician, and if needed, they should be evaluated by videonystagmography and electrocochleography in order to correctly diagnose the cause of vertigo. At this stage, necessary therapeutic interventions would be conducted.