Dr Emmanuel Valton – ENT Specialist – CMI
5% of the consultations in general medicine are due to vertigo. That is not at all negligible and causes of dizziness are numerous. Vertigo feeling is very distressing, and the doctor’s role is to find the reasons to treat the problem correctly. Vertigo gives a person the false sense of having objects spinning around him or having the feeling that he is turning around the objects. Sometimes dizziness comes down to a specific feeling of imbalance. The most telling example of that kind of dizziness is the one caused by excessive alcohol intake. After too many drinks, we have trouble walking, we stagger, right, left, etc. This lightheaded sensation is because alcohol enters into the organ of the inner ear that contains a liquid equivalent to the cerebrospinal fluid. This liquid and alcohol can’t mix, like oil and vinegar, because of their differences in density and causes a malfunction of the organ of balance producing this feeling of drunkenness. It’s crucial to let the patient describe the disorders he is complaining about, doctors usually refrain from using the word “dizziness,” while paying the highest attention to the terms used. The words: “discomfort,” “weakness,” “dizziness,” “dazzling,” “fainting,” “light-headedness,” “floating head,” “empty head,”” “loss of concentration,” are not automatically symptoms of vertigo! Like Vertigo due to heights, that everyone knows with the impossibility to climb a ladder without feeling the Vertigo. It’s the same for psychogenic dizziness that occurs very emotional and anxious people.
Hypotension and hypoglycemia may also cause false vertigo. Sometimes, the patient describes a sensation of imbalance rather than expressing an impression of objects rotating around him. During a Vertigo crisis, nausea and vomiting are often associated. Usually, the doctor asks the patient if he feels other symptoms of the dizziness, such as deafness, tinnitus (ear ringing), or balance disorders. In this case, the patient is asked to close his eyes and stay upright for several minutes. If he feels vertigo, there is often a gradual deviation of the body from one side or the other, a brief examination of the hearing will be conducted using a tuning fork, as well as taking his blood pressure.
But why does vertigo occurs?
Many causes can provoke them. The Meniere’s disease produces the most frequent ones. In fact, Meniere’s disease is characterized by vertigo occurring by seizures of a few minutes to several hours in repeating at varying intervals, with unilateral deafness, and tinnitus also fluctuating on the same side as deafness. The treatment is primarily medical. Benign positional paroxysmal vertigo is the most common and accounts for 75% of vertigo cases. This is a condition related from the falling crystals located inside the inner ear that come to excite organ’s cells. The patient feels a violent rotatory vertigo, very distressing, in a given position of the head, always the same, most of the time when the patient is in bed when turning his head to the side or when raising his head. This vertigo lasts a few seconds and recurs when the person returns to the initial position. The diagnosis is confirmed by a maneuver consisting to strongly lengthen the patient leaning him on the side that causes vertigo. This lead to a high dizziness of a few seconds. The evolution is most often favorable but the recurrences are frequent, and treatment is based on physiotherapy treatment.
The nerve inflammation is also one of the most common causes of Vertigo with a sudden complete, unilateral and isolated loss of the body balance. The cause is probably viral and results in a sudden rotary vertigo forcing the person to lie down, motionless because the slightest movement would increase dizziness. A rapid regression of symptoms will be noticed after a few days. Benign tumors of the balancing nerve, most often give feelings of imbalance, instability. An I.R.M. will confirm the diagnosis. Multiple sclerosis can also cause vertigos; an I.R.M. will also there confirm the diagnosis. Many people think that their dizziness is of cervical origin, but in fact, this is quite rare. Besides the causes that we have just described, sometimes we are unable to identify vertigos accurately. At the CMI in our daily practice with patients, when no syndromes appear apparent, we prefer to give time and observation rather than to assert a baseless diagnosis. If you experience any unexplained dizziness or vertigo that recurs periodically for more than one week, the best thing to do is, of course, see your doctor!