Peripheral Vertigo Overview

peripheral vertigoVertigo is a type of dizziness that is most commonly felt as a spinning sensation but it can also be experienced as motion sickness, nausea, or a feeling of leaning to one side.  In medical terms, vertigo is feeling sensation of movement even when you are sitting or standing completely still, and it is usually brought on by one of two main causes; the balance organs of the inner ear, or a malfunction in part of the brain or neural pathways.

Some other common symptoms of vertigo include:

  • Loss of hearing in one ear
  • Loss of balance
  • Vision problems such as difficulty focusing
  • Ringing sound in ears
  • Nausea or the sensation that you need to vomit
Although there are two main forms of vertigo, Central Vertigo and Peripheral Vertigo, the latter, Peripheral Vertigo, is by far the most severe form of the condition.  The disorder is caused by an imbalance in the delicate inner ear, which controls the body’s balance and there are four main forms of this troubling condition.

Some common causes of Peripheral Vertigo include:

  • Calcium deposits in the inner ear
  • Inflammation of damage to the nerves
  • Motion sickness
  • Post-viral infection
  • Some antibiotics such as minocycline

 

The four main types of Peripheral Vertigo

  1. 1.     Benign Paroxysmal Positional Vertigo (BPPV)

The most common form of Peripheral Vertigo, BPPV is typically triggered by certain head motions, and causes short, frequent, and unpleasant bouts of vertigo.  It is widely accepted that one cause of BPPV is when small pieces of inner ear detritus such as ear wax loosen and break off in the inner ear canals, over-stimulating the delicate and sensitive hairs that line the inner ear system.  The technical name for this event is called Otoconia.

This then causes a sensation of disorientation within the central nervous system which causes the feeling of dizziness within the afflicted person.

Other causes of BPPV include post-viral infection, chronic middle ear disease, head injury, and spontaneous degeneration of the labyrinth.

How can I best treat BPPV?

In many cases the condition will clear up on its own after a few weeks but there are also some established best practises to minimize the discomfort the condition causes.  They are:

  • Limiting symptoms by getting out of bed slowly in the morning
  • Using repositioning techniques such as Epley’s Manoeuvre (link at the end of this guide)
  • Reducing sudden head movements as much as possible to avoid triggering the condition
  • Practising Brandt-Daroff  exercises that have been proven to help ease the condition (scroll down to the end of this guide for an instructional video link)

 

  1. 2.     Labyrinthitis

This form of the condition causes dizziness along with a sensation of perpetual motion even when the sufferer is standing or sitting still. Labyrinthitis is usually triggered by an inner ear infection and because of this it can occur alongside other symptoms such as fever, nausea, and earache.

This disorder occurs because of an inflamed labyrinth, a delicate structure in the inner ear, which, when damaged has the potential to seriously affect both hearing and balance.  The condition can be caused from either a bacterial infection, or a viral infection such as a cold or the flu, that latter of which is more common.

How best to treat Labyrinthitis?

Like BPPV the symptoms of Labyrinthitis pass within a few weeks in most cases but of course, sufferers of this uncomfortable condition will want to learn how to best manage and treat their symptoms.

The best ways to manage this condition are:

  • Bed rest –  Research has shown plenty of bed rest enables the body’s immune system to repair itself more effectively, and regular and adequate rest will undoubtedly help sufferers to cope better with their Labyrinthitis.
  • Vestibular Rehabilitation Treatment (VRT) – This treatment works by attempting to rewire the brain into coping more effectively with the altered signals that it receives from the vestibular system as a result of Labyrinthitis.
  • Drinking plenty of water – Ensuring the body receives enough fluids will prevent sufferers from becoming dehydrated which can lead to a worsening of symptoms.
  • Lying still – During an onset of Labyrinthitis, it is best to lie as still as possible until the most severe symptoms pass.   Research has shown that lying on one side is the most beneficial position for easing symptoms.

Also sufferers should avoid bright lights, smoking, chocolate, and alcohol, as these can all trigger an attack. Steering clear of stressful situations and cutting out intrusive noises is also highly recommended.

