What is Peripheral Vertigo?
It’s important to clarify that vertigo is a symptom, not a condition itself. Most people have felt some form of vertigo at some point in their lives. However, it can be hard to explain, so people describe vertigo in many different ways. A common example of vertigo is the temporary feeling of dizziness and the sensation of ourselves or our surroundings spinning after quickly spinning in circles. Nausea and vomiting often occur at the same time as these symptoms.
What Causes Peripheral Vertigo?
Vertigo is usually caused by a disruption in your vestibular system, semi-circular ear canals, or the 8th cranial nerve. The disruption could be due to damage or unusual signals in these areas. Your central nervous system takes information from these structures and processes it with visual and sensory inputs to understand your body’s movements in space or the movement of the environment around you. If these inputs conflict, the central nervous system gets overwhelmed, causing dizziness, nausea, and a sense of movement.
There are several reasons why you might experience vertigo:
Peripheral Vertigo (related to your ear)
* Benign paroxysmal positional vertigo (BPPV) is a sudden spinning sensation that usually happens after a rapid head movement or turning quickly in bed.
* Meniere’s disease, an abnormal accumulation of fluid in your inner ear.
* Vestibular neuritis or Labyrinthitis, inflammation of your inner ear.
* Herpes zoster, a viral disease.
* Acoustic neuroma, a non-cancerous growth that develops on the 8th cranial nerve.
* Otitis media, an infection in your middle ear.
* Perilymphatic fistula, an abnormal connection between your inner and middle ear.
* Aminoglycoside toxicity, a side effect of a specific group of antibiotics.
* Viral infections.
* Cogan syndrome, an autoimmune disorder.
Central Vertigo (related to your brain)
* Brainstem ischemia/infarction, a condition usually caused by a blockage in the blood vessels that supply blood to your brainstem.
* Vertebrobasilar insufficiency, decreased blood flow to the back of your brain.
* Space-occupying lesions such as tumors.
* Demyelination syndromes, diseases that damage nerve fibers in the brain and spinal cord.
* Vestibular migraine, a type of migraine that includes vertigo.
* Chiari malformation, a condition in which brain tissue extends into your spinal canal.
In addition to peripheral and central vertigo, there are specifics about some of these conditions that might be helpful:
For instance, people with BPPV do not experience ear pain, ringing in the ear, or hearing loss. This condition is often associated with the displacement of tiny calcium particles in your inner ear. A quick test and treatment performed by your doctor, known as Epley maneuver, can help address this issue.
Vestibular neuritis and Meniere’s disease often cause severe nausea, vomiting, vertigo, and unsteadiness. Despite their unstable walk, people can still move around. If vestibular neuritis accompanies one-sided hearing loss, it’s known as labyrinthitis. It’s also worth noting that Cogan syndrome, an autoimmune disease, can present symptoms similar to Meniere’s disease.
Risk Factors and Frequency for Peripheral Vertigo
Vertigo is a condition that can make you feel like you’re spinning or the world around you is spinning. Around 80% of vertigo cases are peripheral, meaning they originate in the inner ear or the nerves connecting the inner ear to the brain. The other 20% of cases are central, meaning they originate in the brain or spinal cord.
- Around 80% of vertigo cases are peripheral, originating in the inner ear or its connecting nerves.
- About 20% of vertigo cases are central, which means they originate in the brain or spinal cord.
- The most common cause of peripheral vertigo is Benign Paroxysmal Positional Vertigo (BPPV).
Signs and Symptoms of Peripheral Vertigo
Peripheral vertigo causes a person to feel dizzy, as if everything around them is spinning. In addition to dizziness, other potential symptoms of peripheral vertigo can include:
- Hearing loss in one ear
- Ringing in one or both ears
- Difficulty focusing vision
- Difficulty maintaining balance
Testing for Peripheral Vertigo
When a doctor is trying to diagnose vertigo, they start by asking detailed questions about your symptoms and your medical history. They’ll also do a physical examination. There are two types of vertigo: peripheral and central.
Peripheral vertigo usually comes on suddenly and strongly. It often feels worse when you move your head. You may also experience a spinning sensation when moving your eyes in a specific direction. This eye movement, known as nystagmus, tends to happen in one direction and can be temporarily tamed.
Central vertigo, on the other hand, tends to last longer and is usually less severe. The nystagmus associated with this type can be multi-directional and doesn’t get better with rest.
The doctor might use a technique called the Dix Hallpike test to help diagnose peripheral vertigo. This involves moving your head in certain ways to see if it makes the vertigo symptoms and the nystagmus more apparent.
Other specialized tests that your doctor might use include:
* Electronystagmography (ENG): a test that measures involuntary movements of your eyes.
* Computerized dynamic posturography (CDP): a balance test that measures your body’s reaction to movement.
* The rotating-chair test or sinusoidal harmonic acceleration (SHA): a test in which you’re seated in a motorized chair that moves back and forth at controlled speeds.
* Vestibular-evoked myogenic potentials: a test that gauges the health of your balance nerves and the parts of your brain that interpret balance information.
Treatment Options for Peripheral Vertigo
The treatment for peripheral vertigo often focuses on allowing the body to recover naturally and addressing the root cause of the dizziness. Antihistamines, benzodiazepines, corticosteroids, anti-nausea medicines, and anticholinergics, which block certain nerve impulses, can sometimes be helpful, depending on what’s causing the vertigo.
Another approach that might offer relief is Vestibular Rehabilitation Therapy (VRT), which is a specialized form of physical therapy. VRT uses special exercises and head movements to boost the brain’s ability to adjust or “plasticity”. These exercises can help with stabilizing your gaze and improving your balance, which can be issues in people with peripheral vertigo.
What else can Peripheral Vertigo be?
Diagnosing peripheral vertigo, a condition that causes dizziness, can lead doctors to consider a wide variety of possible causes. While it’s not feasible to go in-depth on all potential causes, it’s essential to remember that some serious conditions, such as stroke and infections, might be the root cause and need treatment.
What to expect with Peripheral Vertigo
The outlook for peripheral vertigo, a condition that can make you feel like you’re spinning or your surroundings are spinning, is quite promising overall. Although it can cause some serious discomfort or difficulties, once the exact cause is correctly determined, symptoms can often be made bearable or even entirely cleared up.
