When vertigo strikes (and no, it's not the same as dizziness)

Dizziness means that you feel off balance, while vertigo always includes a spinning sensation, whether it feels like you are spinning or your surroundings are. — dpa

Recently, I noticed that I keep feeling like I am tilting more to one side, even though I am not. I am not exactly dizzy though. I have been told about vertigo, a condition in which I feel my head is spinning round and round. But I don’t think I am experiencing that, so what am I having?

You are probably indeed having vertigo.

Vertigo is a sense or feeling of the world around you spinning, rotating or rocking, or that you are spinning, rotating or rocking.

You feel this even if you are standing or sitting perfectly still.

Sometimes, you might feel as if you are swaying or tilting more to one side.

Then, you may feel like you are swaying or tilting more to the other side.

The feeling may get worse when you move your head or body.

Sometimes, you may even have nausea and vomiting.

It is caused by disorders of the balance centres in both your inner ears and brain.

Vertigo is similar in feeling to going on a rollercoaster or the spinning type of ride in an amusement park.

It is important to know that vertigo is a symptom and not a disease in itself, pretty much like a cough, runny nose or fever is a symptom of an upper respiratory tract infection.

Is it the same as dizziness?

Some people use dizziness as a very general term to mean either lightheadedness or vertigo.

Lightheadedness is the sensation of feeling like you are very weak and about to pass out.

It is usually caused by not enough blood or oxygen going to your brain, even temporarily.

Dizziness itself is the feeling of being off-balance.

Both are different from vertigo.

Why do I have vertigo?

There are two types of vertigo: peripheral and central.

Peripheral vertigo is caused by a problem in your inner ear.

Your inner ear is divided into several components (you might remember learning this during science class in school).

The outer ear receives and transmits sound waves to your eardrum.

In the eardrum, the sound is turned into vibrations that are transmitted through three little bones in your middle ear, called the incus, malleus and stapes.

The vibrations get into your cochlea and into the vestibular nerve, where they are converted into impulses that are transmitted to your brain to be interpreted.

Then there is your inner ear, which comprises three semicircular canals positioned at right angles to one another.

They are all lined with very sensitive nerve cells, which are attached to hair cells, and tiny otoliths, which trigger the hair cells in response to motion.

This little system provides feedback to our brain as to our position in space.

Then there is central vertigo, which is caused by a problem in the part of your brain that senses balance, i.e. the cerebellum.

What diseases cause peripheral vertigo? Are they in my inner ear?

The commonest causes of inner ear vertigo are:

> Benign paroxysmal positional vertigo (BPPV)

The structures in your inner ear may become inflamed, leading to displacement of the small crystals or stones that are found in there normally.

These displaced crystals or stones then irritate the hair cells in your semicircular canals and cause vertigo.

The cause of this is unknown, but it is usually not dangerous.

Older women are at higher risk of developing this condition.

> Vestibular neuronitis

Also known as labyrinthitis, this is an infection of the vestibular nerve.

> Meniere’s disease

This is caused by fluid buildup within your inner ear.

It may also cause hearing loss and tinnitus (ringing in your ear).

No one knows the actual cause of the fluid accumulation.

> Acoustic neuroma

This is a tumour of the vestibular nerve.

Ear infections may also result in inflammation in the inner ear, triggering some of the causes of vertigo.

What about central vertigo?

Anything that can interfere with the function of your cerebellum can cause this, such as an injury that results in a concussion.

Strokes, brain tumours and a type of migraine called vestibular migraine can all cause central vertigo.

Some medications can also cause vertigo, such as certain antihypertensives, antidepressants and antiepileptics.

Can vertigo be treated?

The doctor will have to treat the cause of the vertigo.

Peripheral vertigo can be effectively treated by particle repositioning movements, such as the Epley manoeuvre (also known as the canalith repositioning procedure).

The therapist will guide you through specific head movements that reposition the loose crystals (canaliths).

After that, you will be able to do them yourself at home.

There are also some medications that can decrease persistent vertigo over time.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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