Read Labyrinthitis sufferer Emma’s account of coping with this difficult condition:

http://www.labyrinthitis.org.uk/emma.htm

  1. 3.      Vestibular Neuronitis

Also called Vestibular Neuritis, this form of the condition comes on suddenly and is typically triggered by an infection that has spread to the vestibular nerve, which affects balance.

A virus such as the herpes simplex virus can trigger an attack, and, as a result of this, the most effective treatment would be to medicate the virus with drugs that target the underlying condition.   If herpes is the cause for example, then the drug prescribed would be Acyclovir, a drug typically used to treat herpes simplex.

Common symptoms of Vestibular Neuronitis include, unsteadiness when walking or standing, earache, vomiting, and nausea, and the condition typically follows a viral infection such as a cold.  The good news is that attacks are typically a one-time occurrence, with up to 95% of successfully treated patients never suffering a recurring bout of the condition.

How best to treat Vestibular Neuronitis?

Vestibular rehabilitation exercises have been proven to be effective in the treatment of the symptoms of this condition with the sufferer referred to a Vestibular Rehabilitation therapist who will evaluate the severity of the disorder.  After this evaluation, a full treatment plan will be drawn up that will consists of specialized balance exercises that are designed to correct and strengthen balance.

Other treatments include:

  • Treating the underlying virus that caused the infection with medication
  • Ensuring the patient drinks plenty of water to keep hydrated
  • Dizziness reducing drugs may be prescribed to lessen symptoms
  • Drugs to suppress nausea may also be prescribed in severe cases

 

  1. 4.     Menieres disease

This form of Peripheral vertigo is a vestibular disorder that is caused by high inner ear fluid levels which causes a swelling in the delicate labyrinth of the inner ear.  An attack can last from between 20 minutes to several hours with the average being between two and four hours.

Typical symptoms come and go and include:

  • Dulled hearing in the affected ear
  • A dizzy or spinning sensation
  • Tinnitus
  • Ear pressure
  • Loud noises that appear distorted

 

How should I best treat Menieres disease?

There are a number of ways that this form of vertigo can be treated, depending on the severity and depth of symptoms experienced.

  • Antihistamines
  • Antibiotics (used if an infection is also present)
  • Benzodiazepine (anxiety medications that can also relieve symptoms of vertigo)
  • Prochlorperazine (used to relieve symptoms of nausea)
  • Pressure pulse treatment such as the Meniett device, a machine used to generate a pulse of pressurized air into the ear canal
  • Inner ear surgery (used in extreme cases of the disorder where other treatments fail to relieve repeated attacks of the condition)

Sufferers of Menieres disease are also frequently prescribed a medication called betahistine, which helps by reducing pressure caused by fluid levels in the inner ear, relieving the uncomfortable symptoms of the condition.

You can read a sufferer’s account about what it’s like to cope with this awkward condition here:

http://www.nhs.uk/Conditions/Menieres-disease/Pages/Realstories.aspx

 

What to do next?

If you suspect a diagnosis of Peripheral Vertigo then the first thing to do is visit a qualified medical practitioner to confirm diagnosis.  If you have already been diagnosed, following the advice in this guide will help you to best manage your individual form of the condition.

Peripheral Vertigo is not typically treated with conventional medications, but, if your form of the condition is particularly severe, your doctor may prescribe a short course of prescription drugs, such as benzodiazepine or anti-emetics to suppress nausea and vomiting.

Always make sure to see your doctor if you experience a worsening of symptoms or experience additional symptoms such as mental confusion or weakness or numbness in a part of your body as this could indicate a more serious medical condition.

 

Helpful Tips

Youtube video on the Epley Manouvre. Please note this procedure should be performed by a qualified medical practitioner.

Learn how to correctly and safely perform the Brandt-Daroff exercises at home with this instructional video: https://www.youtube.com/watch?v=CTZfIv165sY

Other things you can do to avoid bringing on an onset of symptoms include:

  • Avoiding bright lights
  • Standing up slowly
  • Avoiding rapid head movement and bending over
  • Keeping hydrated
  • Steering clear of stress
  • Sleeping with the head propped up
  • Avoiding smoking, alcohol and caffeine
  • Avoiding looking up