Vertigo is the sense of whirling or spinning. This spinning could be related to the objects around the patient or could be felt inside the head. Moreover, sometimes vertigo is sensed only when the person is moving.
An important point is that vertigo is only one symptom of different possible disorders. Therefore, at first the cause of vertigo must be recognized and then treatment of vertigo would be possible.

Dizziness is a catch-all term which includes a wide range of symptoms attributed to vertigo and imbalance while vertigo is just one of the subtypes of dizziness.

Vertigo could be caused as a result of many disorders and we cannot mention all of them in a brief text. The most common causes of vertigo are benign paroxysmal positional vertigo (BPPV), Ménière’s disease, secondary endolymphatic hydrops, labyrinthitis, stroke, brain tumors, migraine and head trauma.

  1. Although vertigo, especially in the early stages, is a very stressful experience, in many cases, it does not pose a serious risk to the patient. If vertigo is accompanied by falling, hypertension, headache, cold sweat and chest pain, the possibility of serious dangers will be more.

Dizziness is a sign of a disease or disorder in body structures. Therefore, observing a healthy lifestyle and maintaining the general health of the body can help us to prevent dizziness to a great extent. Drinking enough water, reducing salt and sugar consumption, avoiding consuming of canned food and fast food and regular exercise have a great effect on decreasing dizziness rate.

Generally, in acute phases of vertigo, patients are referred to emergency departments and after initials measures; they are referred to a specialist. Usually, a neurologist or ear, nose and throat physician can help vertiginous patients based on different symptoms that patient is experiencing. Moreover, in cases that a thorough examination of the patient is required, blood test, brain imaging, cardiovascular and cerebrovascular investigations are performed. If there is a possibility that vertigo results from a dysfunction in the inner ear, the patient is referred to an audiologist. In this stage, different structures of the inner ear, their connections with the central nervous system and also patient’s balance abilities are examined. Based on these evaluations, an appropriate treatment is recommended. It must be mentioned that if the main cause of vertigo doesn’t properly identify, all of the treatment processes would be affected and in some cases results in worsening of patient’s symptoms.

Managements of vertigo are divided into three main categories: medication, surgery and vestibular rehabilitation. In most cases of acute dizziness, the first treatment option is medication. In this period, medication is utilized to control patient’s symptoms. When the cause of dizziness is recognized after conducting thorough examinations and specialized evaluations, the primary treatment which usually is medication is adopted. In some patients who have severe and debilitating symptoms, surgical treatments are utilized. This treatment option is applied when there are brain hemorrhage and tumor.
If vertigo results from damage to the peripheral vestibular structures (related to the inner ear), vestibular rehabilitation is required in addition to medications. In vestibular rehabilitation program, audiologist specifies some exercises for the patient based on the results of conducted evaluations and involved structures. The duration of these exercises varies from 3 months to 2 years. It should be taken into consideration that in some diseases such as Meniere’s disease vestibular rehabilitation leads to delays in patient’s recovery.

Although it cannot be said with certainty that anxiety and stress are direct causes of dizziness and vertigo, it has been proven that psychological disorders exacerbate these symptoms. In fact, vertigo and psychological disorders form avicious cycle which each one causes another escalation and vice versa.

Meniere’s disease is one of the most common diseases of the inner ear that its symptoms occur episodically. This disease which is caused by an increase in the pressure of the endolymphatic fluid in the inner ear initially causes severe and debilitating vertigo. Presence of four symptoms is necessary to diagnose Meniere’s disease. These symptoms include vertigo, hearing loss, tinnitus and ear fullness.

Otolith Repositioning Maneuvers or Canalith Repositioning Maneuvers are conducted in order to treat BPPV. These maneuvers are the only treatment option for BPPV. Based on BPPV type, the appropriate maneuver is chosen in which the patient is placed in different positions. Although in some patients more sessions are required, in most cases, only one or two treatment sessions are enough.

