I Feel Dizzy: Peripheral Vertigo

Vertigo is dizziness that is often described as a spinning sensation. It may also feel like motion sickness or as if you’re leaning to one side. Other symptoms sometimes associated with vertigo include:

• loss of hearing in one ear
• ringing in your ears
• difficulty focusing your eyes
• loss of balance

There are two different forms of vertigo: peripheral vertigo and central vertigo. According to the American Institute of Balance, peripheral vertigo is usually more severe than central vertigo.

Peripheral vertigo is the result of a problem with your inner ear, which controls balance. Central vertigo refers to problems within your brain or brainstem. There are several different forms of peripheral vertigo.

Benign paroxysmal positional vertigo (BPPV)

BPPV is considered the most common form of peripheral vertigo. This type tends to cause short, frequent bouts of vertigo. Certain head movements trigger BPPV. It’s thought to be due to small pieces of anatomical debris breaking off from the inner ear canals and stimulating the small hairs that line your inner ear. This confuses your brain, producing the sensation of dizziness.

Labyrinthitis

Labyrinthitis causes dizziness or a feeling that you’re moving when you aren’t. An inner ear infection causes this form of vertigo. As a result, it often occurs along with other symptoms such as fever and earache. The infection is in the labyrinth, a structure in your inner ear that controls balance and hearing. A viral illness, such as a cold or flu, often causes this infection. A bacterial ear infection is also sometimes the cause.

Vestibular neuronitis

Vestibular neuronitis is also called vestibular neuritis. This type of vertigo has a sudden onset and may cause unsteadiness, earache, nausea, and vomiting. Vestibular neuronitis is the result of an infection that has spread to the vestibular nerve, which controls balance. This condition usually follows a viral infection, such as a cold or flu.

Meniere’s disease

Meniere’s disease causes sudden vertigo that can last for up to 24 hours. The vertigo is often so severe that it causes nausea and vomiting. Meniere’s disease also causes hearing loss, ringing in your ears, and a feeling of fullness in your ears.

There are several ways your doctor can determine if you have peripheral vertigo. Your doctor may examine your ears to look for signs of infection, as well as see if you can walk in a straight line to test your balance.

If your doctor suspects BPPV, they may perform a Dix-Hallpike maneuver. During this test, your doctor will move you quickly from a sitting position to a lying-down position, with your head being the lowest point of your body. You will be facing your doctor, and you will need to keep your eyes open so your doctor can track your eye movements. This maneuver brings on symptoms of vertigo in individuals with BPPV.

Your doctor may also order balance and hearing tests. Depending on your symptoms, your doctor may also order imaging studies (such as an MRI scan) of your brain and neck to rule out other causes of vertigo.

Drugs and medication

A number of medications are used to treat peripheral vertigo, including:

• antibiotics (to treat infections)
• antihistamines — for example, meclizine (Antivert)
• prochlorperazine — to relieve nausea
• benzodiazepines — anxiety medications that can also relieve physical symptoms of vertigo

People with Meniere’s disease often take a medication called betahistine (Betaserc, Serc), which can help reduce pressure caused by fluid in the inner ear and relieve symptoms of the disease.

Treating hearing loss

Individuals with Meniere’s disease may need treatment for ringing in the ears and hearing loss. Treatment may include medication and hearing aids.

Exercises

If you received a diagnosis of BPPV, your doctor may teach you the Epley maneuver and Brandt-Daroff exercises. Both involve moving your head in a series of three or four guided movements.

Your doctor will typically perform the Epley maneuver, as it requires more rapid movement and turning of your head. It’s not recommended for people with neck or back problems.

You can do Brandt-Daroff exercises at home. These are the most commonly used exercises to treat vertigo. It’s believed that they can help move the debris that is causing the vertigo.

To perform Brandt-Daroff exercises:

1. Sit at the edge of your bed (near the middle) with your legs hanging over the side.
2. Lie down on your right side and turn your head toward the ceiling. Hold this position for at least 30 seconds. If you feel dizzy, hold this position until it passes.
3. Return to an upright position and stare directly ahead for 30 seconds.
4. Repeat step two, this time on your left side.
5. Sit upright and look straight ahead for 30 seconds.
6. Do additional sets at least three to four times per day.

Physical therapy

Vestibular rehabilitation therapy is another treatment option for peripheral vertigo. It involves working with a physical therapist to improve balance by helping your brain learn to compensate for inner ear problems.

Surgery can treat severe, persistent cases of vertigo if other treatment methods are unsuccessful. This surgery involves removing part or all of your inner ear.

You usually can’t prevent initial vertigo, but certain behaviors can help prevent another vertigo attack. You should avoid:

• bright lights
• rapid head movement
• bending over
• looking up

Other helpful behaviors are standing up slowly and sleeping with your head propped up.