Dizziness & Vertigo

 

Learn More Below About The Different Types Of Dizziness and Vertigo

 

Dizziness & Vertigo

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Types of Dizziness & Vertigo

BPPV- Benign Paroxysmal Positional Vertigo

Episodic head movement related dizziness/vertigo is a typical symptom of BPPV. Sometimes however it may present atypically with imbalance, head motion intolerance or other such symptoms. Untreated BPPV may then lead on to other complications such as vestibular migraine or Ménière’s disease.

Diagnosis of BPPV involves full Neuro-otological assessment and positional manoeuvres such as the Hallpike or horizontal roll manoeuvres. BPPV can exist most commonly in the posterior canal of the vestibular organ, but occasionally can also be found in the horizontal and anterior canals.

Sometimes positional symptoms can be secondary to a brain abnormality in particular affecting the cerebellum or brainstem.

Identification of appropriate nystagmus on positional testing clinches the diagnosis and helps to exclude other more serious disorders. Sometimes this may require the use of video Frenzels (goggles to assess your eyes in the dark). Testing of vestibular function may also reveal an underlying peripheral vestibular problem. Hence assessment by a suitably qualified and experienced medical specialist is key in being able to appropriately diagnose these conditions.

Management of BPPV involves repositioning manoeuvres dependent on the site and location of the BPPV. Our physicians are experts in performing repositioning manoeuvres as required during your consultation and assessment. Manoeuvres include the Epley manoeuvre, modified Semont, barbecue role, Gufoni manoeuvre amongst others.

Vestibular Migraine (previously known as migraine associated vertigo, migrainous vertigo)

Migraine is a complex neurological condition which can result in a range of different symptoms including headaches, dizziness, vertigo, visual and abdominal symptoms.

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Vestibular migraine is a diagnosis of exclusion (other similar conditions need to be investigated and excluded prior to diagnosis), and it is one of the most common conditions that our specialists at the Harley St, Audiovestibular clinic see and manage.

Vestibular migraine is a condition characterised by repeated attacks of dizziness and vertigo. Headaches are optional although sometimes you can get other non-specific symptoms. It is unclear why some people develop vestibular migraine although some inner ear conditions can potentially trigger this and would hence require to be identified and treated. Individuals with vestibular migraine are also more likely to develop other associated vestibular conditions such as BPPV. Meniere’s disease can also potentially coexist in certain individuals and complicate the picture.

The diagnosis of vestibular migraine requires thorough clinical assessment and examination by a suitably qualified medical specialist alongside specialised hearing and vestibular function tests in order to assess for inner ear functioning. Management includes lifestyle changes and medications. Treatment of underlying and associated conditions would also help ameliorate symptoms and promote long-term control.

Ménière’s Disease

Ménière’s disease is a condition characterised by disabling repeated attacks of vertigo with associated nausea and vomiting, autonomic symptoms, progressive hearing loss, tinnitus and fullness in the ears. Early features can include just one of these symptoms and hence having symptoms investigated promptly helps earlier and better control of the condition.

The diagnosis of Ménière’s disease can be tricky as it can closely resemble other conditions such as vestibular migraine. A comprehensive workup is required including hearing and vestibular function tests such as CVEMP, and consideration of specialist imaging such as 3T MRI IAM. If diagnosed and treated early, Ménière’s disease can be well-managed on the longer term before significant damage is done to the Audiovestibular system. Other conditions such as BPPV can also be commonly associated with Ménière’s disease.

Management of Ménière’s disease includes lifestyle changes, medications and sometimes steroid injections into the ear.

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Persistent Postural Perceptual Dizziness (PPPD)

PPPD is a relatively newly coined term for symptoms of chronic constant dizziness which can be hugely disabling. Our expert physicians how however been treating this condition for many years under many different other names. PPPD is a diagnosis of exclusion meaning that other conditions required to be fully investigated and excluded the first instance. This may hence require detailed assessment with hearing and vestibular function tests as well as imaging such as MRI scan.

PPPD can be triggered by a variety of underlying causes such as BPPV, vestibular migraine, Ménière’s disease or inner ear balance organ disorder. Identification of the underlying cause and subsequent management will help with symptomatic improvement. Rehabilitation and the correct choice of medication also have a significant impact in helping to improve the symptoms.

Central Vestibular Disorders

Many conditions affecting the brain can result in symptoms of dizziness, vertigo or imbalance. Pathology affecting the part of the brain known as the cerebellum in particular can result in such symptoms. This includes strokes, tumours, multiple sclerosis or degeneration.

As part of your assessment, your physician will be assessing and examining you for these neurological problems. This will also be objectively assessed as part of your vestibular function tests. Further investigation may include imaging such as MRI scan.

Accurate assessment of the eyes and any nystagmus (abnormal movements of the eyes) is critical in the diagnosis of such disorders which may present with any type of vertigo or dizziness. Our expert physicians are hugely experienced at assessing nystagmus in many different types of disorders and often provide tertiary and quaternary opinion to the doctors.

Vestibular Neuritis/ Labyrinthitis

Sudden onset acute continuous vertigo lasting 24 hours or more is termed as acute vestibular neuritis. The commonest aetiology is viral infection affecting the inner ear. However other conditions that may also cause acute vertigo include strokes, Multiple Sclerosis, ear infections, head trauma amongst others. The difference between vestibular neuritis and labyrinthitis is that labyrinthitis also affects your hearing.

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Treatment is supportive at the onset although detailed investigations are recommended in order to exclude other conditions as above. This will involve detailed neuro-otological assessment by a specialist, looking at the ears, eye movements, general balance and performing positional manoeuvres such as Hallpike. Hearing assessment at an early stage, ideally on presentation, is also recommended. MRI or CT scans at the outset tend to be imperfect. If there is associated hearing loss as in labyrinthitis, high-dose oral steroids is also recommended to try and help rescue the hearing loss.

Symptoms generally tend to improve on their own over several days to weeks. However if there is no improvement in symptoms, early assessment and treatment is recommended by a specialist in dizziness and vertigo.

Vestibular Paroxysmia

Episodic short lived attacks of vertigo which lasts for seconds and can occur several times a day is known as vestibular paroxysmia. This is again diagnosis of exclusion meaning that other conditions need to be reliably investigated and excluded. Imaging such as MRI scan may play a part. Management includes medications such as anticonvulsants which may help very severe symptoms.

Superior Semi-circular Canal Dehiscence (SSCD) and Third Mobile Window Disorders:

Known as the “great otological mimicker”, SSCD is a condition which can present with a range of audiological and vestibular symptoms including but not limited to tinnitus, pulsatile tinnitus, hearing your own eyeballs or footsteps, vertigo, dizziness provoked by sounds or pressure changes. Due to the diverse range of symptoms, it can often be missed. It requires a clinician with a keen eye and experience supported by appropriate audiovestibular tests. Management options include surgery

Mal de Debarquement Syndrome (MdDS):

Symptoms of constant imbalance and dizziness often triggered following a boat trip or journey in a moving vehicle is known as MdDS. It has to be differentiated from similar conditions such as PPPD and peripheral vestibular disorders to help with accurate management. Following accurate diagnosis, treatment may require medications alongside vestibular physiotherapy.

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