Vertigo and Balance Disorders Diagnosis and Treatment Center

Vertigo (vertere = to turn + igo suffix in Latin) means a sense of dizziness and a lack of balance. Vertigo is defined differently by each patient with such statements: “Objects in the environment are moving.” “I cannot hold my head.” “Ground is sliding under my feet.” “I am moving to one side while walking.” “My head is emptying out.” “I am blacking out.” Vertigo is not a disease, but a symptom of disease.

Balance System

Maintaining balance is a status involved in by many body systems. Inner ear, eyes and musculoskeletal system are elements of this system. Data originating from these organs is transmitted to brain and cerebellum. Inner ear contains 3 semicircular canals and two saccules. Thanks to the fluid in motion in these canals, our positioning in space in three-dimensional plane is transmitted to brain.

In the case of a sickness affecting these three systems (ears, eyes, musculoskeletal system), in addition to dizziness, some other symptoms relating to the relevant organ are seen. In dizziness associated with ear diseases, tinnitus, hearing loss, pressure in ears and aural fullness, and ear discharge may be reported. However, many patients complain only about dizziness.

Causes of Vertigo

Causes of vertigo may be discussed in two categories.

Peripheral vertigo: Cause of vertigo originates from inner ear:

• Benign paroxysmal positional vertigo (abbreviated as “BPPV”): The most common type is ear-origin dizziness. Its incidence is 17 in every 100,000 population. Dizziness is of short time (less than 1 minute) and starts with head movements. It is thought to be associated with crystals in motion in semicircular canals. It is diagnosed by a maneuver in accompaniment of ENG (DixHall-Pike), and is treated by confining the crystals in pocket in inner ear again via a maneuver (Epley, semont and barbeque).
• Vestibular neuritis: Inner ear involvement due to upper respiratory tract infections (URTI).
• Meniere’s Disease: Status of high pressure of fluids in inner ear accompanied by hearing loss, tinnitus and ear fullness sensation, and dizziness attacks up to 24 hours. It is attributed to stress and salt consumption.
• Spreading of chronic middle ear infections into inner ear (Labryrinthitis).
• Tumoral diseases in inner ear or inner ear nerve.

Central Vertigo

Vertigo caused by neurological ailments effecting the balance centers in brain. Dizziness may be accompanied by such symptoms as loss of consciousness (blackout), diplopia, speech impediments and paralysis. Furthermore, vertigo may develop also in neck problems and systemic diseases.

Method of Diagnosis in Vertigo

First of all, otolaryngologist physically examines both tympanic membranes for perforation. If tympanic membranes show no ailment, some tests are required to be conducted on inner ear. In case of hearing problems, audiometry (hearing test) and stapes reflex test should be carried out, and in case of ear fullness sensation, tympanometry (middle ear pressure test) should be done. ENG (Electronistagmografia) must absolutely be done in order to determine pathologies in inner ear.

Electronistagmografia (ENG)

ENG is based on placement of electrodes around eye ball, and on recording of eye movements (nistagmus) caused by corneoretinal potential difference. In a dark environment, patient is got on stretcher, and electrodes are placed around his eyes. Patient wears glasses, and sits on the stretcher, and his eye movements in certain head positions are examined. Same movements are examined also while the patient is lying on the stretcher, and again, eye movements are recorded. Eyes wiggle (nistagmus) is examined to determine pathologies related to ears.

Treatment of Vertigo

When vertigo is only a finding, first of all, the underlying disease should be treated. If a problem is detected in crystals in inner ear (BPPV), these crystals should be confined into pocket through appropriate maneuvers. If dizziness is associated with Meniere’s disease, it is required to reduce the frequency of dizziness attacks by drugs and salt restriction.