Understanding vertigo: Causes, symptoms and treatment options
By Mary Anna Rodabaugh
Vertigo in older adults can greatly increase the risk of falls and isolation. It is not a normal part of aging.
According to a study in the National Library of Medicine, dizziness affects more than half of adults 65-plus. The incidence increases with age.
“Vertigo is an umbrella term that can describe many different symptoms. It is not a diagnosis. Dizziness, imbalance, unsteadiness and lightheadedness are all ways to describe how vertigo may present in an individual,” says audiologist Barbara E. Stevenson, director of audiology at the Temple Head and Neck Institute, and assistant professor of head and neck surgery at Temple University.
The most common causes of dizziness in older adults are:
• Inner ear disorders
• Orthostatic hypotension, low blood pressure that occurs when standing
• Cardiovascular issues
• Neurological conditions, including stroke and brain tumors
There are two primary categories of vertigo: peripheral and central.
Peripheral vertigo occurs when there is a problem within the inner ear or vestibular nerve. This nerve is part of the sensory system that is responsible for balance and spatial orientation. Both of these are critical to balance. There are several subtypes of peripheral vertigo.
Benign paroxysmal positional vertigo (BPPV) is a sudden spinning sensation that occurs with head movement. This condition is more common in adults 50-plus. It can lead to falls and fractures. BPPV often occurs when tiny calcium crystals in the inner ear become displaced. This disrupts normal balance signals. When you move your head, the particles move around inside the ear. This sends a message to the brain that produces dizziness. BPPV can sometimes resolve on its own. Treatment is available to relieve symptoms and increase stability.
Labyrinthitis occurs when there is inflammation within the inner ear. This type of ear infection causes swelling in both branches of the vestibulocochlear nerve. This nerve sends vital information about balance to your brain.
Vestibular neuritis occurs when there is inflammation in one branch of the vestibulocochlear nerve. According to Cleveland Clinic, vestibular neuritis is the third most common cause of peripheral vertigo. It affects four out of every 100,000 people.
Ménière’s disease may occur when the pressure of the fluid in the inner ear gets too high. Attacks often start without warning. They may occur daily or as rarely as once a year. The severity of each attack can vary. Some attacks may be severe and interfere with daily living activities.
“One thing everyone should know is that balance is not controlled by just one part of the body,” says Dr. Stevenson. “Your brain constantly combines information from the inner ears (vestibular system), your eyes, and sensory feedback from muscles and joints. If even one of these systems is disrupted, your balance can be affected.” These disruptions are caused by poor vision, inner ear problems, neuropathy, fatigue, dehydration or certain medications.
Central vertigo is caused by dysfunction within the central vestibular system or its connections to the brain and nervous system. People with central vertigo may experience spinning, swaying, tilting or rocking.
Symptoms of vertigo may include:
• Spinning sensations
• Nausea or vomiting
• Balance difficulties
• Blurred vision
• Headaches
• Ringing in the ears
• Difficulty walking or standing
• Motion sensitivity
Vestibular and balance disorders affect a significant part of the population. These conditions are frequently underdiagnosed. Since vertigo greatly increases fall risk in older adults, prompt evaluation is important. Persistent dizziness, sudden hearing loss, fainting, difficulty walking or neurological symptoms should be evaluated by a health care professional immediately.
Treatment
While vertigo can interfere with daily activities and quality of life, it is treatable. Treatment for vertigo depends on the cause and severity of symptoms. Medications can reduce nausea, motion sickness or dizziness during severe episodes.
Physical therapy may be another treatment option. It can help patients improve balance and help the brain process balance signals more effectively. “It may take seeing multiple specialists to identify the root cause of vertigo, and it is possible that it stems from multiple areas,” says Dr. Stevenson.
In some cases, treating an underlying condition, such as an ear infection, migraine disorder or cardiovascular issue, may resolve vertigo symptoms. Surgery is rarely required. But it may be considered for severe or persistent cases that do not respond to treatment. Early diagnosis, vestibular rehabilitation, medication and lifestyle modifications can often reduce vertigo symptoms and improve stability.
Mary Anna Rodabaugh is a writer, editor and writing coach.