These medications are usually prescribed to control severe symptoms in the acute phase of vertigo. Without these medications, toleration of severe vertigo and performing daily activities are impossible. On the other hand, in some cases, Long-term use of these medications prevents patients’ full recovery due to this fact that they act as a barrier to the vestibular comensation.

videonystagmography (VNG) is one the main tests which are applied to diagnose the cause of vertigo. After primary examinations by a specialist, if they are suspected to dysfunctions in balance structures in the inner ear and its connections to the central nervous system, VNG test is recommended. This test is usually conducted and interpreted by an audiologist. In this test, abnormalities in different eye movements which are resulted from inner ear disorders are evaluated. Moreover, positional vertigo and vestibular nerve function are evaluated. After diagnosis of patient’s vertigo cause, appropriate treatment option is recommended. Without this test, a definitive diagnosis of the exact cause of vertigo is impossible in many patients.

Vestibular neuritis is the vestibular nerve infection which causes vestibular nerve to become inflamed. This disease is limited to vestibular system in which sudden and severe vertigo, imbalance, nausea and vomiting is seen but hearing is unaffected.

The most common causes of vertigo in children include ear disorders (e.g. middle ear infection or otitis media), some of the inner ear disorders (e.g labyrinthitis, vestibular neuritis and BPVC), brain disorders (e.g. migraine or tumors) and some medical problems (e.g. low blood pressure). In adolescents, Psychological problems may lead to dizziness or vertigo. In some cases, the cause of vertigo remains unknown.

Dizziness, vertigo and feeling faint are normal and common symtoms in pregnancy. These symptoms are more prevalent in first months of pregnancy. The main reason is the rise of hormones that cause blood vessels to relax and widen, and therefore blood pressure will decrease. The other reason of dizziness in pregnancy is lower blood sugar levels as the result of changes in metabolism in pregnancy.

Although vertigo can be caused by disturbances in various parts of the body, including the central nervous system, inner ear diseases are the most important causes of dizziness. For instance, the most common cause of vertigo which is known as Benign Paroxysmal Positional Vertigo (BPPV) happens as the result of the separation of the particles of otoconia from the utricle and floating in one of the semicircular canals of the inner ear. Moreover, Meniere’s disease which is one of the common causes of dizziness appears to be the result of the abnormal pressure of endolymph in the inner ear. Vestibular neuritis is the inflammation of inner ear (vestibular) nerve and infection of the inner ear results in labyrinthitis and vertigo

Labyrinthitis or inner ear infection is one of the ear disorders which leads to dizziness, vertigo, nausea and hearing loss. Labyrinthitis is caused by infections or viruses.

{:en}{:en}{:en}{:en}The most common causes of vertigo in elderly are vascular or central nervous system disorders which are not usually seen in other age groups. Dizziness and disequilibrium could be a side effect of some medications such as cardiovascular drugs, psychotropic drugs and analgesics. Benign paroxysmal positional vertigo (BPPV) and Meniere’s disease are the most common peripheral causes of vertigo in the elderly.

{:en}{:en}{:en}Yes- Videonystagmography is helpful in detecting whether vertigo results from damage to the brain or inner ear. In many forms of vertigo, the choice of the type of treatment is based on the results of tests such as the videonystagmography.

{:en}{:en}Yes- In many cases, the hearing of the patient should be checked to diagnose the cause of vertigo. The presence of hearing loss, type of hearing loss (conductive, sensory-neural or mixed hearing loss), pattern of audiogram and hearing changes over time help clinicians to diagnose the cause of vertigo. Moreover, the results of some tests such as electrocochleography and videonystagmography should be interpreted based on hearing status of patient (presence of hearing loss, middle ear infections and TM perforations).

Yes- Allergy is one of the most common diseases. Its prevalence has been increasing in recent decades. The most common parts of the body that are affected by an allergic factor are head and neck. In these cases, the structures of the middle ear and the inner ear may also be involved, resulting in inflammation and middle ear infections and increased endolymphatic pressure. In both of these ear problems, dizziness and vertigo are expected.

Can dizziness be caused by diabetes?
Yes- Dizziness and vertigo are common complaints in patients with diabetes. Dizziness and vertigo in these patients may be caused by hypoglycemia or hyperglycemia. In these cases, immediate treatment must be done.

High blood pressure does not directly lead to dizziness. However, some medications which are prescribed to treat hypertension cause dizziness.

Sudden dizziness, imbalance and problem in walking are some of the warning signs of a stroke especially when the patient has risk factors of stroke such as cardiovascular diseases and hypertension.

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