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Vertigo And Dizziness In The Inner Ear

Dizziness is a term used to define a wide range of sensations, such as fainting, weakness, loss of balance, among others. When dizziness creates a false feeling that our environment rotates or moves it is called vertigo. Dizziness is one of the most frequent conditions for which a person turns to their doctor when this is very frequent or constant, it can significantly affect a person’s daily life.

Dizziness is not exactly vertigo, but sometimes it accompanies it. The symptoms that define dizziness are abdominal and general discomfort, nausea, yawning, cold sweating, paleness, and that can end with a picture of vomiting. It is best known as what we call motion sickness, which is what happens to some people when travelling by car, ship, plane, and in virtual reality environments. It is due to an incongruity of visual, vestibular and sensory stimuli. The imbalance must not be confused with vertigo. It is a sensation of displacement to the sides or to one side. Its origin is multifactorial due to the affectation of one or more of the systems of equilibrium. Instability is a sensation of floating or walking on a soft unstable ground, it may also accompany vertigo.

Dizziness can have multiple causes, from problems in the inner ear to an adverse effect of medication. The characteristics of dizziness and its triggers provide clues about the causes, as well as the duration and associated symptoms.

Impaired inner ear (vertigo)

The balance depends on a combination of signals emitted to the brain from various sensory systems. These include: vision, inner ear and body sensory system. Dizziness is the illusory sensation of movement. When there is an alteration in the inner ear, the brain receives signals from it that is not consistent with what the eyes and sensory nerves are perceiving. Vertigo is the result of the brain working to resolve the confusion.

Symptoms that we should not call vertigo, but sometimes accompany vertigo or are confused with it are:

Vertigo at height: It is a physiological dizziness, it is not a disease as such, and it is suffered by a significant percentage of the population, about 10%. It is presented as a set of subjective sensations, dizziness, instability, loss of balance and fear of falling from height. It occurs in situations where the distance between a person and the fixed object (the ground) is so large that there is no reference to the visual and vestibular system (they fail to calculate that distance) that a sensory incongruity is created and one needs to touch the ground, crouch or sit down to add sensory references and the situation gives way.

What causes vertigo?

As stated above, vertigo is a symptom of different diseases that usually affect the inner ear and/or the vestibular nerve (balance nerve). The vestibular nerve is very important in our development since childhood, it played a vital role when we were learning to walk, run, ride a bike, skate, etc. The vestibular nerve is located in our head, next to the auditory nerve, and as such, hardly anyone knows that it exists until it fails.

vertigo

A vestibular nerve consists of five receptors, two are, the Utricle and the Saculo, where there are small crystals that move on some receptor cells specialized in detecting linear acceleration, they send information to our brain where our head is going. For example, if we travel by car with our eyes closed, we can know perfectly if our movement is forward or backward, and if we get on an elevator, it informs us if the elevator goes up or down. The other three are semicircular ducts, located in the three planes of space and filled with a liquid that moves as we move the head making turns in any direction, and have sensors that move by the movement of this liquid, informing the brain of the direction and angular velocity of our head. Through a reflex way, very fast, connected with the muscles that move the eyes (vestibule-ocular reflex) makes our eyes move at the same speed of our head and with the same angle so that they are centered at the same moment that the head has stopped moving.

All things considered, any disease that affects this delicate system will cause this reflex route to fail and our eyes move in a way out of sync with the head, giving us an unpleasant sensation of turning in the environment.

The causes can be multiple, the most frequent being the displacement of the small crystals of the Utricle and their abnormal accommodation in one of the semicircular canals, the increase in pressure of the fluids of said receptors, in turn this increase in pressure can be due to different causes, the involvement of the vestibular nerve by a viral, bacterial, circulatory, tumor, toxic or autoimmune disease. For this reason, a good diagnosis is essential to treat the disease of origin.

Can it appear suddenly?

Depending on the actual cause of vertigo, it has one type or another in the form of onset. Indeed, it can occur suddenly when getting out of bed, without warning or simply turning the head in a certain way, and it happens so abruptly and violently that one has to hold on to where one cannot fall. On the other hand, it can appear gradually, beginning with deafness, beeping in the ears than vertigo seems to warn in this way, progressively increasing, accompanied by symptoms such as sweating, nausea, vomiting, urinary incontinence and diarrhoea on some occasions.

Can it become invalidating for the person?

To a greater or lesser extent all dizziness is invalidating, because with that feeling nobody can carry on normal activity. Everything depends on the duration of the situation. There are times that it only lasts seconds while other times it lasts for hours. In addition, it also depends on the frequency or recurrence thereof.

How is the diagnosis made?

To diagnose and treat vertigo caused by an alteration in the inner ear, the assessment of an Audiologist will be required. For other causes of dizziness, you will need the assessment of other medical specialists: physician, cardiologist or neurologist, as necessary.

Diagnosis is carried out to know which disease causes the alteration of the equilibrium nerve (vestibular nerve) and in what way or which part or parts of the nerve are affected. There is advanced exploration equipment for the study of the different systems that configure the balance. Below are the equipment’s used to diagnose the disease:

the retino-ocular system

The retino-ocular system, the exploration is carried out with Videonistagmography equipment (VNG), which allows the Audiologist to analyze different movements of the eye; the so-called saccadic movements, which are precision movements of the eye before an object with random movement, the speed of the eye in terms of the ocular tracking of a mobile object, the optokinetic stimuli, the capacity of ocular fixation, and the movements of vergence.

The vestibule-ocular system, using the previously mentioned Videonistagmography (VNG) equipment, Audiologists analyze the responses of the vestibular nerve, to assess its parameters of normality or pathology, using rotational, caloric stimuli. Currently, with the most advanced analysis equipment of the Video Head Impulse Test (VHIT), Audiologists can study very small movements of the eye that are explored with high-speed cameras (micro-sacks of ocular refraction), being able to obtain data on the individual functioning of the six semicircular channels. And with Vestibular Myogenic Potential (VEMP) and subjective vertical and horizontal tests, they provide the Audiologists with information about the possible involvement of the Saculo and Utricle.

Are there effective treatments?

It is common for untreated vertigo to improve on their own in a couple of weeks and this is because our brain is able to compensate for the deficit. To treat vertigo, there are different methods depending on the cause and the evolution of each person. Having problems with your balance? The best solution for you would be to either get in contact with your GP and get referred to an Audiologist for a balance check or get in contact with a hearing service provider directly. If you are suffering from dizziness or vertigo, call your nearest Attune clinic today and get a thorough diagnosis of your ear by one of our friendly qualified Audiologists. 

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