Peripheral dizziness, rotatory vertigo, vestibular dizziness, vertigo
Introduction
The term “dizziness” refers to a disturbance of the sense of balance. Affected persons find it increasingly difficult to interpret their own posture in space. In most cases, dizziness is accompanied by pronounced nausea, vomiting and visual disturbances.
How does dizziness caused by the ear manifest itself?
In addition, most of those affected describe a tendency to fall to one side of the body. For this reason, dizziness can be very stressful for the person affected, regardless of its mechanism of origin. In general, two important forms of vertigo must be distinguished: While the causes for the development of central vertigo are not found in the area of the ear, peripheral vestibular disorders usually involve a change in the ear.
In this context, patients speak of either a so-called swaying or a spinning vertigo. Typical for a central genesis of the vestibular disturbance is the occurrence of a swaying vertigo. In contrast, impairments in the area of the ear lead to the development of a so-called rotary vertigo.
Irrespective of the exact form and cause of the vertigo, the affected patients usually experience a great deal of suffering. Especially due to the pronounced insecurity of gait, everyday life and the ability to take care of oneself can be significantly limited. Persons who frequently suffer from vertigo attacks or notice persistent dizziness should urgently consult a specialist in ear, nose and throat medicine (ENT).
Only after comprehensive diagnostics can the cause of the disturbance of balance be determined and appropriate treatment initiated. Since a neurological cause is usually to be found in the case of so-called swindling vertigo, a neurologist can also be consulted.
- Central vertigo and
- Peripheral vertigo.
Possible causes of dizziness
There can be a variety of causes for the occurrence of dizziness that occurs in the ear. Common to all possible causes, however, is the fact that damage is present in the area of the organ of balance in the ear (more precisely in the inner ear) or directly on the vestibular nerve. An overview of the most common causes of dizziness that occurs in the ear: Meniere’s disease Hearing loss Benign paroxysmal positional vertigo Neuritis vestibularis (inflammation of the vestibular nerve) Irritation of the vestibular organ
- Meniere’s disease
- Hearing loss
- Benign paroxysmal positional vertigo
- Vestibular neuritis (inflammation of the vestibular nerve)
- Irritations of the vestibular organ
Meniere’s disease (or Menière’s disease) is one of several diseases affecting the inner ear or the organ of equilibrium, which causes dizziness.
The cause of this disease is an increased amount of fluid in the inner ear. This special fluid is called endolymph and is both produced and broken down by the cells of the inner ear. The inner ear is responsible for both hearing and the sense of balance, so both functions are disturbed in Menière’s disease: the affected persons suffer from sudden onset of rotational vertigo, tinnitus and hearing loss as well as nausea, often with vomiting.
These symptoms last for minutes or even hours. Menière’s disease is a chronic disease for which causal treatment is not yet possible. However, it is possible to treat the seizures and to try to prevent them.
Treatment is carried out with the administration of mild sedatives (for example bromazepam or diazepam). In addition, drugs to treat nausea and vomiting (dimenhydrinate or scopolamine) are used in acute Meniere’s seizures. The direct cause of the occurrence of this form of dizziness, which develops in the ear, can be treated with glucocorticoids.
- Suddenly appearing rotation vertigo,
- Tinnitus and
- Hearing loss and
- Nausea, often with vomiting.
Benign paroxysmal positional vertigo is a disease of the inner ear characterized by sudden attacks of vertigo. The dizziness attacks are perceived by the affected persons as if their surroundings were turning. In medical terms, this is therefore referred to as rotational vertigo.The cause of positional vertigo is a detachment of the so-called otoliths, which are normally anchored in the semicircular canals of the inner ear and, due to their fixed position, perceive the position of the head.
This detachment disrupts this function of the sense of balance and triggers the dizziness attacks. For both diagnosis and therapy, so-called positioning maneuvers are used in which the head is moved in accordance with the structure of the archways. On the one hand, this can cause dizziness, on the other hand, such maneuvers bring the otolith pieces into a position that does not irritate the organ of equilibrium.
The most common form of dizziness in the adult ear is caused by small crystals that form within the organ of equilibrium. The disease known as “benign paroxysmal positional vertigo” (benign positional vertigo) can cause severe discomfort to the affected patients and can therefore be very stressful. The direct cause of this form of dizziness in the ear are small calcareous crystals that detach from the so-called posterior atrial sac (technical term: utricle) and enter the archways.
In most cases, these calcareous crystals can be detected in the area of the posterior archway. For this reason, affected patients experience a pronounced sense of rotational vertigo. The removal of the causative crystals is carried out by means of special positioning exercises, which must be performed several times a day.
The prognosis for benign paroxysmal positioning vertigo is generally considered very good. The single occurrence of a causative crystal does not necessarily mean that the affected person will experience repeated attacks of vertigo. An inflammation of the nerves (neuritis) on the organ of equilibrium (medical vestibular organ) usually leads to a loss of function of the sense of balance on the affected side.
The cause of this neuritis vestibularis is usually not clear. However, it is suspected that the vestibular neuritis is caused by a viral infection of the nerve. The affected persons complain of a sudden dizziness, as if the environment is spinning around them (rotational vertigo).
Accompanying symptoms such as nausea and vomiting are typical of vestibular neuritis. Even though these symptoms cause a high level of suffering for the persons affected, this disease can be treated very well and without long-term damage. In addition to Meniere’s disease, the so-called acute hearing loss is one of the most common causes of dizziness that develops in the ear.
Hearing loss, too, typically occurs suddenly out of full health. Affected patients usually notice a significant reduction in hearing in one ear. The occurrence of ringing in the ears (tinnitus) and dizziness are also part of the classic picture of sudden deafness.
The exact cause of this form of dizziness, which occurs in the ear, has not yet been determined. It is sometimes assumed that sudden deafness is provoked by several factors. Above all, a lack of blood circulation in the inner ear is believed to play a decisive role.
Hearing loss is a serious clinical picture that can be a considerable burden for the patient concerned. In addition, with this form of dizziness, which develops in the ear, it must be noted that there is no treatment that has been proven to help against the symptoms. In some cases, however, the symptoms can be alleviated by the venous administration of glucocorticoids in high doses.
Dizziness that develops in the ear may be due to an increased production of fluid in the inner ear. The increase in this fluid in the inner ear is usually directly related to the so-called “Menière’s disease” (technical term: Menière’s disease). Menière’s disease is a disease that can be observed mainly in people between the ages of 40 and 60.
Affected patients describe pronounced rotational vertigo due to the increasing amount of fluid in the inner ear. The vertigo attacks typical of Meniere’s disease usually occur suddenly, out of full health and are very stressful for those affected. In addition to the pronounced rotary vertigo, the increasing fluid causes hearing loss (especially in the low frequencies) and ear noises (tinnitus).
A strong feeling of pressure on the affected ear is also not uncommon.This form of dizziness in the ear, which is due to increased fluid in the ear, usually requires medication. The symptomatic therapy of the accompanying symptoms is of particular importance in this form of dizziness in the ear. In addition, betahistine is one of the standard medications in the treatment of Meniere’s disease.
The prognosis for this type of vertigo, which develops directly in the ear, is considered very good. In general, it can be assumed that about 90 percent of patients under drug therapy will remain seizure-free for several years. Small stones, so-called otoliths, are responsible for the perception of acceleration, gravity and uniform rotational movements in all organisms.
These pebbles usually consist of calcium carbonate. Even in healthy people who do not complain of vertigo in the ear, these stones are located in the organ of equilibrium of the inner ear. Various anatomical structures are attributed to the organ of equilibrium.
In addition to the so-called sacculus, the human organ of equilibrium consists of the utricle and three spatially differently arranged archways. In healthy people who do not suffer from vertigo in the ear, small stones can only be found in the sacculus and the utricle. However, these can become detached during a trauma, for example, and enter the archways.
The result is an irritation of the sensory cells in the affected semicircular canal that occurs with every movement of the head. In most cases, these calcium crystals can be found in the area of the posterior arcade. For this reason, affected patients feel a pronounced sense of vertigo.
In medical terminology, the disease resulting from this is called “benign positional vertigo”. Special positioning exercises, which must be consistently performed several times a day, are considered the only effective treatment method. Through the systematic repositioning of the head, the causative stones can be removed from the arcade under certain circumstances and thus the dizziness can be eliminated. In general, it can be assumed that the prognosis for benign positioning vertigo is very good.
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